Change in classification grade by the SRS-Schwab Adult Spinal Deformity Classification predicts impact on health-related quality of life measures: prospective analysis of operative and nonoperative treatment.
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Study designMulticenter, prospective, consecutive series.
ObjectiveTo evaluate responsiveness of the Scoliosis Research Society (SRS)-Schwab adult spinal deformity (ASD) classification to changes in health-related quality of life (HRQOL) after treatment for ASD.
Summary of background dataIdeally, a classification system should describe and be responsive to changes in a disease state. We hypothesized that the SRS-Schwab classification is responsive to changes in HRQOL measures after treatment for ASD.
MethodsA multicenter, prospective, consecutive series from the International Spine Study Group.
Inclusion criteriaASD, age more than 18, operative or nonoperative treatment, baseline and 1-year radiographs, and HRQOL measures (Oswestry Disability Index [ODI], SRS-22, Short Form [SF]-36). The SRS-Schwab classification includes a curve descriptor and 3 sagittal spinopelvic modifiers (sagittal vertical axis [SVA], pelvic tilt, pelvic incidence/lumbar lordosis [PI-LL] mismatch). Changes in modifiers at 1 year were assessed for impact on HRQOL from pretreatment values based on minimal clinically important differences.
ResultsThree hundred forty-one patients met criteria (mean age = 54; 85% females; 177 operative and 164 nonoperative). Change in pelvic tilt modifier at 1-year follow-up was associated with changes in ODI and SRS-22 (total and appearance scores) (P ≤ 0.034). Change in SVA modifier at 1 year was associated with changes in ODI, SF-36 physical component score, and SRS-22 (total, activity, and appearance scores) (P ≤ 0.037). Change in PI-LL modifier at 1 year was associated with changes in SF-36 physical component score and SRS-22 (total, activity, and appearance scores) (P ≤ 0.03). Patients with improvement of pelvic tilt, SVA, or PI-LL modifiers were significantly more likely to achieve minimal clinically important difference for ODI, SF-36 physical component score (SVA and PI-LL only), SRS activity, and SRS pain (PI-LL only).
ConclusionThe SRS-Schwab classification provides a validated system to evaluate ASD, and the classification components correlate with HRQOL measures. This study demonstrates that the classification modifiers are responsive to changes in disease state and reflect significant changes in patient-reported outcomes.
Level of evidence3.
Published Version (Please cite this version)
Smith, Justin S, Eric Klineberg, Frank Schwab, Christopher I Shaffrey, Bertrand Moal, Christopher P Ames, Richard Hostin, Kai-Ming G Fu, et al. (2013). Change in classification grade by the SRS-Schwab Adult Spinal Deformity Classification predicts impact on health-related quality of life measures: prospective analysis of operative and nonoperative treatment. Spine, 38(19). pp. 1663–1671. 10.1097/brs.0b013e31829ec563 Retrieved from https://hdl.handle.net/10161/28825.
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I have more than 25 years of experience treating patients of all ages with spinal disorders. I have had an interest in the management of spinal disorders since starting my medical education. I performed residencies in both orthopaedic surgery and neurosurgery to gain a comprehensive understanding of the entire range of spinal disorders. My goal has been to find innovative ways to manage the range of spinal conditions, straightforward to complex. I have a focus on managing patients with complex spinal disorders. My patient evaluation and management philosophy is to provide engaged, compassionate care that focuses on providing the simplest and least aggressive treatment option for a particular condition. In many cases, non-operative treatment options exist to improve a patient’s symptoms. I have been actively engaged in clinical research to find the best ways to manage spinal disorders in order to achieve better results with fewer complications.
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