• Javier Pizones, Montserrat Baldan Martin, Perez-Grueso Francisco Javier Sánchez FJS Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Madrid, Spain., Caglar Yilgor, Alba Vila-Casademunt, Miquel Serra-Burriel, Ibrahim Obeid, Ahmet Alanay, Emre R Acaroglu, Ferran Pellisé, and ESSG European Spine Study Group.
• Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Madrid, Spain.
• Spine. 2019 Feb 15; 44 (4): 270-279.

Study DesignA retrospective analysis of data collected prospectively in an adult spine deformity multicenter database.ObjectiveThe aim of this study was to determine the impact of adult scoliosis (AS) on the type of Roussouly sagittal shape in terms of classification applicability, scoliosis modification of a patient theoretical sagittal shape, and coronal-sagittal deformity associations.Summary Of Background DataRoussouly described a four-type sagittal shape classification in healthy individuals, which has been also applied to patients with degenerative spinal disease. However, it remains uncertain if its principles can be applied to AS patients.MethodsAS patients recorded in a prospective multicenter database of adult spinal deformity were included. Preoperative sagittal radiographs were analyzed using the KEOPS software to measure pelvic parameters, global sagittal alignment, and the various criteria used for the Roussouly classification. The different sagittal shape types were compared using the Chi-square and McNemars tests, and analysis of variance with Bonferroni correction.ResultsThe classification was applicable to all of the 190 analyzed AS patients. In addition to Roussouly criteria, two parameters helped differentiate the different shapes: T10-L2 angle (24° ± 19 type-1; 14° ± 15 type-2; 3° ± 15 type-3; 0.4° ± 14 type-4; P < 0.001), and lordosis distribution index (90% ± 17 type-1; 83% ± 16 type-2; 73% ± 21 type-3; 63% ± 16 type-4; P < 0.001). AS changed the theoretical shape in 34% of the patients (P < 0.001). Curve etiology and curve pattern were not associated with any particular type of sagittal shape (P > 0.05). Type-1 was associated with older patients (P = 0.02), degenerative curves (P = 0.02), and greater PI-LL mismatch (P = 0.012). Types 3 to 4 were associated with younger age and idiopathic etiology (P < 0.001).ConclusionRoussouly four-type sagittal shape classification could be applied to AS patients. AS modified the theoretical type in one of every three patients. No particular association was found between the sagittal types and specific coronal deformities. Sagittal shape recognition in patients with AS will help restore the appropriate theoretical shape through surgery, which can eventually lead to better surgical outcomesLevel of Evidence: 2.

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