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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 ?. Must develop a common language: exchange of information

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A comprehensive clinical impact classification of Adult Scoliosis

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  1. 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

  2. Why a classification ? • Must develop a common language: • exchange of information • comparison of data • Correlation with clinical impact • treatment algorithms • surgical guidelines

  3. 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

  4. Adult Scoliosis Classification: • Chicago 2002 • Arizona 2003 • Chicago 2003 • Miami 2004 IMAST Worldspine SRS NASS

  5. Significant Spondylolisthesis Frontal plane subluxation Lumbar lordosis Thoracolumbar alignment Apical level +/- Global alignment Not significant Coronal Cobb AISA vs DDS Age Adult Scoliosis Classification:Clinical impact

  6. 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

  7. 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)

  8. The Classification • Lordosis Modifier (T12-S1) A: marked lordosis >400 B: moderate lordosis 0-400 C: no lordosis present Cobb >00

  9. The Classification • Subluxation modifier • Maximal intervertebral subluxation • Frontal or sagittal plane 0 : no subluxation + : subluxation 1-6mm ++: subluxation >7mm

  10. Adult Scoliosis Classification • Intra-, inter-observer variability study • 20 cases • full-length films • AP and Lateral • 13 one-time readers • 6 repeat readers

  11. Adult Scoliosis ClassificationInter-observer analysis • Disagreements on • thoracic levels (Type II, III) • thoracolumbar vs. lumbar

  12. Adult Scoliosis ClassificationIntra-observer analysis

  13. SDSG data set 1/05 Primary curve apex

  14. 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%

  15. 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%

  16. 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%

  17. 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%

  18. 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%

  19. Adult Scoliosis Classification • Lordosis Modifier (T12-S1) A B C

  20. Adult Scoliosis Classification • Subluxation Modifier (maximal, in mm)

  21. Adult Scoliosis Classification

  22. 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

  23. 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 ?

  24. 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

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