ORIGINAL ARTICLE Disagreements in surgical planning still exist between spinal surgeons in adolescent idiopathic scoliosis: a multisurgeon assessment H. Yener Erken • Halil Burc • Gursel Saka • Mehmet Aydogan Received: 10 January 2014 / Revised: 11 March 2014 / Accepted: 13 March 2014 Ó Springer-Verlag Berlin Heidelberg 2014 Abstract Purpose Determining a surgical plan for the treatment of adolescent idiopathic scoliosis (AIS) can be challenging. Despite treatment recommendations and classification systems (such as the Lenke classification system) there is still no consensus on the optimal surgical plan for each curve type. The main objective of this study is to analyze the disagreements in surgical planning between spinal surgeons in AIS. Methods In a monthly meeting, four orthopaedic spine surgeons from different institutions analyzed a consecutive series of AIS patients. The differences in surgical plans were evaluated for each patient. The primary physician of the patient presented the case and specifically stated the Lenke type of the deformity in the presentation. We wanted to specifically document the disagreements between sur- geons despite knowing the Lenke type of the deformity. Results One hundred consecutive AIS patients were reviewed over a 10-month period. There was a difference of at least one surgical plan from at least one surgeon in 31 of the cases; 30 of these disagreements in surgical planning were about fusion levels; 19 of these 30 disagreements were in only the upper instrumented vertebra (UIV), while seven were disagreements in only the lowest instrumented vertebra (LIV). In four cases, both the UIV and LIV levels varied. Conclusions There was at least one difference in surgical planning in 31 of the 100 cases (31 %). This shows that despite treatment algorithms and the Lenke classification system, disagreements in surgical planning still exist between spinal surgeons. Keywords Adolescent idiopathic scoliosis Á Disagreement Á Lenke system Á Surgical planning Introduction In the treatment of spinal deformities, preoperative plan- ning, intraoperative technique, and postoperative manage- ment all contribute to the ultimate outcome. The goal of treatment is to achieve a stable, balanced spine and main- tain as much flexibility in the lumbar spine as possible [1]. Determining a surgical plan for the treatment of pedi- atric spinal deformity can be challenging since several treatment categories require decision-making including surgical approach, levels to be fused, further preoperative imaging, and the implant type to be utilized (rod diameter, anchor types, etc.). Careful attention needs to be paid to the preoperative curve classification, analysis of structural characteristics for each curve, and a documented clinical examination, all of which are essential features in deter- mining which curves require inclusion into the fusion prior to surgery [2]. Following these decisions, determination of the exact levels to instrument and fuse is necessary to H. Y. Erken (&) Department of Orthopaedic Surgery, Anadolu Medical Center, Cumhuriyet Mahallesi 2255 Sokak No. 3 Gebze, 41400 Kocaeli, Turkey e-mail: yenererken@yahoo.com H. Burc Department of Orthopaedic Surgery, School of Medicine, Suleyman Demirel University, Isparta, Turkey G. Saka Department of Orthopaedic Surgery, Umraniye Education and Research Hospital, Istanbul, Turkey M. Aydogan Bosphorus Spine Center, Istanbul, Turkey 123 Eur Spine J DOI 10.1007/s00586-014-3278-y