SRS-Schwab 成人脊柱畸形分类：基于前瞻性手术和非手术队列的评估和临床相关性。
The SRS-Schwab adult spinal deformity classification: assessment and clinical correlations based on a prospective operative and nonoperative cohort.
机构信息
*Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, New York, New York; ‡Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia; §Department of Neurosurgery, University of California San Francisco, San Francisco, California; ¶Department of Neurosurgery, Weill Cornell Medical College, New York, New York; ‖Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas; #Department of Orthopedic Surgery, Baylor Scoliosis Center, Plano, Texas; **Department of Orthopedic Surgery, University of California Davis, Sacramento, California; ‡‡Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California; §§Department of Orthopedic Surgery, San Diego Center for Spinal Disorders, La Jolla, California; ¶¶Department of Orthopedic Surgery, Oregon Health Sciences University, Portland, Oregon; ‖‖Department of Orthopedic Surgery, Rocky Mountain Hospital for Children, Denver, Colorado.
出版信息
Neurosurgery. 2013 Oct;73(4):559-68. doi: 10.1227/NEU.0000000000000012.
BACKGROUND
The SRS-Schwab classification of adult spinal deformity (ASD) is a validated system that provides a common language for the complex pathology of ASD. Classification reliability has been reported; however, correlation with treatment has not been assessed.
OBJECTIVE
To assess the clinical relevance of the SRS-Schwab classification based on correlations with health-related quality of life (HRQOL) measures and the decision to pursue operative vs nonoperative treatment.
METHODS
Prospective analysis of consecutive ASD patients (18 years of age and older) collected through a multicenter group. The SRS-Schwab classification includes a curve type descriptor and 3 sagittal spinopelvic modifiers (sagittal vertical axis, pelvic tilt, pelvic incidence/lumbar lordosis mismatch). Differences in demographics, HRQOL (Oswestry Disability Index, SRS-22, Short Form-36), and classification between operative and nonoperative patients were evaluated.
RESULTS
A total of 527 patients (mean age, 52.9 years; range, 18.4-85.1 years) met inclusion criteria. Significant differences in HRQOL were identified based on SRS-Schwab curve type, with thoracolumbar and primary sagittal deformities associated with greater disability and poorer health status than thoracic or double curve deformities. Operative patients had significantly poorer grades for each of the sagittal spinopelvic modifiers, and progressively higher grades were associated with significantly poorer HRQOL (P < .05). Patients with worse sagittal spinopelvic modifier grades were significantly more likely to require major osteotomies, iliac fixation, and decompression (P ≤ .009).
CONCLUSION
The SRS-Schwab classification provides a validated language to describe and categorize ASD. This study demonstrates that the SRS-Schwab classification reflects severity of disease state based on multiple measures of HRQOL and significantly correlates with the important decision of whether to pursue operative or nonoperative treatment.
背景
成人脊柱畸形（ASD）的 SRS-Schwab 分类是一个经过验证的系统，为 ASD 的复杂病理提供了一种通用语言。已经报道了分类的可靠性；然而，尚未评估其与治疗的相关性。
目的
根据与健康相关的生活质量（HRQOL）测量和是否选择手术治疗的决策，评估 SRS-Schwab 分类的临床相关性。
方法
通过多中心组收集连续 ASD 患者（18 岁及以上）的前瞻性分析。SRS-Schwab 分类包括曲线类型描述符和 3 个矢状脊柱骨盆修饰符（矢状垂直轴、骨盆倾斜、骨盆入射角/腰椎前凸不匹配）。比较手术与非手术患者的人口统计学特征、HRQOL（Oswestry 残疾指数、SRS-22、短格式-36）和分类差异。
结果
共有 527 名患者（平均年龄 52.9 岁；范围 18.4-85.1 岁）符合纳入标准。根据 SRS-Schwab 曲线类型，HRQOL 存在显著差异，胸腰椎和原发性矢状畸形与较差的残疾和健康状况相关，而胸段或双曲线畸形则与较差的残疾和健康状况相关。手术患者的每个矢状脊柱骨盆修饰符评分均明显较差，且评分越高，HRQOL 越差（P <.05）。矢状脊柱骨盆修饰符评分较差的患者更有可能需要主要截骨术、髂骨固定和减压（P ≤.009）。
结论
SRS-Schwab 分类提供了一种经过验证的语言，用于描述和分类 ASD。本研究表明，SRS-Schwab 分类基于多个 HRQOL 测量指标反映疾病严重程度，并与是否选择手术治疗的重要决策显著相关。
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