Multicenter, prospective, consecutive clinical series.
To establish and validate classification
in the adult
Summary of Background Data.
Studies of adult scoliosis
reveal the impact of radiographic parameters on self-assessed function: lumbar lordosis and frontal plane obliquity of lumbar vertebrae, not Cobb angle, correlate with pain scores. Deformity apex and intervertebral subluxations correlate with disability.
A total of 947 adults with spinal deformity had radiographic analysis: frontal Cobb angle, deformity apex, lumbar lordosis, and intervertebral subluxation. Health assessment included Oswestry Disability Index and Scoliosis
Research Society instrument. Deformity apex, lordosis (T12–S1), and intervertebral subluxation were used to classify patients. Outcomes measures and surgical rates were evaluated.
Mean maximal coronal Cobb was 46° and lumbar lordosis 46°. Mean maximal intervertebral subluxation (frontal plane) was 4.2 mm (sagittal plane, 1.2 mm). In thoracolumbar/lumbar deformities, the loss of lordosis/higher subluxation was associated with lower Scoliosis
Research Society pain/function and higher Oswestry Disability Index scores. Across the study group, lower apex combined with lower lordosis led to higher disability. Higher surgical rates with decreasing lumbar lordosis and higher intervertebral subluxation were detected.
A clinical impact classification
has been established based on radiographic markers of disability. The classification
has shown correlation with self-reported disability as well as rates of operative treatment.