A comprehensive clinical impact classification of Adult Scoliosis : A comprehensive clinical impact classification of Adult Scoliosis F. Schwab
K. Bridwell
S. Berven
J-P Farcy
S. Glassman
J. Harrast
W. Horton
M. Ferguson Spine Deformity Study Group, San Diego 2005
Why a classification ? : Why a classification ? Must develop a common language:
exchange of information
comparison of data
Correlation with clinical impact
treatment algorithms
surgical guidelines
Scoliosis : Scoliosis Prevalence
AIS 2-4% of screened pediatric population
Adult >60% of screened elderly population Demographic :
Life expectancy, birth rates….
Significant growth of aging population segment
Adult Scoliosis Classification: : Adult Scoliosis Classification: Chicago 2002
Arizona 2003
Chicago 2003
Miami 2004 IMAST
Worldspine
SRS
NASS
Adult Scoliosis Classification:Clinical impact : Adult Scoliosis Classification:Clinical impact Significant
Spondylolisthesis
Frontal plane subluxation
Lumbar lordosis
Thoracolumbar alignment
Apical level +/-
Global alignment Not significant
Coronal Cobb
AISA vs DDS
Age
The Classification : The Classification Simple
Basic structure 3 parameters
Lumbar lordosis T12-S1
Maximal intervertebral subluxation (frontal/sagittal)
Apical level of deformity (lumbar dominant) Selected for high clinical impact: SRS-22, ODI
The Classification : The Classification Apical Level…curve Type
Type I : thoracic-only scoliosis
Type II: upper thoracic major curve, apex T4-8
(with a thoracolumbar or lumbar curve)
Type III: lower thoracic major curve, apex T9-T10
(with thoracolumbar or lumbar curve)
Type IV: thoracolumbar major curve, apex T11-L1
(with any other minor curve)
Type V: lumbar major curve, apex L2-L4
(with any other minor curve)
The Classification : The Classification Lordosis Modifier (T12-S1)
A: marked lordosis >400
B: moderate lordosis 0-400
C: no lordosis present Cobb >00
The Classification : The Classification Subluxation modifier
Maximal intervertebral subluxation
Frontal or sagittal plane
0 : no subluxation
+ : subluxation 1-6mm
++: subluxation >7mm
Slide 10: Intra-, inter-observer variability study
20 cases
full-length films
AP and Lateral
13 one-time readers
6 repeat readers Adult Scoliosis Classification
Adult Scoliosis ClassificationInter-observer analysis : Adult Scoliosis ClassificationInter-observer analysis Disagreements on
thoracic levels (Type II, III)
thoracolumbar vs. lumbar
Adult Scoliosis ClassificationIntra-observer analysis : Adult Scoliosis ClassificationIntra-observer analysis
SDSG data set 1/05 : SDSG data set 1/05 Primary curve apex
Adult Scoliosis Classification : Adult Scoliosis Classification Type I curves (thoracic only)
17 subjects (12F, 5 M)
Coronal Cobb mean 43 (SD17)
Mean SRS pain 67 (SD 19)
Mean SRS function 66 (SD 23)
Mean ODI 27 (SD 20)
Surgical rate 41%
Adult Scoliosis Classification : Adult Scoliosis Classification Type II curves (upper thoracic major, apex T4-7)
48 subjects (43F, 5 M)
Coronal Cobb mean 47 (SD 22)
Mean SRS pain 65 (SD 20)
Mean SRS function 69 (SD 18)
Mean ODI 28 (SD 22)
Surgical rate 35%
Adult Scoliosis Classification : Adult Scoliosis Classification Type III curves (lower thoracic major, apex T8-10)
260 subjects (215 F, 44 M)
Coronal Cobb mean 50 (SD 20)
Mean SRS pain 65 (SD 21)
Mean SRS function 72 (SD 17)
Mean ODI 24 (SD 20)
Surgical rate 39%
Adult Scoliosis Classification : Adult Scoliosis Classification Type IV curves (thoracolumbar major apex T11-L1)
343 subjects (302 F, 40 M)
Coronal Cobb mean 47 (SD 19)
Mean SRS pain 60 (SD 19)
Mean SRS function 65 (SD 17)
Mean ODI 31 (SD 19)
Surgical rate 48%
Adult Scoliosis Classification : Adult Scoliosis Classification Type V curves (lumbar major, apex L2-L4)
279 subjects (242 F, 37 M)
Coronal Cobb mean 42 (SD 19)
Mean SRS pain 61 (SD 19)
Mean SRS function 63 (SD 17)
Mean ODI 34 (SD 19)
Surgical rate 37%
Adult Scoliosis Classification : Adult Scoliosis Classification Lordosis Modifier (T12-S1) A B C
Adult Scoliosis Classification : Subluxation Modifier (maximal, in mm) Adult Scoliosis Classification
Adult Scoliosis Classification : Adult Scoliosis Classification
Adult Scoliosis : Adult Scoliosis A valid Classification
Simple approach possible
High clinical impact
Frontal and sagittal plane considerations
Validated through largest database available
Reliable system
Intra- and inter-observer
Adult Scoliosis Classification : Adult Scoliosis Classification The Classification – clinical impact
Apex
Lumbar Lordosis
Intervertebral subluxation Do we need descriptive parameters ?
exact number/patterns of curves
Cobb angles
Levels of instability, DJD Other parameters ?
Adult Scoliosis Classification : Adult Scoliosis Classification Next Steps:
Refine group definitions
Combine with Surgical Classification
T-L junction
L-S junction
Longitudinal analysis
Ongoing review as database grows