title: Surgical rates and operative outcome analysis in thoracolumbar and lumbar major adult scoliosis: application of the new adult deformity classification.
abstract: METHODS
  Multicenter prospective consecutive clinical series.
  
  
  OBJECTIVE
  Investigate the interaction between the Adult Deformity Classification and treatment patterns, surgical strategies, surgery effectiveness, and complication rates.
  
  
  BACKGROUND
  An Adult Deformity Classification has been established that applies radiographic parameters of disability. Preliminary intraobserver and interobserver analysis reveals excellent reliability of the classification. Outcomes studies have not been reported to date.
  
  
  METHODS
  A total of 784 adult patients with thoracolumbar or lumbar deformity underwent radiographic evaluation (full-length frontal/sagittal) as well as health assessment: Oswestry Disability Index, Scoliosis Research Society-22, and SF-12. Patients were subdivided by treatment and surgical strategies; 1 year (111 patients) and 2 year (45 patients) follow-up data were analyzed. Interaction between classification, treatment, surgical strategy, health assessment changes, and complications were analyzed.
  
  
  RESULTS
  Classification modifiers (lordosis, subluxation, sagittal balance) were found to have significant variation (higher rates) in surgical care as the grade of the modifier increased. Classification differentiated patients by surgical approach and/or technique. Interaction between classification and baseline health assessment impacts both postoperative health scores and complication rates.
  
  
  CONCLUSIONS
  This investigation appears to offer the first comprehensive analysis of classification, treatment, and outcomes in a large adult deformity patient group. Significant treatment patterns and outcomes are coming to light as is the impact of surgical strategy.
authors.affiliation: New York University Hospital for Joint Diseases, New York, NY, USA. fschwab@att.net
authors.forename: Frank
authors.initials: F
authors.lastname: Schwab
authors.forename: Virginie
authors.initials: V
authors.lastname: Lafage
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Farcy
authors.forename: Keith
authors.initials: K
authors.lastname: Bridwell
authors.forename: Steven
authors.initials: S
authors.lastname: Glassman
authors.forename: Stephen
authors.initials: S
authors.lastname: Ondra
authors.forename: Tom
authors.initials: T
authors.lastname: Lowe
authors.forename: Michael
authors.initials: M
authors.lastname: Shainline
mesh_terms: D000328:Adult; D000368:Aged; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008141:Lordosis / Q000145:classification / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010027:Osteotomy / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D011859:Radiography; D012447:Sacrum / Q000000981:diagnostic imaging / Q000601:surgery; D012600:Scoliosis / Q000145:classification* / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D012720:Severity of Illness Index; D013123:Spinal Fusion / Q000706:statistics & numerical data*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D016896:Treatment Outcome