• Frank Schwab, Virginie Lafage, Jean-Pierre Farcy, Keith Bridwell, Steven Glassman, Stephen Ondra, Tom Lowe, and Michael Shainline.
• New York University Hospital for Joint Diseases, New York, NY, USA. fschwab@att.net
• Spine. 2007 Nov 15;32(24):2723-30.

Study DesignMulticenter prospective consecutive clinical series.ObjectiveInvestigate the interaction between the Adult Deformity Classification and treatment patterns, surgical strategies, surgery effectiveness, and complication rates.Summary Of Background DataAn Adult Deformity Classification has been established that applies radiographic parameters of disability. Preliminary intraobserver and interobserver analysis reveals excellent reliability of the classification. Outcomes studies have not been reported to date.MethodsA total of 784 adult patients with thoracolumbar or lumbar deformity underwent radiographic evaluation (full-length frontal/sagittal) as well as health assessment: Oswestry Disability Index, Scoliosis Research Society-22, and SF-12. Patients were subdivided by treatment and surgical strategies; 1 year (111 patients) and 2 year (45 patients) follow-up data were analyzed. Interaction between classification, treatment, surgical strategy, health assessment changes, and complications were analyzed.ResultsClassification modifiers (lordosis, subluxation, sagittal balance) were found to have significant variation (higher rates) in surgical care as the grade of the modifier increased. Classification differentiated patients by surgical approach and/or technique. Interaction between classification and baseline health assessment impacts both postoperative health scores and complication rates.ConclusionThis investigation appears to offer the first comprehensive analysis of classification, treatment, and outcomes in a large adult deformity patient group. Significant treatment patterns and outcomes are coming to light as is the impact of surgical strategy.

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