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Triple major curves in children.

INTRODUCTION
The predominant classification systems for scoliosis have been based either on etiology or curve pattern. Traditionally triple curves have not been included in either classification system.


METHODS
We reviewed the records of all children with an idiopathic triple scoliotic curve seen between 1988 and 2001 at the Children's Hospital of Eastern Ontario, Ottawa, a major pediatric referral centre. The triple curve had 3 structural curved segments in accordance with the classification of Lenke and associates. Scoliosis was defined by a curve greater than 10 degrees, and the apical vertebra was determined according to Scoliosis Research Society guidelines. Laterality of the curve was determined from the curve with the greatest magnitude. Curve progression was an increase in magnitude of at least 5 degrees. Management included observation, with bracing if any curve progressed to greater than 20 degrees. Surgery was reserved for curves that were unstable, rapidly progressive and greater than 45 degrees-50 degrees.


RESULTS
Thirteen children (9 girls, 4 boys) were treated for a triple scoliosis curve. The average age at the time the triple curve developed was 13 years and 9 months (range from 9 yr 1 mo-17 yr 5 mo). The average follow-up was 3 years and 6 months (range from 1-11 yr). One child required spinal fusion, and 6 years postoperatively the curve was stable with a good fusion mass. Of the remaining children, 2 were treated with an orthosis and 10 with observation.


CONCLUSION
The triple major curve is a neglected curve pattern that should be included in classifications of scoliosis.