Classification of Congenital Scoliosis and Kyphosis: A New Approach to the Three-dimensional Classification for Progressive Vertebral Anomalies Requiring Operative Treatment

Noriaki Kawakami, MD; Taichi Tsuji, MD; Shiro Imagama, MD; Lawrence G. Lenke, MD; Rolando M. Puno, MD; Timothy R. Kuklo, MD

Disclosures

Spine. 2009;34(17):1756-1765. 

In This Article

The Clinical Significance of 3D Images of CT in Congenital Spinal Deformity

With the recent improvement of diagnostic imaging, particularly with 3D CT, detailed observation of the anterior and posterior components of the malformed vertebrae and relationships with adjacent vertebrae by means other than macroscopic observation during surgery has become possible. Many reports have described the superiority of 3D CT over plain x-ray from different viewpoints.[7,9–11] Newton et al[9] mentioned that more than 50% of the cases showed additional abnormalities that were not appreciated on plain radiographs or axial 2D CT images. Hedequist and Emans[10,11] reported that unexpected anomalies might be encountered posteriorly when plain films alone were used in surgical planning. These morphologic findings might be one of the causative factors that changed the recent strategy of operation from in situ fusion or partial correction of the deformity to maximum correction with osteotomy including vertebrectomy.

However, most of the 3D analysis of congenital scoliosis performed in literature reached the conclusion that the 3D CT was superior in demonstrating abnormal vertebrae more clearly and did not describe the detailed characteristics of congenital scoliosis. In 2007, Nakajima et al[7] analyzed the 3D morphology of formation failure type of congenital scoliosis in detail and reported that even the same type of hemivertebrae diagnosed by plain x-ray images exhibited different types of laminae in the same manner as that observed in the vertebral body anomaly. Furthermore, they advocated 2 types of congenital vertebral anomalies, unison anomaly, and discordant anomaly, as the new categories of congenital spinal deformity. Imagama et al[5] attempted to evaluate the type and site of segmentation failure using 3D CT images in congenital spinal deformities and presented the existence of discordant anomaly of segmentation (Figure 4).

Figure 4.

Morphology of the Posterior Components of Malformed Vertebrae.
These abnormal shapes of laminae are observed not only in the solitary malformation group but also in the multiple group. In the latter, various combinations of abnormal shaped-laminae exist closely together. Reprinted with permission from Spine.[7]

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