New proposed classification for lumbar and thoracolumbar deformity

Lumbar and thoracolumbar deformity in the adult is a condition with impairment of health status that can need surgical treatment.

Classification

In contrast with adolescent spinal deformity, where magnitude of the spinal curvature plays a significant role in surgical indication, the aspects relevant in adult spinal deformity are pain and dysfunction that correlate with segment degeneration and imbalance. Previous classifications of adult deformity have been of little use for surgical planning.

Berjano and Lamartina from the IVth Spine Surgery Division, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy, presented a chart review and classification of radiographic and clinical findings.

A classification of degenerative disc disease based on distribution of diseased segments and balance status of the spine is presented.

Four main categories are presented:

Type I (limited nonapical segment disease)

Type II (limited apical segment disease)

Type III (extended segment disease-apical and non apical)

Type IV (imbalanced spine: IVa, sagittally imbalanced; IVb, sagittally and coronally imbalanced).

Types I and II can be treated by fusion of a selective area of the curve.

Type III needs fusion of all the extension of the coronal curve.

Type IV usually needs aggressive corrective procedures, frequently including posterior tricolumnar spine osteotomy. This classification permits interpreting the extension, magnitude and can help establish a surgical plan regarding selective fusion and methods of sagittal correction. Future research is needed to validate the classification 1).

1) Berjano P, Lamartina C. Classification of degenerative segment disease in adults with deformity of the lumbar or thoracolumbar spine. Eur Spine J. 2014 Sep;23(9):1815-24. doi: 10.1007/s00586-014-3219-9. Epub 2014 Feb 23. PubMed PMID: 24563272.

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