title: Clinically orientated classification incorporating shoulder balance for the surgical treatment of adolescent idiopathic scoliosis.
abstract: OBJECTIVE
  The achievement of shoulder balance is an important measure of successful scoliosis surgery. No previously described classification system has taken shoulder balance into account. We propose a simple classification system for AIS based on two components which include the curve type and shoulder level.
  
  
  METHODS
  Altogether, three curve types have been defined according to the size and location of the curves, each curve pattern is subdivided into type A or B depending on the shoulder level. This classification was tested for interobserver reproducibility and intraobserver reliability. A retrospective analysis of the radiographs of 232 consecutive cases of AIS patients treated surgically between 2005 and 2009 was also performed.
  
  
  RESULTS
  Three major types and six subtypes were identified. Type I accounted for 30 %, type II 28 % and type III 42 %. The retrospective analysis showed three patients developed a decompensation that required extension of the fusion. One case developed worsening of shoulder balance requiring further surgery. This classification was tested for interobserver and intraobserver reliability. The mean kappa coefficients for interobserver reproducibility ranged from 0.89 to 0.952, while the mean kappa value for intraobserver reliability was 0.964 indicating a good-to-excellent reliability.
  
  
  CONCLUSIONS
  The treatment algorithm guides the spinal surgeon to achieve optimal curve correction and postoperative shoulder balance whilst fusing the smallest number of spinal segments. The high interobserver reproducibility and intraobserver reliability makes it an invaluable tool to describe scoliosis curves in everyday clinical practice.
authors.affiliation: University of Cairo, Giza, Egypt.
authors.forename: H B
authors.initials: HB
authors.lastname: Elsebaie
authors.affiliation: Royal National Orthopaedic Hospital, Stanmore, UK.
authors.forename: Z
authors.initials: Z
authors.lastname: Dannawi
authors.affiliation: Royal National Orthopaedic Hospital, Stanmore, UK. farhaanaltaf@hotmail.com.
authors.forename: F
authors.initials: F
authors.lastname: Altaf
authors.affiliation: Royal National Orthopaedic Hospital, Stanmore, UK.
authors.forename: A
authors.initials: A
authors.lastname: Zaidan
authors.affiliation: Royal National Orthopaedic Hospital, Stanmore, UK.
authors.forename: M
authors.initials: M
authors.lastname: Al Mukhtar
authors.affiliation: Royal National Orthopaedic Hospital, Stanmore, UK.
authors.forename: M J
authors.initials: MJ
authors.lastname: Shaw
authors.affiliation: Royal National Orthopaedic Hospital, Stanmore, UK.
authors.forename: A
authors.initials: A
authors.lastname: Gibson
authors.affiliation: Royal National Orthopaedic Hospital, Stanmore, UK.
authors.forename: H
authors.initials: H
authors.lastname: Noordeen
mesh_terms: D000293:Adolescent; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D015588:Observer Variation; D011859:Radiography; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012600:Scoliosis / Q000145:classification* / Q000601:surgery*; D012782:Shoulder / Q000000981:diagnostic imaging*; D013123:Spinal Fusion; D013131:Spine / Q000000981:diagnostic imaging*
keywords: Classification; Scoliosis; Shoulder balance