title: A clinical impact classification of scoliosis in the adult.
abstract: METHODS
  Multicenter, prospective, consecutive clinical series.
  
  
  OBJECTIVE
  To establish and validate classification of scoliosis in the adult.
  
  
  BACKGROUND
  Studies of adult scoliosis reveal the impact of radiographic parameters on self-assessed function: lumbar lordosis and frontal plane obliquity of lumbar vertebrae, not Cobb angle, correlate with pain scores. Deformity apex and intervertebral subluxations correlate with disability.
  
  
  METHODS
  A total of 947 adults with spinal deformity had radiographic analysis: frontal Cobb angle, deformity apex, lumbar lordosis, and intervertebral subluxation. Health assessment included Oswestry Disability Index and Scoliosis Research Society instrument. Deformity apex, lordosis (T12-S1), and intervertebral subluxation were used to classify patients. Outcomes measures and surgical rates were evaluated.
  
  
  RESULTS
  Mean maximal coronal Cobb was 46 degrees and lumbar lordosis 46 degrees . Mean maximal intervertebral subluxation (frontal plane) was 4.2 mm (sagittal plane, 1.2 mm). In thoracolumbar/lumbar deformities, the loss of lordosis/higher subluxation was associated with lower Scoliosis Research Society pain/function and higher Oswestry Disability Index scores. Across the study group, lower apex combined with lower lordosis led to higher disability. Higher surgical rates with decreasing lumbar lordosis and higher intervertebral subluxation were detected.
  
  
  CONCLUSIONS
  A clinical impact classification has been established based on radiographic markers of disability. The classification has shown correlation with self-reported disability as well as rates of operative treatment.
authors.affiliation: Spine Center for Orthopaedic and Neurosurgical Care, New York, NY, USA. fschwab@att.net
authors.forename: Frank
authors.initials: F
authors.lastname: Schwab
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Farcy
authors.forename: Keith
authors.initials: K
authors.lastname: Bridwell
authors.forename: Sigurd
authors.initials: S
authors.lastname: Berven
authors.forename: Steven
authors.initials: S
authors.lastname: Glassman
authors.forename: John
authors.initials: J
authors.lastname: Harrast
authors.forename: William
authors.initials: W
authors.lastname: Horton
mesh_terms: D000328:Adult; D004185:Disability Evaluation; D005260:Female; D006304:Health Status; D006801:Humans; D004204:Joint Dislocations; D008141:Lordosis / Q000145:classification / Q000000981:diagnostic imaging / Q000503:physiopathology; D017116:Low Back Pain / Q000145:classification / Q000000981:diagnostic imaging / Q000503:physiopathology; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D015203:Reproducibility of Results; D012600:Scoliosis / Q000145:classification* / Q000000981:diagnostic imaging* / Q000503:physiopathology; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging* / Q000503:physiopathology