A Clinical Impact Classification of Scoliosis in the Adult

Abstract

In Brief Study Design. Multicenter, prospective, consecutive clinical series. Objectives. To establish and validate classification of scoliosis 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. Methods. 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. Results. 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. Conclusions. 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. A multicenter prospective effort, including 947 patients, focused on classification of adult scoliosis. Radiographic analysis (deformity apex, lumbar lordosis, and intervertebral subluxation), outcomes measures (Oswestry Disability Index and Scoliosis Research Society instruments), and surgical rates were examined. The classification into types (apex) and addition of modifiers (lordosis and subluxation) permitted clinically significant groupings (disability, pain, and surgical rates).