# Lenke — Lenke 2D classification of operative adolescent idiopathic scoliosis

> Full operative-AIS designation combining curve type 1-6, lumbar modifier A/B/C and thoracic sagittal modifier minus/N/plus from standing and side-bending radiographs. It describes a two-dimensional deformity pattern and assists surgical planning but does not itself establish surgical indication, fusion levels, progression risk or the newer transverse-plane 3D modifiers.

**Situação:** vigente · **Órgão:** Coluna · **Órgão emissor:** Lenke et al. / Scoliosis Research Society · **Versão:** 2001 classic 2D AIS system; 2026 SRS-Lenke-Aubin 3D extension tracked separately · **Ano:** 2001

> ⚠️ Uma versão mais nova pode existir (em revisão).

## Procedência e vigência
- Família: léxico
- Tipo de lógica: flat
- Modalidade: XR
- Fonte primária: Lenke LG, Betz RR, Harms J, Bridwell KH, Clements DH, Lowe TG, Blanke K. Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis (2001) — https://pubmed.ncbi.nlm.nih.gov/11507125/
- Última verificação: 2026-07-24
- Última checagem: 2026-08-12

## Lógica de decisão
Produce the complete classic 2D code only from a complete standing and flexibility series. Preserve the raw measurements, treat 1-6 as patterns rather than severity, and keep the 2026 3D extension explicitly separate.

## Categorias

| Código | Rótulo | Critérios | Conduta | Risco | Localizador | Verificado |
| --- | --- | --- | --- | --- | --- | --- |
| 1 | Type 1, main thoracic | Main thoracic pattern: the main thoracic curve is the structural major curve; proximal thoracic and thoracolumbar/lumbar curves are nonstructural. Structurality requires the major-curve rule or a minor residual side-bending Cobb angle of at least 25 degrees, with the applicable regional sagittal threshold also considered. A complete designation still requires lumbar A/B/C and T5-T12 sagittal minus/N/plus modifiers. | Use the full type-plus-modifiers pattern to support operative deformity planning, while separately assessing shoulder/trunk balance, flexibility, rotation, maturity, symptoms and goals. Type 1 may inform consideration of a selective thoracic strategy, but it does not prescribe fusion levels or establish that surgery is indicated. | Type 1 is a morphology, not a low-risk or single-curve prognosis label. Progression and outcome depend on Cobb magnitude, growth remaining, serial change, balance and treatment; no validated per-type probability should be attached. | Slattery and Verma 2018, PMC6259994, Table 1 Curve Types, Structural Curves, Lumbar Spine Modifiers and Thoracic Sagittal Modifier; Lenke et al. 2001, PMID 11507125. | ✓ |
| 2 | Type 2, double thoracic | Double thoracic pattern: proximal thoracic and main thoracic curves are structural, the main thoracic curve is major, and the thoracolumbar/lumbar curve is nonstructural. Proximal-thoracic structurality may arise from residual bending Cobb of at least 25 degrees or T2-T5 kyphosis of at least 20 degrees. Append the lumbar and sagittal modifiers to form the full code. | The structural proximal thoracic curve is relevant to shoulder and upper-instrumentation planning, but Type 2 alone does not select the upper or lower instrumented vertebra. Integrate radiographic balance/flexibility, clinical shoulders and trunk, maturity, rotation and patient-specific operative goals. | Type 2 does not quantify progression, postoperative shoulder imbalance or revision risk. Those outcomes require patient-, measurement-, technique- and treatment-specific evidence rather than a type-number inference. | Slattery and Verma 2018, PMC6259994, Table 1 and Structural Curves section, including PT sagittal structural criterion; Lenke et al. 2001, PMID 11507125. | ✓ |
| 3 | Type 3, double major | Double major pattern: the main thoracic curve is the structural major curve, the thoracolumbar/lumbar curve is also structural, and the proximal thoracic curve is nonstructural. Distinguish Type 3 from Type 6 by major-curve identity; Type 3 is MT-major. Return the full curve type, lumbar modifier and sagittal modifier. | Both structural regions must be represented in multidisciplinary operative planning, but the label does not mandate fusion of every structural curve or define exact levels. Preserve the measured flexibility, coronal/sagittal balance, trunk shift, rotation, maturity and clinical goals that drive the actual construct. | Type 3 is not intrinsically a worse prognostic grade than Types 1-2 and supplies no natural-history or surgical-outcome percentage. Risk assessment requires magnitude, growth, balance, symptoms and the proposed treatment. | Slattery and Verma 2018, PMC6259994, Table 1 Curve Types and discussion of major versus structural curves; Lenke et al. 2001, PMID 11507125. | ✓ |
| 4 | Type 4, triple major | Triple major pattern: proximal thoracic, main thoracic and thoracolumbar/lumbar curves are all structural. The major curve may be either main thoracic or thoracolumbar/lumbar, whichever has the largest Cobb angle; it is incorrect to force the main thoracic curve to be major. Add lumbar and sagittal modifiers for the complete designation. | Treat the classification as a complete three-region deformity map for planning, not an automatic long-fusion recipe. Exact levels and strategy require curve magnitudes/flexibility, shoulder and trunk balance, sagittal profile, rotation, maturity, neurologic/clinical findings, goals and surgeon judgment. | Type 4 denotes three structural regions but is not an ordinal maximum-severity or futility state. It does not itself predict progression, complications, pulmonary effects, disability or surgical outcome. | Slattery and Verma 2018, PMC6259994, Table 1 Curve Types (Type 4 permits MT or TL/L major) and modifier sections; Lenke et al. 2001, PMID 11507125. | ✓ |
| 5 | Type 5, thoracolumbar/lumbar | Thoracolumbar/lumbar pattern: the thoracolumbar or lumbar curve is the structural major curve; proximal thoracic and main thoracic curves are nonstructural. The apex determines TL versus lumbar regional naming. Classic Types 5 and 6 use lumbar modifier C; the sagittal modifier still requires measured standing T5-T12 kyphosis. | Use the full geometry to support planning around the structural TL/L curve while retaining global coronal/sagittal balance, lowest-instrumented-level considerations, flexibility, rotation, maturity and goals. Type 5 neither mandates surgery nor prescribes a fusion construct. | Type 5 does not provide a type-specific probability of progression, decompensation, adjacent-segment disease or outcome. Serial Cobb change and skeletal maturity are essential for progression assessment. | Slattery and Verma 2018, PMC6259994, Table 1, curve apex definitions and Lumbar Spine Modifiers; Lenke et al. 2001, PMID 11507125. | ✓ |
| 6 | Type 6, thoracolumbar/lumbar-main thoracic | Thoracolumbar/lumbar-main thoracic pattern: the TL/L curve is structural and major, the main thoracic curve is also structural, and the proximal thoracic curve is nonstructural. The TL/L Cobb angle is at least 5 degrees greater than the MT angle, separating Type 6 from MT-major Type 3. Classic Type 6 pairs with lumbar modifier C and also requires a sagittal modifier. | Both structural MT and TL/L regions and their relative magnitudes must be carried into operative planning, but Type 6 does not itself determine whether or where to fuse. Integrate balance, flexibility, rotation, maturity, symptoms, neurologic findings and patient goals. | Type 6 is a deformity pattern rather than the sixth step of severity. The label alone does not quantify progression, imbalance, complication or outcome risk and should not be used as a prognosis. | Slattery and Verma 2018, PMC6259994, Table 1 and Curve Types discussion; Lenke et al. 2001, PMID 11507125. The 5-degree Type 3/6 major-curve boundary is retained in the structured map with explicit raw Cobb measurements. | ✓ |

### Citações por categoria
- **1**: Slattery C, Verma K. Classifications in Brief: The Lenke Classification for Adolescent Idiopathic Scoliosis (2018) — https://pmc.ncbi.nlm.nih.gov/articles/PMC6259994/ · Slattery and Verma 2018, PMC6259994, Table 1 Curve Types, Structural Curves, Lumbar Spine Modifiers and Thoracic Sagittal Modifier; Lenke et al. 2001, PMID 11507125.
- **2**: Slattery C, Verma K. Classifications in Brief: The Lenke Classification for Adolescent Idiopathic Scoliosis (2018) — https://pmc.ncbi.nlm.nih.gov/articles/PMC6259994/ · Slattery and Verma 2018, PMC6259994, Table 1 and Structural Curves section, including PT sagittal structural criterion; Lenke et al. 2001, PMID 11507125.
- **3**: Slattery C, Verma K. Classifications in Brief: The Lenke Classification for Adolescent Idiopathic Scoliosis (2018) — https://pmc.ncbi.nlm.nih.gov/articles/PMC6259994/ · Slattery and Verma 2018, PMC6259994, Table 1 Curve Types and discussion of major versus structural curves; Lenke et al. 2001, PMID 11507125.
- **4**: Slattery C, Verma K. Classifications in Brief: The Lenke Classification for Adolescent Idiopathic Scoliosis (2018) — https://pmc.ncbi.nlm.nih.gov/articles/PMC6259994/ · Slattery and Verma 2018, PMC6259994, Table 1 Curve Types (Type 4 permits MT or TL/L major) and modifier sections; Lenke et al. 2001, PMID 11507125.
- **5**: Slattery C, Verma K. Classifications in Brief: The Lenke Classification for Adolescent Idiopathic Scoliosis (2018) — https://pmc.ncbi.nlm.nih.gov/articles/PMC6259994/ · Slattery and Verma 2018, PMC6259994, Table 1, curve apex definitions and Lumbar Spine Modifiers; Lenke et al. 2001, PMID 11507125.
- **6**: Slattery C, Verma K. Classifications in Brief: The Lenke Classification for Adolescent Idiopathic Scoliosis (2018) — https://pmc.ncbi.nlm.nih.gov/articles/PMC6259994/ · Slattery and Verma 2018, PMC6259994, Table 1 and Curve Types discussion; Lenke et al. 2001, PMID 11507125. The 5-degree Type 3/6 major-curve boundary is retained in the structured map with explicit raw Cobb measurements.

## Histórico de versões

| Data | Evento | Detalhe | Situação |
| --- | --- | --- | --- |
| 2026-08-12 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-08-11 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-08-10 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-08-09 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-08-08 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-08-07 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-08-06 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-08-05 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-08-04 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-08-03 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-08-02 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-08-01 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-07-31 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-07-30 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-07-29 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-07-28 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-07-27 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-07-26 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-07-25 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-05-23 | revised | A correction replaced Figure 5 of the SRS-Lenke-Aubin 3D article because the lumbar apical vertebral rotation example had been inadequately rounded. | confirmed |
| 2025-12-16 | revised | The SRS-Lenke-Aubin 3D extension was published online, retaining the classic base and adding regional transverse-plane ORPD and AVR modifiers from 3D reconstructions. It is tracked separately from the classic code. | confirmed |
| 2001-08-01 | published | Lenke and colleagues published the classic three-component two-dimensional operative-AIS classification: curve type, lumbar modifier and thoracic sagittal modifier. | confirmed |
| 2001-01-01 | published | Lenke classification of adolescent idiopathic scoliosis published. | confirmed |


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> Conteúdo de referência reescrito. Confira a publicação primária vigente. Não é dispositivo médico nem substitui o julgamento clínico. O radiologista responsável pelo laudo permanece o autor e o responsável.

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