The Comprehensive Anatomical Spinal Osteotomy Classification
The Comprehensive Anatomical Spinal Osteotomy Classification
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DOI：
10.1227/neu.0000000000000182o
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发表时间：
2014-01-01
期刊：
影响因子：
4.8
通讯作者：
Lafage, Virginie
中科院分区：
文献类型：
--
作者：
Schwab, Frank;Blondel, Benjamin;Lafage, Virginie
背景：在脊柱畸形的情况下，整体矢状面排列不良与健康相关的生活质量评分显著相关。为了解决僵硬的畸形模式，脊柱截骨术的使用已经大幅增加。不幸的是，已建立的技术和截骨术的混合组合的变化使得结果的比较困难。目的：提出一个基于解剖学的脊柱截骨术的分类系统，并在脊柱专家中提供一个共同的语言。方法：建议的分类系统是基于6个解剖等级的切除（1至6）对应于骨切除的程度和增加的不稳定可能程度。此外，还增加了手术入路改良器（后路或前后路联合入路）。通过分析16例临床病例，由8名不同的阅片者进行2次评分，并计算Fleisskappa系数，对该分类系统的可靠性进行了评估。结果：观察者内可靠性被归类为“几乎完美”;切除类型的Fleisskappa系数平均为0.96（范围，0.92-1.0），入路修改器的Fleisskappa系数平均为0.90（0.71-1.0）。从观察者间的可靠性的分类结果为0.96切除类型和0.88的方法modifiers.CONCLUSION：这个建议的解剖学为基础的分类系统提供了一个一致的描述在脊柱畸形矫正手术中进行的各种截骨术。可靠性研究证实，分类是简单和一致的。其应用的进一步发展将为截骨术评估提供一个通用框架，并允许对不同治疗进行比较分析。
BACKGROUND: Global sagittal malalignment is significantly correlated with health-related quality-of-life scores in the setting of spinal deformity. In order to address rigid deformity patterns, the use of spinal osteotomies has seen a substantial increase. Unfortunately, variations of established techniques and hybrid combinations of osteotomies have made comparisons of outcomes difficult.OBJECTIVE: To propose a classification system of anatomically-based spinal osteotomies and provide a common language among spine specialists.METHODS: The proposed classification system is based on 6 anatomic grades of resection (1 through 6) corresponding to the extent of bone resection and increasing degree of destabilizing potential. In addition, a surgical approach modifier is added (posterior approach or combined anterior and posterior approaches). Reliability of the classification system was evaluated by an analysis of 16 clinical cases, rated 2 times by 8 different readers, and calculation of Fleiss kappa coefficients.RESULTS: Intraobserver reliability was classified as "almost perfect"; Fleiss kappa coefficient averaged 0.96 (range, 0.92-1.0) for resection type and 0.90 (0.71-1.0) for the approach modifier. Results from the interobserver reliability for the classification were 0.96 for resection type and 0.88 for the approach modifier.CONCLUSION: This proposed anatomically based classification system provides a consistent description of the various osteotomies performed in spinal deformity correction surgery. The reliability study confirmed that the classification is simple and consistent. Further development of its use will provide a common frame for osteotomy assessment and permit comparative analysis of different treatments.