Abstract
Précis: A multi-centre prospective effort focused on analysis of a previously reported Classification of adult scoliosis. 809 thoracolumbar/lumbar deformities were studied. Radiographic analysis (deformity apex, lumbar lordosis, intervertebral subluxation), outcomes measures (ODI, SRS instruments) and surgical rates were examined. The Classification into Types, based on deformity apex location, and addition of modifiers (lordosis, subluxation) established clinically significant groups (disability, pain). In addition to high clinical impact, the Classification was also able to predict surgical rates.
Introduction: A recently proposed radiographic classification of adult scoliosis offers a reliable method of categorizing patients. Continued work on this classification is expected to develop treatment guidelines. This investigation anald treatment patterns of a large patient population of thoracolumbar and lumbar adult scoliosis, emphasizing surgical rates and approaches by classification subtypes.
Methods: This investigation anald 809 Type IV (thoracolumbar major) and Type V (lumbar major) curves from the Spinal Deformity Study Group database. Enrolled patients had complete SRS, ODI and SF-12 outcomes questionnaires and free standing full-length spine radiographs. Analysis compared non-operative versus surgical treatment (no imposed protocol) with surgical treatment assessed by approach (anterior, posterior, both), +/− osteotomies.
Results: Of 809 patients, 348 were treated surgically (43%) and classified as lordosis type A (n=422), B (n=313), C (n=74). Surgical rates were greater for B vs. A (51% vs. 37%, p< 0.05)), trend for A vs. C (46%). Subluxation modifier scores: 0 (n=360), + (n=159), ++ (n=290). Surgical rates were greater for ++ vs. 0 (52% vs. 36 %, p< 0.05), trend vs. + (42 %). Greater sagittal imbalance was more likely to receive surgical treatment. Loss of lumbar lordosis (modifier B, C) was associated with increased osteotomy rates and posterior or circumferential treatment versus anterior only procedures (most common in modifier A). Greater subluxation (modifier ++) was associated with more circumferential surgery. Greater sagittal imbalance was associated with higher rate of posterior only surgery.
Discussion: In this analysis, greater lordosis or subluxation modifier score was associated with higher surgical rates. Loss of lordosis and greater subluxation grade was associated with higher rates of circumferential surgery than lordotic spines or those without significant subluxation. This information suggests the ability of this classification system to predict treatment. Longitudinal follow up will permit validation of optimal treatment by classification of adult spinal deformity.
Correspondence should be addressed to Jeremy C T Fairbank at The Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford OX7 7LD, UK
