外科
队列
前瞻性队列研究
回顾性队列研究
队列研究
脊柱畸形
作者
Jamie S. Terran,Frank J. Schwab,Christopher I. Shaffrey,Justin S. Smith,Pierre Devos,Christopher P. Ames,Kai-Ming G. Fu,Douglas Burton,Richard A. Hostin,Eric O. Klineberg,Munish C. Gupta,Vedat Deviren,Gregory M. Mundis,Robert A. Hart,Shay Bess,Virginie Lafage
出处
期刊:Neurosurgery
[Oxford University Press]
日期:2013-10-01
卷期号:73 (4): 559-568
被引量:243
标识
DOI:10.1227/neu.0000000000000012
摘要
BACKGROUND The SRS-Schwab classification of adult spinal deformity (ASD) is a validated system that provides a common language for the complex pathology of ASD. Classification reliability has been reported; however, correlation with treatment has not been assessed. OBJECTIVE To assess the clinical relevance of the SRS-Schwab classification based on correlations with health-related quality of life (HRQOL) measures and the decision to pursue operative vs nonoperative treatment. METHODS Prospective analysis of consecutive ASD patients (18 years of age and older) collected through a multicenter group. The SRS-Schwab classification includes a curve type descriptor and 3 sagittal spinopelvic modifiers (sagittal vertical axis, pelvic tilt, pelvic incidence/lumbar lordosis mismatch). Differences in demographics, HRQOL (Oswestry Disability Index, SRS-22, Short Form-36), and classification between operative and nonoperative patients were evaluated. RESULTS A total of 527 patients (mean age, 52.9 years; range, 18.4-85.1 years) met inclusion criteria. Significant differences in HRQOL were identified based on SRS-Schwab curve type, with thoracolumbar and primary sagittal deformities associated with greater disability and poorer health status than thoracic or double curve deformities. Operative patients had significantly poorer grades for each of the sagittal spinopelvic modifiers, and progressively higher grades were associated with significantly poorer HRQOL (P < .05). Patients with worse sagittal spinopelvic modifier grades were significantly more likely to require major osteotomies, iliac fixation, and decompression (P ≤ .009). CONCLUSION The SRS-Schwab classification provides a validated language to describe and categorize ASD. This study demonstrates that the SRS-Schwab classification reflects severity of disease state based on multiple measures of HRQOL and significantly correlates with the important decision of whether to pursue operative or nonoperative treatment.
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