• Yong Liu, Zhen Liu, Feng Zhu, Bang-ping Qian, Zezhang Zhu, Leilei Xu, Yitao Ding, and Yong Qiu.
• School of Medicine, Southeast University, Nanjing, Jiangsu Province, China.
• Spine. 2013 May 15;38(11):902-8.

Study DesignAn inter- and intra-observer reliability study.ObjectiveTo determine the inter- and intra-observer reliabilities of the new SRS-Schwab system for classifying adult spinal deformity (ASD) using nonpremarked cases.Summary Of Background DataSchwab et al reported excellent inter- and intra-observer reliability and interobserver agreement for classification based on curve type and 3 modifiers.MethodsA total of 102 patients with ASD were included in this study, which was conducted from February 2009 to January 2012. Long-cassette standing posterior-anterior and lateral radiographs of the spine and the pelvis were obtained from patients with ASD in the fist-on-clavicle position. All 102 cases were classified according to the new SRS-Schwab classification by 4 observers. After a 2-week interval, the same classification was independently repeated by each observer with the cases in a different randomly assigned order. The Fless κ coefficient was calculated to test the inter- and intra-observer reliabilities of the new SRS-Schwab classification.ResultsWith the new SRS-Schwab classification system, 12 patients were classified as having a type T curve, 30 cases as having a type L, 45 cases as having a type D, and 15 cases as having a type S. For overall classification, the mean κ value was 0.73 for interobserver reliability and 0.83 for intraobserver reliability. Disagreements occurred most often when differentiating type T curves from type L curves and when determining the pelvic incidence minus lumbar lordosis modifier.ConclusionWith the nonpremarked cases, this new SRS-Schwab system for patients with ASD could achieve good to excellent intra- and inter-observer reliability, but the definition of thoracic or lumbar curves was still predisposed to confusion. Overall, the SRS-Schwab system is a simple and clear classification system with incorporated spinopelvic parameters, which significantly increase its value for practical usage.

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