Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, NY.
Department of Orthopedics, Hospital for Special Surgery, New York, NY.
Spine (Phila Pa 1976). 2022 Mar 15;47(6):455-462. doi: 10.1097/BRS.0000000000004300.
Retrospective cohort study of a prospectively collected database.
To compare clinical utility of two common classification systems for adult spinal deformity (ASD) and determine whether both should be considered in surgical planning to improve patient outcomes.
Surgical restoration of appropriate Roussouly classification shape or SRS-Schwab ASD classification may improve outcomes.
ASD patients with pre- and 2-year postop (2Y) radiographic/health-related quality of life (HRQL) data were grouped by "theoretical" and "current" Roussouly type. Univariate analyses assessed outcomes of patients who mismatched Roussouly types at both pre- and 2Y intervals (Mismatched) and those of preoperative mismatched patients who matched at 2-years (Matched). Subanalysis assessed outcomes of patients who improved in Schwab modifiers, and patients who both improved in both Schwab modifiers and matched Roussouly type by 2Y.
Included: 515 ASD patients (59 ± 14 yrs, 80% F). Preoperative breakdown of "current" Roussouly types: Type 1 (10%), 2 (54%), 3 (24%), and 4 (12%). Matched and Mismatched groups did not differ in rates of reaching MCID for any HRQL metrics by 2Y (all P > 0.10). Reoperation, PJK, and complications did not differ between Matched and Mismatched (all P > 0.10), but Roussouly Matched patients had toward lower rates of instrumentation failure (17.2% vs. 24.8%, P = 0.038). By 2Y, 28% of patients improved in PT Schwab modifier, 37% in SVA, and 46% in PI-LL. Patients who both Matched Roussouly at 2Y and improved in all Schwab modifiers met MCID for Oswestry Disability Index (ODI) and Scoliosis Research Society (SRS) activity at higher rates than patients who did not.
Isolated restoration per the Roussouly system was not associated with superior outcomes. Patients who both matched Roussouly type and improved in Schwab modifiers had superior patient-reported outcomes at 2-years. Concurrent consideration of both systems may offer utility in establishing optimal realignment goals.Level of Evidence: 3.
前瞻性收集数据库的回顾性队列研究。
比较两种常见的成人脊柱畸形（ASD）分类系统的临床实用性，并确定在手术计划中是否都应考虑这两种系统，以改善患者的治疗效果。
手术恢复适当的 Roussouly 分类形状或 SRS-Schwab ASD 分类可能会改善结果。
将术前和术后 2 年（2Y）影像学/健康相关生活质量（HRQL）数据的 ASD 患者按“理论”和“当前”Roussouly 类型分组。单变量分析评估了在术前和 2Y 间隔都不符合 Roussouly 类型的患者（不匹配）和在 2Y 时符合术前不匹配患者的治疗效果（匹配）。亚分析评估了 Schwab 修正项改善的患者和 Schwab 修正项和 Roussouly 类型在 2Y 时都改善的患者的治疗效果。
纳入 515 例 ASD 患者（59±14 岁，80%为女性）。术前“当前”Roussouly 类型的分布：1 型（10%）、2 型（54%）、3 型（24%）和 4 型（12%）。匹配组和不匹配组在任何 HRQL 指标达到 MCID 的 2Y 时，其比例没有差异（均 P＞0.10）。再手术、PJK 和并发症在匹配组和不匹配组之间没有差异（均 P＞0.10），但 Roussouly 匹配的患者发生器械失败的比率较低（17.2%比 24.8%，P=0.038）。在 2Y 时，28%的患者 PT Schwab 修正项改善，37%的患者 SVA 改善，46%的患者 PI-LL 改善。在 2Y 时同时符合 Roussouly 类型且 Schwab 修正项都改善的患者比不符合这两个条件的患者达到 Oswestry 残疾指数（ODI）和脊柱侧凸研究协会（SRS）活动的 MCID 更高。
单独按照 Roussouly 系统进行修复与更好的结果无关。在 2Y 时同时符合 Roussouly 类型且 Schwab 修正项都改善的患者，其患者报告的结果在 2Y 时更好。同时考虑这两种系统可能有助于确定最佳的矫正目标。
3 级。
