Spinal Deformity Classification Research Articles

Correlation analysis of global sagittal alignment of the spine in cases of low-grade degenerative lumbar spondylolisthesis.

Disruptions in global sagittal spinal alignment can lead to changes in global sagittal spinal alignment, often manifesting as sagittal malalignment, where the trunk shifts forward. We proposed that these alignment changes are linked to degenerative lumbar spondylolisthesis (DS). The objective was to assess global spinal alignment in low-grade DS using sagittal vertical axis (SVA) classification. The patients with DS were categorized into three groups based on the adult spinal deformity classification: type I, defined by a SVA of less than 40mm; type II, with an SVA ranging from 40mm to 95mm; and type III, where the SVA is 95mm or greater. The study compared age and various sagittal parameters among these groups, including thoracic kyphosis (TK), lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI). Notable differences were observed between type I and type II, as well as between type I and type III, whereas no substantial variation was detected between type II and type III. Additionally, PI increased with advancing type classification, with a distinct contrast observed between type I and type III. A high PI is a key risk factor for worsening SVA in DS, and it may contribute to the initiation and progression of the condition.

Roussouly classification of adult spinal deformity

With an estimated prevalence of 68% among healthy adults without a previous diagnosis of scoliosis, adult spinal deformities are a growing concern as the population ages. Our understanding of this growing concern has been historically guided by previous studies performed on the pediatric population. Over time, different classifications have been developed with their own respective limitations. The Roussouly classification was the first classification to describe the shapes of an asymptomatic spine. It considers lumbar lordosis, pelvic incidence, and the inflection point from lumbar lordosis to thoracic kyphosis to attempt to stratify the shapes of an asymptomatic spine. This classification aims to guide treatment, provide information regarding prognosis, allow stratification for research, and be highly reproducible. Overall, the Roussouly classification is a novel way to think about sagittal malalignment, considering the patient’s individual anatomy, while allowing for communication between surgeons. Additionally, it has proven to be a reliable system that provides prognostic value for clinicians and may minimize complications when a patient’s sagittal alignment is optimized using this classification system.

Two-stage video-based convolutional neural networks for adult spinal deformity classification.

Assessment of human gait posture can be clinically effective in diagnosing human gait deformities early in life. Currently, two methods-static and dynamic-are used to diagnose adult spinal deformity (ASD) and other spinal disorders. Full-spine lateral standing radiographs are used in the standard static method. However, this is a static assessment of joints in the standing position and does not include information on joint changes when the patient walks. Careful observation of long-distance walking can provide a dynamic assessment that reveals an uncompensated posture; however, this increases the workload of medical practitioners. A three-dimensional (3D) motion system is proposed for the dynamic method. Although the motion system successfully detected dynamic posture changes, access to the facilities was limited. Therefore, a diagnostic approach that is facility-independent, has low practice flow, and does not involve patient contact is required. We focused on a video-based method to classify patients with spinal disorders either as ASD, or other forms of ASD. To achieve this goal, we present a video-based two-stage machine-learning method. In the first stage, deep learning methods are used to locate the patient and extract the area where the patient is located. In the second stage, a 3D CNN (convolutional neural network) device is used to capture spatial and temporal information (dynamic motion) from the extracted frames. Disease classification is performed by discerning posture and gait from the extracted frames. Model performance was assessed using the mean accuracy, F1 score, and area under the receiver operating characteristic curve (AUROC), with five-fold cross-validation. We also compared the final results with professional observations. Our experiments were conducted using a gait video dataset comprising 81 patients. The experimental results indicated that our method is effective for classifying ASD and other spinal disorders. The proposed method achieved a mean accuracy of 0.7553, an F1 score of 0.7063, and an AUROC score of 0.7864. Additionally, ablation experiments indicated the importance of the first stage (detection stage) and transfer learning of our proposed method. The observations from the two doctors were compared using the proposed method. The mean accuracies observed by the two doctors were 0.4815 and 0.5247, with AUROC scores of 0.5185 and 0.5463, respectively. We proved that the proposed method can achieve accurate and reliable medical testing results compared with doctors' observations using videos of 1 s duration. All our code, models, and results are available at https://github.com/ChenKaiXuSan/Walk_Video_PyTorch. The proposed framework provides a potential video-based method for improving the clinical diagnosis for ASD and non-ASD. This framework might, in turn, benefit both patients and clinicians to treat the disease quickly and directly and further reduce facility dependency and data-driven systems.

Value of multi-channel somatosensory evoked potentials recording in patients undergoing scoliosis correction surgery.

We aimed to investigate the value of intraoperative multi-channel recording of somatosensory evoked potentials (SSEPs) in patients undergoing posterior instrumentation surgery with fusion. This study included 176 patients with scoliosis who underwent posterior correction surgery from January 2019 to June 2020. Among them, 88 patients underwent routine SSEPs monitoring via single-channel (Cz'-Fpz) cortical recording (control group), while the remaining 88 patients underwent multi-channel (Cz'-Fpz and C3'-C4') SSEPs monitoring in the cortex. Chi-square and Fisher's exact tests were used to analyze the influence of age, spinal deformity classification, and Cobb angle on waveform differentiation and the success rate of SSEPs monitoring. Univariate analysis revealed that age, type of scoliosis, and Cobb angle exerted significant effects on the success rate of intraoperative SSEPs monitoring, and the SSEPs waveform differentiation rate was poorest among patients with congenital scoliosis. Intraoperative monitoring results indicated that the success rate of single-channel SSEPs monitoring was 90.9%, while that of multi-channel monitoring was 98.9% (P < 0.05). Among the intraoperative alarm cases, the incidence of adverse events after single-channel SSEPs monitoring was 66.7%, while the incidence of adverse events after multi-channel SSEPs monitoring was only 28.6%. Multi-channel cortical SSEPs monitoring can effectively and accurately evaluate the function of the posterior column of the spinal cord. Use of multi-channel SSEP monitoring may help to improve the success rate of monitoring and reduce the incidence of postoperative adverse events in patients with congenital scoliosis.

Augmenting the Cobb angle: Three-dimensional analysis of whole spine shapes using Bézier curves

Background and objective:The identification and classification of pathological spinal deformities poses a major challenge to any diagnostician. First, available medical images are usually two-dimensional projections, obscuring elaborated spatial information. Second, several measurement techniques with different thresholds for certain clinical syndromes make it difficult to classify measured results. Here, a method is presented to augment and standardize the analysis of spinal shapes in three dimensions.Methods:Regarding the first limitation, (semi-)automatic, three-dimensional segmentation techniques of medical images have already been developed. To overcome the second, we propose here a representation of the whole spine by a Bézier curve using the vertebral centers as control points. After normalization, a differential-geometric approach yields information on curvature and torsion at each spinal level as well as in between.Results:Based on literature data and multi-body simulations, we show how these quantities alter with individual posture and during motion. Robustness with respect to missing data is investigated. Approaches towards the identification of spinal disorders are motivated.Conclusion:Our results emphasize the need for individualizable identification and classification of spinal deformities and give an outlook on how it might be achieved. The presented methodology constitutes the first fully three-dimensional analysis of spinal shapes, i.e. without the requirement of certain physiological planes (e.g. the sagittal plane) or landmarks (e.g. the apex vertebra).

A Complement Type to SRS-Schwab Adult Spinal Deformity Classification: The Failure of Pelvic Compensation

Retrospective review. To determine characteristics of patients with adult spinal deformity (ASD) who showed failed pelvic compensation even with significant sagittal imbalance. Patients who show failed pelvic compensation despite significant sagittal imbalance reportedly present distinct clinical outcomes. However, to our knowledge, no study has clearly defined or characterized this subgroup of patients with ASD. We examined 126 patients who underwent reconstructive spinal surgery for ASD between September 2016 and September 2020. Radiographic spinopelvic parameters were assessed. The patients were divided into four quadrant groups based on the two axes of pelvic tilt/pelvic incidence (PT/PI) and the sagittal vertical axis (SVA) with reference to the population median values (0.68 and 147.5mm, respectively). Patients with low PT/PI and high SVA were considered to have failed pelvic compensation, and they were compared with other patient groups. Patients with failed pelvic compensation (low PT/PI and high SVA) had worse clinical outcomes than those with successful pelvic compensation (high PT/PI and high SVA) at one year after surgery. Regarding radiographic outcomes, patients with failed pelvic compensation showed a significantly larger postoperative SVA even after correcting the PI-lumbar lordosis mismatch was corrected to a comparable range with the group of successful pelvic compensation. Notably, patients with failed pelvic compensation showed larger cross-sectional areas of the psoas and back extensor muscles than those with successful pelvic compensation. This suggests that failure of pelvic compensation did not occur because of back muscle weakness, which implies another underlying pathophysiology, including neurological origin. Compared with patients with successful pelvic compensation, those with failed pelvic compensation showed lower postoperative improvements in clinical and radiographic outcomes. Therefore, it is important to consider pelvic compensation when planning surgical correction of deformities. Distinct surgical approaches, including overcorrection of the PI-lumbar lordosis mismatch or global sagittal alignment, should be attempted to ensure postoperative symptom improvement.

Assessment of Adult Spinal Deformity Complication Timing and Impact on 2-Year Outcomes Using a Comprehensive Adult Spinal Deformity Classification System.

Retrospective review of prospectively collected multicenter registry data. To identify rates and timing of postoperative complications in adult spinal deformity (ASD) patients, the impact of complication type and timing on health related quality of life (HRQoL) outcomes, and the impact of complication timing on readmission and reoperation rates. Better understanding of complication timing and impact on HRQoL may improve patient selection, preoperative counseling, and postoperative complication surveillance. ASD is common and associated with significant disability. Surgical correction is often pursued, but is associated with high complication rates. The International Spine Study Group, AO Spinal Deformity Forum, and European Spine Study Group have developed a new complication classification system for ASD (ISSG-AO spine complications classification system). The ISSG-AO spine complications classification system was utilized to assess complications occurring over the 2-year postoperative time period amongst a multicenter, prospectively enrolled cohort of patients who underwent surgery for ASD. Kaplan-Meier survival curves were established for each complication type. Propensity score matching was performed to adjust for baseline disability and comorbidities. Associations between each complication type and HRQoL, and reoperation/readmission and complication timing, were assessed. Of 584 patients meeting inclusion criteria, cardiopulmonary, gastrointestinal, infection, early adverse events, and operative complications contributed to a rapid initial decrease in complication-free survival. Implant-related, radiographic, and neurologic complications substantially decreased long-term complication-free survival. Only radiographic and implant-related complications were significantly associated with worse 2-year HRQoL outcomes. Need for readmission and/or reoperation was most frequent among those experiencing complications after postoperative day 90. Surgeons should recognize that long-term complications have a substantial negative impact on HRQoL, and should carefully monitor for implant-related and radiographic complications over long-term follow-up.Level of Evidence: 4.

Prevalence and Characteristics of Spinal Sagittal Malalignment in Patients with Osteoporosis.

Spinal sagittal malalignment due to vertebral fractures (VFs) induces low back pain (LBP) in patients with osteoporosis. This study aimed to elucidate spinal sagittal malalignment prevalence based on VF number and patient characteristics in individuals with osteoporosis and spinal sagittal malalignment. Spinal sagittal alignment, and VF number were measured in 259 patients with osteoporosis. Spinal sagittal malalignment was defined according to the SRS-Schwab classification of adult spinal deformity. Spinal sagittal malalignment prevalence was evaluated based on VF number. In patients without VFs, bone mineral density, bone turnover markers, LBP scores and health-related quality of life (HRQoL) scores of normal and sagittal malalignment groups were compared. In 205 of the 259 (79.2%) patients, spinal sagittal malalignment was detected. Sagittal malalignment prevalence in patients with 0, 1, or ≥2 VFs was 72.1%, 86.0%, and 86.3%, respectively. All LBP scores and some subscale of HRQoL scores in patients without VFs were significantly worse for the sagittal malalignment group than the normal alignment group (p < 0.05). The majority of patients with osteoporosis had spinal sagittal malalignment, including ≥70% of patients without VFs. Patients with spinal sagittal malalignment reported worse LBP and HRQoL. These findings suggest that spinal sagittal malalignment is a risk factor for LBP and poor HRQoL in patients with osteoporosis.

Toward the Development of a Comprehensive Clinically Oriented Patient Profile: A Systematic Review of the Purpose, Characteristic, and Methodological Quality of Classification Systems of Adult Spinal Deformity.

BACKGROUNDExisting adult spinal deformity (ASD) classification systems are based on radiological parameters but management of ASD patients requires a holistic approach. A comprehensive clinically oriented patient profile and classification of ASD that can guide decision-making and correlate with patient outcomes is lacking.OBJECTIVETo perform a systematic review to determine the purpose, characteristic, and methodological quality of classification systems currently used in ASD.METHODSA systematic literature search was conducted in MEDLINE, EMBASE, CINAHL, and Web of Science for literature published between January 2000 and October 2018. From the included studies, list of classification systems, their methodological measurement properties, and correlation with treatment outcomes were analyzed.RESULTSOut of 4470 screened references, 163 were included, and 54 different classification systems for ASD were identified. The most commonly used was the Scoliosis Research Society-Schwab classification system. A total of 35 classifications were based on radiological parameters, and no correlation was found between any classification system levels with patient-related outcomes. Limited evidence of limited quality was available on methodological quality of the classification systems. For studies that reported the data, intraobserver and interobserver reliability were good (kappa = 0.8).CONCLUSIONThis systematic literature search revealed that current classification systems in clinical use neither include a comprehensive set of dimensions relevant to decision-making nor did they correlate with outcomes. A classification system comprising a core set of patient-related, radiological, and etiological characteristics relevant to the management of ASD is needed.

Development and Validation of a Multidomain Surgical Complication Classification System for Adult Spinal Deformity.

Prospective analysis of example cases. The aim of this study was to analyze the accuracy and repeatability of a new comprehensive classification system for capturing complications data in adult spinal deformity. Complications are common in adult spinal deformity surgery. However, no consensus exists on the definition or classification of complications in adult spinal deformity surgery. The lack of consensus significantly limits understanding of complications' effects on outcomes in surgery for adult spinal deformity. Using a Delphi method, members of the International Spine Study Group, AO Spine, and the European Spine Study Group collaborated to develop an adult spinal deformity classification system. The multidomain classification system accounts for medical complications (cancer, cardiopulmonary, central nervous system, gastrointestinal, infectious, musculoskeletal, renal) and surgical complications (implant complications, radiographic complications, neurologic events, intraoperative events, and wound complications). Seventeen individuals ("event readers"), including spine surgeons, trainees, and research coordinators, used the new classification system two separate times to analyze complications in ten example cases. The accuracy and repeatability of the classification system were subsequently calculated based on the providers' responses for the example cases. The 10 example cases included 22 complications. Nearly 95% of complications were captured by >95% of the event readers. The system demonstrated good repeatability of 86.9% between the first and second set of responses provided by event readers. The ISSG-AO Multi-Domain Spinal Deformity Complication Classification System for Adult Spinal Deformity demonstrated good accuracy and repeatability among both surgeons and research coordinators in capturing complications in adult spinal deformity surgery. The ISSG-AO system may be applied to help better understand the impact of complications on outcomes and costs in adult spinal deformity surgery.Level of Evidence: 5.

Global 3D parameter of the spine: application of Călugăreanu-White-Fuller theorem in classification of pediatric spinal deformity.

Several classification systems of the spinal curves in adolescent idiopathic scoliosis (AIS) have been developed to guide surgical decision-making. The current classification systems are based on the spinal deformity patterns or deformity magnitudes in one or two anatomical planes. Considering the 3D nature of the spinal deformity in AIS, these classifications fail to capture the spine's curve in its entirety. We proposed a classification based on the axial plane and showed that mathematical analysis of the 3D spinal curve, using differential geometry, supports the differences between the subtypes in this classification system. We calculated the writhe and twist of the entire spinal centerline, elements of the Călugăreanu-White-Fuller theorem, in a cohort of 30 right thoracic AIS patients. We also classified this cohort manually based on the vertebral level at which the direction of vertebral rotation caudal to the thoracic curve changes: Lumbar in Group I (V-shaped axial projection) or thoracolumbar in Group II (S-shaped axial projection). The writhe and twist of the spinal curve were significantly different between these manual classification subgroups. Our manual classification distinguished the axial subgroups of right thoracic AIS supported by mathematical specifications of the entire curve in three dimensions. Graphical abstract.

Spinopelvic Alignment and Low Back Pain before and after Total Knee Arthroplasty.

Study DesignProspective cohort study.PurposeThis study aims to examine changes in spinopelvic alignment, sagittal global balance, and low back pain (LBP) following the removal of knee flexion contracture by total knee arthroplasty (TKA).Overview of LiteratureThe limitation of the knee extension was correlated with the decrease in lumbar lordosis (LL). Currently, there are no studies evaluating the spinopelvic alignment and LBP before and after TKAs.MethodsSagittal spinopelvic alignment was evaluated in 110 subjects using radiographs of the whole spine. Parameters measured in this study included sagittal vertical axis (SVA), LL, sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI). The distribution of sagittal plane modifier grade was evaluated according to the Scoliosis Research Society-Schwab classification of adult spinal deformity (ASD). Consequently, personal history related to LBP was obtained, and the association of pre- and postoperative LBP and spinopelvic alignment was investigated.ResultsPreoperatively, 66% of all subjects showed LBP and mostly exhibited anteriorly shifted global imbalance associated with a decrease in LL and knee flexion contractures, and the subject who had severe flexion contracture of the knee joint showed more forwardly shifted global balance with backward PT and decrease in LL. After TKAs, the knee flexion contractures were eliminated in most cases, and one-third of subjects experienced decrease in LBP. However, SVA increased more and associated with slight decrease of PT and increase of SS. No significant differences were confirmed between pre- and postoperative values of LL and PI. In addition, there were no significant differences in postoperative values of spinopelvic parameters between subjects with and without relieved LBP.ConclusionsAlthough one-third of subjects experienced decrease of LBP after TKAs, the sagittal global imbalance was not restored through the removal of knee flexion contracture.

Impact of L4/5 Posterior Interbody Fusion With or Without Decompression on Spinopelvic Alignment and Health-related Quality-of-Life Outcomes.

This was a retrospective case control study. The objective was to determine the impact of single-level interbody fusion at L4/5 with or without concomitant decompression on various spinopelvic parameters and health-related quality-of-life (HRQOL) outcomes. Recently, focus has swayed from a regional concern to a global sagittal alignment, more comprehensive approach in multilevel, corrective fusion for adult spinal deformity. However, only a few comprehensive studies have investigated the relationships between the various related spinopelvic parameters and HRQOL outcomes using single-level interbody fusion. In total, 119 patients with lumbar degenerative disorders (mean age, 68 y; 38 males and 81 females) who underwent L4/5 single-level posterior interbody fusion with a minimum 2-year follow-up were included. Participants were divided into 2 groups according to preoperative sagittal modifiers of the SRS-Schwab adult spinal deformity classification. The correlation between spinopelvic parameters and HRQOL outcomes was investigated. Negative or positive values indicated lordosis. HRQOL outcomes were assessed using visual analog scale scores, Japanese Orthopedic Association Back Pain Evaluation Questionnaires (JOABPEQ), and short form-36 (SF-36). L4/5 local lordosis increased from 6.4±4.4 degrees preoperatively to 11.3±4.5 degrees at 2 years postoperatively (P<0.0001). Further analysis of the results also showed a correlation between change in L4/5 local lordosis and change in lumbar lordosis (LL) (rs=0.229, P=0.0143). The high pelvic incidence-LL (≥20 degrees, n=28) and high sagittal vertical axis groups (≥5 cm, n=29) had lower scores in walking ability, social life domains of JOABPEQ, and physical component summary scores of SF-36 preoperatively, and 2 years postoperatively. Fusion status did not affect the HRQOL outcomes, except that concomitant decompression at the adjacent disk level yielded lower SF-36 physical component summary scores 2 years postoperatively. Improvement in L4/5 local lordosis possibly triggers a simultaneous sequence of change in total LL after posterior single-level fusion. HRQOL outcomes were negatively affected by both preoperative and postoperative pelvic incidence-LL mismatch and global sagittal malalignment. Level III.

Global sagittal spinal alignment in patients with degenerative low-grade lumbar spondylolisthesis.

Global sagittal spinal alignment undergoes changes on the basis of sagittal malalignment (trunk inclined forward) in natural degenerative progression. We hypothesized that this change would associate with the disease state of the degenerative lumbar spondylolisthesis (DS). This study aimed to evaluate the global sagittal spinal alignment of low-grade DS by classifying in accordance with sagittal vertical axis (SVA). The DS group was classified into three types according to the adult spinal deformity classification: type 1, SVA < 40 mm; type 2, 40 mm ≤ SVA < 95 mm; and type 3, 95 mm ≤ SVA. Age and sagittal spinal parameters (thoracic kyphosis, lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI)) were compared among three types. There were statistically significant differences in age, LL, PI, and PT among the three types. In comparison between two types, there was a statistically significant difference between type 1 and type 2 and between type 1 and type 3, but not between type 2 and type 3 in these parameters. PI tended to increase as the type increases. Furthermore, there was significant difference between types 1 and 3. We evaluated the features of the DS types classified by sagittal alignment. Large PI is one of the risk factors for SVA deterioration of DS. PI may be involved in the onset and progression of DS.

P102. Does matching Roussouly spinal shape and improvement in SRS-Schwab modifier contribute to improved patient-reported outcomes?

BACKGROUND CONTEXT The Roussouly Classification system of sagittal spinal shape and the SRS-Schwab adult spinal deformity (ASD) classification system have become important indicators of spine deformity. No prior studies have examined the outcomes of matching both Roussouly type and improving in Schwab modifiers postoperatively. PURPOSE Evaluate outcomes of matching Roussouly Type and improving in Schwab modifier following ASD surgery. STUDY DESIGN/SETTING Retrospective review of single-center ASD database. PATIENT SAMPLE A total of 103 ASD patients. OUTCOME MEASURES Roussouly types, Schwab modifiers, Health Related Quality of Life scores(HRQLs): Minimal Clinical Important Difference for ODI, EQ5D, VAS Leg B Type 2: PI 60°); (2) “current” Roussouly type (1: SS 45°), as previously published. One year (1Y) matched Roussouly: preoperative mismatched (Between ‘actual’ and ‘theoretical’ patients that matched at 1Y. Schwab modifiers at BL were identified: non-, moderate and severe deformity (0, +, ++) for PT, SVA, and PI-LL. Schwab improvement was defined as a decrease in a modifier at one year. RESULTS A total of 103 ASD patients (61.8yrs, 63.1%F, 30kg/m2). By surgical approach, 79.6% posterior, 10.7% combined, 2.9% anterior). Average levels fused: 4.6. BL breakdown of ‘current; Roussouly type: 28% Type 1, 25.3% Type 2, 32.0% Type 3, 14.7% Type 4. BL Roussouly mismatch: 65.3%. Breakdown BL Schwab modifiers: PT (0: 8.7%, +: 41.7%, ++: 49.5%), SVA (0: 29.7%, +: 20.3%, ++: 50%), PI-LL mismatch (0: 28.2%, +: 25.2%, ++: 46.6%). At one year, 19.2% of patients matched Roussouly target type, while according to Schwab modifiers, 12.6% improved in SVA, 42.7% in PI-LL, and 45.6% in PT. Patients who both met Roussouly type and improved in a Schwab by the modifiers: 9 PT (8.7%), 8 PI-LL (7.8%), 2 SVA (1.9%). There were 2 patients (1.9%) who met their Roussouly type and improved in all 3 Schwab modifiers. One year (1Y) matched Roussouly patients improved more in HRQLs (MCID for ODI, EQ5D, VAS Leg/Back Pain), when compared to mismatched Roussouly, but was not significant(P>0.05). Match Roussouly and improvement in PT Schwab met MCID for EQ5D significantly more (33.3% vs 10.6%, p=0.050). Matched Roussouly and PI-LL Schwab had more patients meet MCID for all HRQLs, yet none were significant, p>0.05. Matched Roussouly and improvement in SVA Schwab met MCID for ODI significantly more (p=0.024). CONCLUSIONS Patients who both matched Roussouly sagittal spinal type and improved in SRS-Schwab modifiers had superior patient-reported outcomes at 1-year. Utilizing both classification systems in surgical decision making can optimize postop patient outcomes. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

What Should an Ideal Adult Spinal Deformity Classification System Consist of?: Review of the Factors Affecting Outcomes of Adult Spinal Deformity Management.

This literature review aims to determine potential clinical factors or comorbidities besides radiological parameters that affect the outcome of adult spinal deformity (ASD) management and review existing classifications associated with ASD. ASD is a multifactorial disease that comprises pathologies like radiological spine deformity, coexistence of spinal canal stenosis, radiculopathy, and multiple comorbidities. The available classification systems of ASD are predominantly based on radiological parameters and do not consider related clinical conditions. ASD patients with different combinations of these parameters behave differently and need different management strategies. We conducted a narrative literature review with search limited to English language of PubMed/MEDLINE using Medical Subject Heading (MeSH) terms. The terms specific to the review were ASD and several other related terminologies. We analyzed the information of the selected papers including factors affecting surgical outcomes for degenerative scoliosis. We reviewed 614 citations. Based on the inclusion criteria, 39 citations were selected for full-text retrieval; of these, 28 were excluded because of not fulfilling the inclusion criteria. Thus, 11 studies were selected and included for the final analysis. The presence of leg pain, spinal stenosis, obesity, osteoporosis, smoking, and age of patients were major influencing factors. Furthermore, the factors included in the available classifications, such as the Scoliosis Research Society–Schwab classifications, were reviewed and results were tabulated. This review highlights the significance of neurological symptoms, spinal stenosis, osteoporosis, obesity, age, and smoking, which markedly affect the management of ASD. With increasing number of patients being diagnosed and treated with ASD, there has been a growing need to comprehensively classify these patients into clinicoradiological subgroups.

Classification of Adult Spinal Deformity: Review of Current Concepts and Future Directions.

Although adult spinal deformity (ASD) has become a global health problem, the classification system and optimal surgical treatment for ASD is yet to be standardized worldwide. A significant part of the population, as high as 10%, in industrialized societies will be aged above 65 years within the next 10 years. Herein, a systematic review of the scientific literature related to the classification and treatment of ASD was conducted wherein historical to the most recent classifications of ASD were reviewed. By discussing the benefits and limitations of the previous classification systems and considering the factors affecting the clinical outcomes of surgical treatment of ASD, this article would like to propose future directions for the development of a new classification system for ASD.

Sagittal Spinal Alignment in Adult Spinal Deformity: An Overview of Current Concepts and a Critical Analysis Review.

* Changes in spinal alignment trigger several compensatory changes in the pelvis and lower extremities to maintain upright posture. Activating these mechanisms of compensation may require increased energy expenditure to maintain upright posture.* The Scoliosis Research Society-Schwab Adult Spinal Deformity (ASD) classification system allows for a uniform classification and discussion of ASD. A higher sagittal deformity classifier is associated with increased disability.* Age-related changes in spinal alignment are important to consider when setting alignment goals for deformity correction. Less-aggressive correction should be considered in older patients because of their increased risk for complications.* A structured approach to the treatment of ASD consists of 6 steps: (1) find and quantify the driver of deformity, (2) evaluate how deformity impacts global alignment, (3) define alignment targets, (4) determine spinal flexibility, (5) choose a surgical strategy, and (6) execute this strategy intraoperatively in a controlled fashion.

Spinopelvic Changes Based on the Simplified SRS-Schwab Adult Spinal Deformity Classification: Relationships With Disability and Health-Related Quality of Life in Adult Patients With Prolonged Degenerative Spinal Disorders.

Cross-sectional, observational study. To study the occurrence of sagittal malalignment, the adaptability of a simplified sagittal modifiers grading of the Scoliosis Research Society (SRS)-Schwab adult spinal deformity (ASD) classification, and the deformity-specific SRS questionnaire version 30 (SRS-30) in an unselected adult cohort with symptomatic degenerative spinal disorders. The sagittal modifiers of the SRS-Schwab ASD classification correlate with health-related quality of life (HRQoL) measures in patients with ASD. The deformities and disabilities caused by sagittal malalignment in patients with common degenerative spinal disorders of multiple etiologies are rarely studied. A simplified and categorizing version of the SRS-Schwab ASD classification in relation to the Oswestry Disability Index (ODI) and the SRS-30 outcomes has not yet been developed. We recruited 874 consecutive patients with degenerative spinal disorders between March 2013 and February 2014. Full spine radiographs were taken and the patients divided into sagittal deformity severity groups: mild or none, moderate, and marked deformity. Participants completed the ODI, SRS-30, and a general health questionnaire. We included 637 patients in the analysis. The severity of sagittal deformity was mild or none in 407 (63.9%) patients, moderate in 159 (25.0%), and marked in 71 (11.1%). Linearity across the modifier grades and deformity classes was found for ODI total score (P = 0.033), and the function/activity (P = 0.004) and self-image/appearance (P = 0.030) domains of the SRS-30. Age, body mass index, duration of symptoms, and the use of painkillers increased while physical activity, working, and educational status decreased significantly with deformity severity. Sagittal spinopelvic malalignment is significantly related to deterioration of the ODI and the SRS-30 in symptomatic adults with degenerative spinal disorders. The SRS-Schwab classification sagittal modifiers categorized into three groups is a practical tool to detect various clinically significant grades of deformity in a cohort with no recognized ASD. 3.

Classification in Brief: SRS-Schwab Classification of Adult Spinal Deformity.

Classification in Brief: SRS-Schwab Classification of Adult Spinal Deformity.