Proposal for a Treatment-oriented Classification System for Congenital Kyphosis in Children

Abstract

Study design: Proposal of a new classification system for pediatric congenital kyphosis.

Objective: To propose a new treatment-oriented classification system for pediatric congenital kyphosis based on radiographic findings and evaluates the reliability of this new classification system.

Summary of background data: The classification of congenital kyphosis described by Winter is the one most commonly used. However, this classification of congenital kyphosis cannot direct the surgical options and the treatment choices remain controversial.

Methods: For each type of congenital kyphosis, we propose a set of radiological criteria that are suggestive for diagnosis as well as the corresponding surgical options. To evaluate the reliability of this new classification system, 35 patients with congenital kyphosis were reviewed and classified by four attending spine surgeons and five spine fellows.

Results: Our new classification system divides congenital kyphosis into five types. The overall Fleiss kappa coefficient ( κ ) value for the new classification system was 0.755, which indicates significant agreement. The interobserver and intraob-server κ values were 0.755 and 0.828, respectively, and there were no significant differences in the k values between the attending spine surgeons and spine fellows.

Conclusion: The proposed classification system provides clear descriptions and surgical options for various types of pediatric congenital kyphotic deformities. The reliability study confirmed that the classification system is both simple and consistent, although further research may be needed to validate the system.