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

Justin S. Smith, Eric Klineberg, Frank Schwab, Christopher I. Shaffrey, Bertrand Moal, Christopher P. Ames, Richard Hostin, Kai Ming G Fu, Douglas Burton, Behrooz Akbarnia, Munish Gupta, Robert Hart, Shay Bess, Virginie Lafage

Research output: Contribution to journalArticle

133 Scopus citations


Study Design. Multicenter, prospective, consecutive series. Objective. To 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 Data. Ideally, 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. Methods. A multicenter, prospective, consecutive series from the International Spine Study Group. Inclusion criteria: ASD, 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 modifi ers (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. Results. Three 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). Conclusion. The 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.

Original languageEnglish (US)
Pages (from-to)1663-1671
Number of pages9
Issue number19
Publication statusPublished - Sep 1 2013



  • Adult spinal deformity
  • Classification
  • Outcomes
  • Pelvis
  • Sagittal alignment
  • Surgery
  • Treatment

ASJC Scopus subject areas

  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this