From the Guidelines
The most famous framework for scoliosis is the Lenke Classification System, which categorizes adolescent idiopathic scoliosis into six main curve types based on curve location, flexibility, and lumbar spine alignment. This system, developed by Dr. Lawrence Lenke in 2001, helps surgeons determine which spinal segments need fusion during corrective surgery, allowing for more tailored treatment approaches. It considers three main components: curve type (1-6), lumbar spine modifier (A, B, or C), and sagittal thoracic modifier (-, N, or +) 1.
Key Components of the Lenke Classification System
- Curve type (1-6): determines the location and severity of the curve
- Lumbar spine modifier (A, B, or C): assesses the flexibility of the lumbar spine
- Sagittal thoracic modifier (-, N, or +): evaluates the sagittal balance of the thoracic spine
The Lenke system has become the gold standard in scoliosis assessment because it provides a standardized approach to curve analysis, facilitates communication between healthcare providers, and helps predict which treatment approaches will be most effective for specific curve patterns 1.
Clinical Application
The Lenke Classification System is used in conjunction with other diagnostic tools, such as radiography, to evaluate the severity of scoliosis and monitor progression. The Society on Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT) recommends limiting spine radiographs to once every 12 months for those adolescent patients at Risser stages 0 to 3 and every 18 months for patients at Risser stages 4 to 5, unless there are objective clinical changes in the appearance of the scoliosis 1.
Conclusion is not needed, and the answer is based on the most recent and highest quality study, which in this case is not explicitly provided, but the Lenke Classification System is widely accepted as the gold standard for scoliosis assessment.
From the Research
Overview of the Lenke Classification System
- The Lenke classification system is a widely used framework for categorizing adolescent idiopathic scoliosis (AIS) curves 2, 3, 4, 5, 6.
- This system provides a comprehensive and reliable means to classify all surgical AIS curves, taking into account the upright coronal and sagittal radiographs, as well as the supine side bending radiographic views 2.
Key Components of the Lenke Classification System
- The system consists of a curve type (1-6), a lumbar spine modifier (A, B, C), and a sagittal thoracic modifier (-, N, +) 2, 5.
- The classification system designates the proximal thoracic, main thoracic, and thoracolumbar/lumbar regions as either the major curve (largest Cobb measurement) or minor curves, with the minor curves further separated into structural and nonstructural types 2.
Treatment Recommendations Based on the Lenke Classification System
- The Lenke classification system provides treatment recommendations, with the major and structural minor curves typically included in the instrumentation and fusion, and the nonstructural minor curves excluded 2.
- The system serves as a guide for selection of levels for surgical treatment of AIS, with surgical goals including maximizing correction in the coronal, sagittal, and axial planes 3.
- Selective thoracic or thoracolumbar/lumbar fusions can be successfully performed in a variety of AIS curve patterns, based on the Lenke classification system and analysis of structural characteristics between the planned instrumented and noninstrumented regions of the spine 5.