Modified PUMC classification for adolescent idiopathic scoliosis

Abstract

Background: The original Peking Union Medical College (PUMC) classification of adolescent idiopathic scoliosis (AIS) is one system to combine each type with corresponding surgical fusion guidance, presenting comparable interobserver reliability, and reproducibility with Lenke classification. However, during its application in previous over 10 years, we found 2 main problems of this classification, which required modification.

Purpose: (1) To evaluate the interobserver and intraobserver reliability, (2) to assess the effects of the added fusion criteria of proximal thoracic (PT) curve on improving postoperative shoulder balance of the modified PUMC classification of AIS.

Study design/setting: Retrospective analysis of our AIS cohort and prospective validation of its effectiveness.

Patient sample: Fifty sets of preoperative radiographs of AIS patients were randomly chosen from our AIS database. Furthermore, 46 consecutive AIS cases with PT curve were enrolled who underwent surgeries in our center from July 2007 to July 2013, with at least 2-year follow-up.

Outcome measures: The classification results of 50 sets of preoperative radiographs by 5 surgeons. The shoulder balance was evaluated using radiographic shoulder height.

Methods: Five surgeons independently evaluated and classified presurgical radiographs of 50 AIS patients based on the modified PUMC classification. Inter- and intraobserver reliabilities were calculated. Furthermore, the post-op shoulder balance was investigated in 46 consecutive cases of AIS with PT curve who were treated strictly based on the modified PUMC classification.

Results: The Kappa coefficients of inter- and intraobserver reliability of the overall modified PUMC classification are 0.889 and 0.865, respectively. The Kappa coefficients of inter- and intraobserver reliability for the type II are 0.791 and 0.746, respectively. In addition, the shoulder balance rate of the 46 AIS patients with PT curve at the final follow-up was 95.7%.

Conclusions: Modified PUMC classification presents incremental improvement compared to our original published version, with high interobserver and intraobserver reliability and better performance of postoperative shoulder balance. Furthermore, the modified PUMC classification provides corresponding surgical fusion guidance for each subtype. Multicenter prospective studies with larger samples are still needed to further improve this system.

Keywords: Classification; Idiopathic scoliosis; Lenke; Modified; PUMC; Selective fusion.