The SRS-Schwab Adult Spinal Deformity Classification

Terran, Jamie S.; Schwab, Frank J.; Shaffrey, Christopher I.; Smith, Justin S.; Devos, Pierre; Ames, Christopher P.; Fu, Kai; Burton, Douglas C.; Hostin, Richard A.; Klineberg, Eric O.; Gupta, Munish C.; Deviren, Vedat; Mundis, Gregory M.; Hart, Robert A.; Bess, Shay; Lafage, Virginie

doi:10.1227/neu.0000000000000012

Cited by 333 publications

(124 citation statements)

References 26 publications

Supporting

Mentioning

121

Contrasting

Order By: Relevance

“…However, recent studies have shown that sagittal spinopelvic parameters among patients with spinal deformity play a role in clinical outcomes. These studies rated the severity of adult spinal deformity using the Scoliosis Research Society (SRS)-Schwab ASD classification and compared the results to HRQOL, PI-LL mismatch, SVA, and PT values19). The radiological parameters are important, as they can predict the patients' prognosis and satisfaction levels.…”

Section: Discussionmentioning

confidence: 99%

“…Among these parameters, LL can be modified through surgical intervention, but PI is a constant value that is fixed for each individual10). Similarly, the PI-LL mismatch can adversely affect HRQOL, regardless of actual surgical performance15161719). Schwab et al14) reported threshold values for sagittal spinopelvic alignment to achieve during reconstructive surgery for improved HRQOL.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Surgical Outcomes of Post-Fusion Lumbar Flatback Deformity with Sagittal Imbalance

Kim

2016

J Korean Neurosurg Soc

View full text Add to dashboard Cite

ObjectivesTo review surgical results of post-fusion lumbar flatback treated with pedicle subtraction osteotomy (PSO) or Smith-Petersen osteotomies (SPOs).MethodsTwenty-eight patients underwent osteotomies. Radiological outcomes by sagittal vertical axis (SVA), and pelvic tilt (PT), T1 pelvic angle (T1PA), and pelvic incidence (PI)-lumbar lordosis (LL) at preoperative, postoperative 1 month, and final were evaluated. Oswestry Disability Index (ODI), visual analog scale (VAS) score of back pain/leg pain, and Scoliosis Research Society-22 score (SRS-22r) were analyzed and compared. Patients were divided into 2 groups (SVA ≤5 cm : normal, SVA >5 cm : positive) at final and compared outcomes.ResultsNineteen patients (68%) had PSO and the other 9 patients had SPOs with anterior lumbar interbody fusions (ALIFs) (Mean age : 65 years, follow-up : 31 months). The PT, PI-LL, SVA, T1PA were significantly improved at 1 month and at final (p<0.01). VAS score, ODI, and SRS-22r were also significantly improved at the final (p<0.01). 23 patients were restored with normal SVA and the rest 5 patients demonstrated to positive SVA. SVA and T1PA at 1 month and SVA, PI-LL, and T1PA at final were significantly different (p<0.05) while the ODI, VAS, and SRS-22r did not differ significantly between the groups (p>0.05). Common reoperations were early 4 proximal junctional failures (14%) and late four rod fractures.ConclusionOur results demonstrate that PSO and SPOs with ALIFs at the lower lumbar are significantly improves sagittal balance. For maintenance of normal SVA, PI-LL might be made negative value and T1PA might be less than 11° even though positive SVA group was also significantly improved clinical outcomes.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Surgical Outcomes of Post-Fusion Lumbar Flatback Deformity with Sagittal Imbalance

Kim

2016

J Korean Neurosurg Soc

View full text Add to dashboard Cite

show abstract

“…PI-LL mismatch was calculated from these measurements. Once all data were collected, patients were grouped into radiographic modifier groups using the SRS-Schwab Adult Spinal Deformity Classification 9,10 for sagittal plane deformities (SVA, PT and PI-LL mismatch modifiers) and consensus amongst the authors for coronal plane deformities (lumbar Cobb and CVA modifiers).…”

Section: Methodsmentioning

confidence: 99%

“…3 Since then there has been a considerable amount of work published investigating the impact of sagittal spinopelvic parameters on PROs in ASD. 6–10 Schwab et al reported the most clinically important radiographic parameters with the strongest correlations to functional outcome measures to be SVA, pelvic tilt (PT) and pelvic incidence-lumbar lordosis (PI-LL) mismatch. 8 …”

Section: Introductionmentioning

confidence: 99%

Baseline Patient-Reported Outcomes Correlate Weakly With Radiographic Parameters

Chapman

Baldus

Lurie

et al. 2016

Spine

Self Cite

View full text Add to dashboard Cite

Study Design Prospective, cross sectional study. Objective Determine which radiographic parameters drive patient-reported outcomes (PROs) in primary presentation adult symptomatic lumbar scoliosis (ASLS). Summary of Background Data Previous literature suggests correlations between PROs and sagittal plane deformity (sagittal vertical axis [SVA], pelvic incidence-lumbar lordosis [PI-LL] mismatch, pelvic tilt [PT]). Prior work included revision and primary adult spinal deformity patients. This study addresses only primary presentation ASLS. Methods Prospective baseline data were analyzed on 286 patients enrolled in an NIH RO1 clinical trial by nine centers from 2010–2014. Inclusion criteria: 40–80 years old, lumbar Cobb (LC) ≥30° and Scoliosis Research Society-23 (SRS-23) score ≤4.0 in Pain, Function or Self-Image domains or Oswestry Disability Index (ODI) ≥20. Patients were primary presentation (no prior spinal deformity surgery) and had complete baseline data: standing coronal/sagittal 36” radiographs and PROs (ODI, SRS-23, Short Form-12). Correlation coefficients were calculated to evaluate relationships between radiographic parameters and PROs for the study population and a subset of patients with ODI ≥40. ANOVA was used to identify differences in PROs for radiographic modifier groups. Results Mean age was 60.3 years. Mean spinopelvic parameters were: LL=−39.2°; SVA=3.1cm; sacral slope (SS)=32.5°; PT=23.9°; PI-LL mismatch=16.8°. Only weak correlations (0.2–0.4) were identified between population SS, SVA and SVA modifiers and SRS Function. SVA and SVA modifiers were weakly associated with ODI. While there were more correlations in subset analysis of high-symptom patients, all were weak. ANOVA identified significant differences in ODI reported by SVA modifier groups. Conclusions In primary presentation ASLS patients and a subset of ‘high-symptom’ patients (ODI ≥40), only weak associations between baseline PROs and radiographic parameters were identified. For this patient population, these results suggest regional radiographic parameters (LC, LL, PT, PI-LL mismatch) are not drivers of PROs and cannot be used to extrapolate impact on patient-perceived pathology. Level of Evidence 2

show abstract

“…Previous studies called this syndrome of loss of lumbar lordosis or flat back “fixed sagittal imbalance (FSI)”1,4,5,26), degenerative sagittal imbalance4), LDK23), or “primary sagittal deformity”25). FSI as defined by Bridwell and colleagues was a syndrome in which the patient is unable to stand up erect without flexing the knees and hips, characterized by degenerative changes, and may refer to only a severe form of PDSI5,6).…”

Section: Introductionmentioning

confidence: 99%

‘Lumbar Degenerative Kyphosis’ Is Not Byword for Degenerative Sagittal Imbalance : Time to Replace a Misconception

Lee

Chung

Jang

et al. 2017

J Korean Neurosurg Soc

View full text Add to dashboard Cite

Lumbar degenerative kyphosis (LDK) is a subgroup of the flat-back syndrome and is most commonly caused by unique life styles, such as a prolonged crouched posture during agricultural work and performing activities of daily living on the floor. Unfortunately, LDK has been used as a byword for degenerative sagittal imbalance, and this sometimes causes confusion. The aim of this review was to evaluate the exact territory of LDK, and to introduce another appropriate term for degenerative sagittal deformity. Unlike what its name suggests, LDK does not only include sagittal balance disorder of the lumbar spine and kyphosis, but also sagittal balance disorder of the whole spine and little lordosis of the lumbar spine. Moreover, this disease is closely related to the occupation of female farmers and an outdated Asian life style. These reasons necessitate a change in the nomenclature of this disorder to prevent misunderstanding. We suggest the name “primary degenerative sagittal imbalance” (PDSI), which encompasses degenerative sagittal misalignments of unknown origin in the whole spine in older-age patients, and is associated with back muscle wasting. LDK may be regarded as a subgroup of PDSI related to an occupation in agriculture. Conservative treatments such as exercise and physiotherapy are recommended as first-line treatments for patients with PDSI, and surgical treatment is considered only if conservative treatments failed. The measurement of spinopelvic parameters for sagittal balance is important prior to deformity corrective surgery. LDK can be considered a subtype of PDSI that is more likely to occur in female farmers, and hence the use of LDK as a global term for all degenerative sagittal imbalance disorders is better avoided. To avoid confusion, we recommend PDSI as a newer, more accurate diagnostic term instead of LDK.

show abstract

The SRS-Schwab Adult Spinal Deformity Classification

Cited by 333 publications

References 26 publications

Surgical Outcomes of Post-Fusion Lumbar Flatback Deformity with Sagittal Imbalance

Surgical Outcomes of Post-Fusion Lumbar Flatback Deformity with Sagittal Imbalance

Baseline Patient-Reported Outcomes Correlate Weakly With Radiographic Parameters

‘Lumbar Degenerative Kyphosis’ Is Not Byword for Degenerative Sagittal Imbalance : Time to Replace a Misconception

Contact Info

Product

Resources

About