A cluster analysis describing spine and torso shape in Lenke type 1 adolescent idiopathic scoliosis
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ORIGINAL ARTICLE
A cluster analysis describing spine and torso shape in Lenke type 1 adolescent idiopathic scoliosis Adrian Gardner1,2 · Fiona Berryman2 · Paul Pynsent1 Received: 20 May 2020 / Accepted: 27 September 2020 © The Author(s) 2020
Abstract Purpose The purpose of this work is to identify the variability and subtypes of the combined shape of the spine and torso in Lenke type 1 adolescent idiopathic scoliosis (AIS). Methods Using ISIS2 surface topography, measures of coronal deformity, kyphosis and skin angulation (as a measure of torso asymmetry) in a series of children with Lenke 1 convex to the right AIS were analyzed using k-means clustering techniques to describe the combined variability of shape in the spine and torso. Following this, a k-nearest neighbor algorithm was used to measure the ability to automatically identify the correct cluster for any particular datum. Results There were 1399 ISIS2 images from 691 individuals available for analysis. There were 5 clusters identified in the data representing the variability of the 3 measured parameters which included mild, moderate and marked coronal deformity, mild, moderate and marked asymmetry alongside normal and hypokyphosis. The k-nearest neighbor identification of the correct cluster had an accuracy of 93%. Conclusion These clusters represent a new description of Lenke 1 AIS that comprises both coronal and sagittal measures of the spine combined with a measure of torso asymmetry. Automated identification of the clusters is accurate. The ability to identify subtypes of deformity, based on parameters that affect both the spine and the torso in AIS, leads to as better understanding of the totality of the deformity seen. Keywords ISIS2 · Cluster · Analysis · Scoliosis
Introduction In adolescent idiopathic scoliosis (AIS), the spinal curve in the coronal plane is associated with changes in sagittal shape [1] and axial rotation [2] of the vertebral column. There is often an associated asymmetry of the posterior torso, otherwise known as the rib hump, best observed in the Adams forward bend position. The classification of AIS, has been used to describe and guide management of the condition. Historically, classification has been based on a number of different subtypes of spinal shape [3–5]. The King classification used the coronal view of the spine [4]. The Lenke classification [3] makes use of both the * Adrian Gardner [email protected] 1
Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Birmingham, UK
2
coronal and sagittal shape of the spine including the size of the deformity in the coronal plane, the sagittal profile the behavior of the lumbar curve and the anatomical location and flexibility of the curves. The Peking Union Medical College (PUMC) classification also describes a number of spinal shapes in the coronal and sagittal planes.[5]. Further developments in the description of AIS have come with a greater understanding of the
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