Skip Navigation LinksHome > October 2013 - Volume 73 - Issue 4 > The SRS-Schwab Adult Spinal Deformity Classification: Asses...
doi: 10.1227/NEU.0000000000000012
Research-Human-Clinical Studies: Editor's Choice

The SRS-Schwab Adult Spinal Deformity Classification: Assessment and Clinical Correlations Based on a Prospective Operative and Nonoperative Cohort

Terran, Jamie BS*; Schwab, Frank MD*; Shaffrey, Christopher I. MD; Smith, Justin S. MD, PhD; Devos, Pierre MS*; Ames, Christopher P. MD§; Fu, Kai-Ming G. MD, PhD; Burton, Douglas MD; Hostin, Richard MD#; Klineberg, Eric MD**; Gupta, Munish MD**; Deviren, Vedat MD‡‡; Mundis, Gregory MD§§; Hart, Robert MD¶¶; Bess, Shay MD‖‖; Lafage, Virginie PhD*; International Spine Study Group

Editor's Choice
CNS University of Neurosurgery
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BACKGROUND: The SRS-Schwab classification of adult spinal deformity (ASD) is a validated system that provides a common language for the complex pathology of ASD. Classification reliability has been reported; however, correlation with treatment has not been assessed.

OBJECTIVE: To assess the clinical relevance of the SRS-Schwab classification based on correlations with health-related quality of life (HRQOL) measures and the decision to pursue operative vs nonoperative treatment.

METHODS: Prospective analysis of consecutive ASD patients (18 years of age and older) collected through a multicenter group. The SRS-Schwab classification includes a curve type descriptor and 3 sagittal spinopelvic modifiers (sagittal vertical axis, pelvic tilt, pelvic incidence/lumbar lordosis mismatch). Differences in demographics, HRQOL (Oswestry Disability Index, SRS-22, Short Form-36), and classification between operative and nonoperative patients were evaluated.

RESULTS: A total of 527 patients (mean age, 52.9 years; range, 18.4-85.1 years) met inclusion criteria. Significant differences in HRQOL were identified based on SRS-Schwab curve type, with thoracolumbar and primary sagittal deformities associated with greater disability and poorer health status than thoracic or double curve deformities. Operative patients had significantly poorer grades for each of the sagittal spinopelvic modifiers, and progressively higher grades were associated with significantly poorer HRQOL (P < .05). Patients with worse sagittal spinopelvic modifier grades were significantly more likely to require major osteotomies, iliac fixation, and decompression (P ≤ .009).

CONCLUSION: The SRS-Schwab classification provides a validated language to describe and categorize ASD. This study demonstrates that the SRS-Schwab classification reflects severity of disease state based on multiple measures of HRQOL and significantly correlates with the important decision of whether to pursue operative or nonoperative treatment.

ABBREVIATIONS: ASD, adult spinal deformity

CCI, Charlson Comorbidity Index

HRQOL, health-related quality of life

ODI, Oswestry Disability Index

PI-LL, pelvic incidence minus lumbar lordosis

PT, pelvic tilt; SVA, sagittal vertical axis

Copyright © by the Congress of Neurological Surgeons


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