• Kenny Yat Hong Kwan, J Naresh-Babu, Wilco Jacobs, Marinus de Kleuver, David W Polly, Caglar Yilgor, Yabin Wu, Jong-Beom Park, Manabu Ito, and Miranda L van Hooff.
• Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong.
• Neurosurgery. 2021 May 13; 88 (6): 1065-1073.

BackgroundExisting adult spinal deformity (ASD) classification systems are based on radiological parameters but management of ASD patients requires a holistic approach. A comprehensive clinically oriented patient profile and classification of ASD that can guide decision-making and correlate with patient outcomes is lacking.ObjectiveTo perform a systematic review to determine the purpose, characteristic, and methodological quality of classification systems currently used in ASD.MethodsA systematic literature search was conducted in MEDLINE, EMBASE, CINAHL, and Web of Science for literature published between January 2000 and October 2018. From the included studies, list of classification systems, their methodological measurement properties, and correlation with treatment outcomes were analyzed.ResultsOut of 4470 screened references, 163 were included, and 54 different classification systems for ASD were identified. The most commonly used was the Scoliosis Research Society-Schwab classification system. A total of 35 classifications were based on radiological parameters, and no correlation was found between any classification system levels with patient-related outcomes. Limited evidence of limited quality was available on methodological quality of the classification systems. For studies that reported the data, intraobserver and interobserver reliability were good (kappa = 0.8).ConclusionThis systematic literature search revealed that current classification systems in clinical use neither include a comprehensive set of dimensions relevant to decision-making nor did they correlate with outcomes. A classification system comprising a core set of patient-related, radiological, and etiological characteristics relevant to the management of ASD is needed.© Congress of Neurological Surgeons 2021.

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