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Journal of Healthcare Engineering
Volume 6 (2015), Issue 2, Pages 145-158
Research Article

A Computer-aided Method for Improving the Reliability of Lenke Classification for Scoliosis

Junhua Zhang,1 Hongjian Li,2 Liang Lv,3 Xinling Shi,1 Fei Guo,3 and Yufeng Zhang1

1Department of Electronic Engineering, Yunnan University, China
2Department of Orthopedics, China
3Department of Radiology, the First People’s Hospital of Yunnan Province, China

Received 1 September 2014; Accepted 1 March 2015

Copyright © 2015 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Classification of the spinal curve pattern is crucial for assessment and treatment of scoliosis. We developed a computer-aided system to improve the reliability of three components of the Lenke classification. The system semi-automatically measured the Cobb angles and identified the apical lumbar vertebra and its pedicles on digitized radiographs. The system then classified the curve type, lumbar modifier, and thoracic sagittal modifier of the Lenke classification based on the computerized measurements and identifications. The system was tested by five operators for 62 scoliotic cases. The kappa statistic was used to assess the reliability. With the aid of computer, the average intra- and interobserver kappa values were improved to 0.89 and 0.81 for the curve type, to 0.83 and 0.81 for the lumbar modifier, and to 0.94 and 0.92 for the sagittal modifier of the Lenke classification, respectively, relative to the classification by two of the operators without the aid of computer. Results indicate that the computerized system can improve reliability for all three components of the Lenke classification.