Anouar Bourghli1, Louis Boissière2, Faisal Konbaz3, Sami Al Eissa3, Amro Al-Habib4, Bang-Ping Qian5, Yong Qiu5, Kazunori Hayashi6, Javier Pizones7, Christopher Ames8, Jean-Marc Vital9, Ibrahim Obeid2. 1. Orthopedic and Spinal Surgery Department, Kingdom Hospital, PO Box 84400, Riyadh, 11671, Saudi Arabia. Anouar.bourghli@gmail.com. 2. Clinique du Dos, Elsan Jean Villar Private Hospital, Bordeaux, France. 3. Division of Orthopedics, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia. 4. Division of Neurosurgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia. 5. Department of Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China. 6. Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan. 7. Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Madrid, Spain. 8. Department of Neurosurgery, University of California San Francisco, San Francisco, CA, USA. 9. Orthopedic Spinal Surgery Unit 1, Bordeaux Pellegrin Hospital, Bordeaux, France.
Abstract
PURPOSE: To propose a complementary classification to the Schwab's osteotomy classification that would regroup together under a common umbrella different published pedicle subtraction osteotomy (PSO) variations that are commonly used, to have a common language and complete the spine surgeon's armamentarium when dealing with rigid spinal deformities. METHODS: The 2 general types corresponding to the grades 3 and 4 of the Schwab classification were separated into 6 gradual subtypes (grades 3A, 3B, 3C, 4A, 4B, 4C). The classification is based on the amount of resected pedicle, the inclusion or not of the disc above, and the location of the axis of rotation. Based on the proposed classification, a reliability study was performed using 18 cases that were classified by 8 readers with expertise in the management of adult deformities with the use of osteotomies. RESULTS: Clinical cases were classified according to the 6 grades proposed in the classification. The intra-rater reliability for the classification was "almost perfect agreement" with a Fleiss kappa coefficient average of 0.92 (range 0.85-1.00). The inter-rater reliability was "almost perfect agreement" with a coefficient average of 0.90 for the 2 readings that were done at an interval of 2 weeks. CONCLUSION: The developed classification proved to be reliable and intuitive. It is an original way to display a catalog of different available PSO modifications including the original technique, in a logical and gradual order to help the surgeons in their decisions and show them that between a grade 2 osteotomy and a grade 5 osteotomy, many intermediate options are available. Further work with a treatment algorithm for clinical practice based on the current classification may be developed in the future.
PURPOSE: To propose a complementary classification to the Schwab's osteotomy classification that would regroup together under a common umbrella different published pedicle subtraction osteotomy (PSO) variations that are commonly used, to have a common language and complete the spine surgeon's armamentarium when dealing with rigid spinal deformities. METHODS: The 2 general types corresponding to the grades 3 and 4 of the Schwab classification were separated into 6 gradual subtypes (grades 3A, 3B, 3C, 4A, 4B, 4C). The classification is based on the amount of resected pedicle, the inclusion or not of the disc above, and the location of the axis of rotation. Based on the proposed classification, a reliability study was performed using 18 cases that were classified by 8 readers with expertise in the management of adult deformities with the use of osteotomies. RESULTS: Clinical cases were classified according to the 6 grades proposed in the classification. The intra-rater reliability for the classification was "almost perfect agreement" with a Fleiss kappa coefficient average of 0.92 (range 0.85-1.00). The inter-rater reliability was "almost perfect agreement" with a coefficient average of 0.90 for the 2 readings that were done at an interval of 2 weeks. CONCLUSION: The developed classification proved to be reliable and intuitive. It is an original way to display a catalog of different available PSO modifications including the original technique, in a logical and gradual order to help the surgeons in their decisions and show them that between a grade 2 osteotomy and a grade 5 osteotomy, many intermediate options are available. Further work with a treatment algorithm for clinical practice based on the current classification may be developed in the future.
Authors: Jay D Turner; Behrooz A Akbarnia; Robert K Eastlack; Ramin Bagheri; Stacie Nguyen; Luiz Pimenta; Rex Marco; Vedat Deviren; Juan Uribe; Gregory M Mundis Journal: Eur Spine J Date: 2015-03-28 Impact factor: 3.134
Authors: Frank Schwab; Benjamin Blondel; Edward Chay; Jason Demakakos; Lawrence Lenke; Patrick Tropiano; Christopher Ames; Justin S Smith; Christopher I Shaffrey; Steven Glassman; Jean-Pierre Farcy; Virginie Lafage Journal: Neurosurgery Date: 2014-01 Impact factor: 4.654
Authors: Thomas J Buell; James H Nguyen; Marcus D Mazur; Jeffrey P Mullin; Juanita Garces; Davis G Taylor; Chun-Po Yen; Mark E Shaffrey; Christopher I Shaffrey; Justin S Smith Journal: J Neurosurg Spine Date: 2018-11-09
Authors: Anouar Bourghli; Louis Boissiere; Thomas Chevillotte; Maxime Huneidi; Clement Silvestre; Kariman Abelin-Genevois; Pierre Grobost; Javier Pizones; Pierre Roussouly; Ibrahim Obeid Journal: Eur Spine J Date: 2021-09-29 Impact factor: 3.134
Authors: Anouar Bourghli; Louis Boissière; David Kieser; Daniel Larrieu; Javier Pizones; Ahmet Alanay; Ferran Pellise; Franck Kleinstück; Ibrahim Obeid Journal: Neurospine Date: 2021-10-21