Three-dimensional classification of spinal deformities using fuzzy clustering.

STUDY DESIGN

A prospective study of a large set of three-dimensional (3D) reconstructions of spinal deformities in adolescent idiopathic scoliosis (AIS).

OBJECTIVES

To determine the value of fuzzy clustering techniques to automatically detect clinically relevant 3D curve patterns within this set of 3D spine models.

SUMMARY OF BACKGROUND DATA

Classification is important for the assessment of AIS and has been mainly used to guide surgical treatment. Current classification systems are based on visual curve pattern identification using two-dimensional radiologic measurements but remain controversial because of their low interobserver and intraobserver reliability. A clinically useful 3D classification remains to be found.

METHODS

An unsupervised learning algorithm, fuzzy k-means clustering, was applied on 409 3D spine models. Analysis of data distribution using clinical parameters was performed by studying similar curve patterns, near each cluster center identified.

RESULTS

The algorithm determined that the entire sample of models could be segmented in five easily differentiated curve patterns similar to those of the Lenke and King classifications. Furthermore, a system with 12 classes made possible the identification of subpatterns of spinal deformity with true 3D components.

CONCLUSIONS

Automatic and clinically relevant 3D classification of AIS is possible using an unsupervised learning algorithm. This approach can now be used to build a relevant 3D classification of AIS using appropriate key features of 3D models selected by a panel of expert spinal deformity surgeons.