Geometric torsion in idiopathic scoliosis - Three dimensional analysis and proposal for a new classification

Study Design. Three-dimensionally reconstructed spines of 62 subjects with idiopathic scoliosis were reviewed for three-dimensional pattern classification based on the measurement of geometric torsion. Objectives. To evaluate the relevance of geometric torsion as a three-dimensional index of scoliosis, and to develop a three-dimensional classification of deformity for idiopathic scoliosis as opposed to the current classifications based on two-dimensional frontal views. Summary of Background Data. Attempts have been made to measure the geometric torsional shape of scoliotic curves represented curvilinearly. However, the geometric torsion phenomenon has never been properly analyzed and thus has never been precisely defined. Methods. Standardized stereoradiographs of 62 patients with idiopathic scoliosis were obtained and used to generate three-dimensional reconstructions. A continuous parametric form of the curved line that passes through the vertebrae was created by least square fitting of Fourier series functions. Frenet's formulas then were used to calculate the geometric torsion. Results. Analysis of geometric torsion associated with 94 major scoliotic curves allowed three basic categories of torsion curve patterns to be identified. Scoliotic spines with multiple major curves are described by a combination of basic torsion patterns, one for each curve. Conclusions, A three-dimensional analysis of the spine in terms of geometric torsion has defined three distinct patterns of torsion in a group of scoliotic curves. Geometric torsion had extreme values at the levels of upper and lower vertebrae, but zero or nearly zero values at the levels of the apexes. The torsional phenomenon can be unidirectional or bidirectional in both single and double major curves.