Surgical Treatment Analysis of 809 Thoracolumbar and Lumbar Major Adult Deformity Cases by a New Adult Scoliosis Classification System
Introduction: A recently proposed radiographic classification of adult scoliosis offers a reliable method of categorizing patients. Continued work on this classification is expected to develop treatment guidelines. This investigation analyzed treatment patterns of a large patient population of thoracolumbar and lumbar adult scoliosis, emphasizing surgical rates and approaches by classification subtypes.
Methods: This investigation analyzed 809 Type IV (thoracolumbar major) and Type V (lumbar major) curves from the Spinal Deformity Study Group database. Enrolled patients had complete SRS, ODI and SF-12 outcomes questionnaires and free standing full-length spine radiographs. Analysis compared non-operative versus surgical treatment (no imposed protocol) with surgical treatment assessed by approach (anterior, posterior, both), +/- osteotomies.
Results: Of 809 patients, 348 were treated surgically (43%) and classified as lordosis type A (n=422), B (n=313), C (n=74). Surgical rates were greater for B vs. A (51% vs. 37%, p 0.05)), trend for A vs. C (46%). Subluxation modifier scores: 0 (n=360), + (n=159), ++ (n=290). Surgical rates were greater for ++ vs. 0 (52% vs. 36 %, p<0 .05), trend vs. + (42 %). Greater sagittal imbalance was more likely to receive surgical treatment. Loss of lumbar lordosis (modifier B, C) associated with increased osteotomy rates and posterior or circumferential treatment versus anterior only procedures (most common in modifier A). subluxation ++) surgery. higher rate
Discussion: In this analysis, greater lordosis or subluxation modifier score was associated with higher surgical rates. Loss of lordosis and greater subluxation grade was associated with higher rates of circumferential surgery than lordotic spines or those without significant subluxation. This information suggests the ability of this classification system to predict treatment. Longitudinal follow up will permit validation of optimal treatment by classification of adult spinal deformity.