A Lumbar Classification of Scoliosis in the Adult Patient: Preliminary Approach

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Abstract
Retrospective consecutive clinical review of 98 patients. To create a preliminary approach to a clinically important classification of scoliosis in adult patients. There is currently no accepted classification of scoliosis in adults. High prevalence rates of scoliosis in the elderly and recent studies of health impact support the need for a clinically relevant classification. A total of 98 adult patients with scoliosis with a 2-year minimum treatment/follow-up were included. Patients were classified into one of 3 types of deformity based on the degree of lordosis (L1–S1) and frontal plane endplate obliquity of L3 on standing radiographs: type I = lordosis >55°, L3 obliquity <15°; type II = lordosis 35°–55°, L3 obliquity 15°–25°; and type III = lordosis 25°. Curve patterns included thoracic, thoracolumbar, lumbar, thoracic, and lumbar (mean Cobb angle 30°, standard deviation 19°). Cobb angle revealed no correlation to visual analog pain score (VAS) or general health (36-Item Short-Form Health Survey). Significant correlation between endplate obliquity L3, L1–S1 lordosis and VAS was noted (P < 0.05). Mean pain scores of classified patients were: type I, VAS = 27.7; type II, VAS = 43.3; and type III, VAS = 47.1 (type I vs. III, P < 0.05). Surgical rates (failed minimum 3-month conservative care, including bracing, physical therapy, and pharmacological treatment) by group were: type I, 0%; type II, 9%; and type III, 22.7% (P = 0.002). A simple classification of adult scoliosis was developed based on frontal and sagittal plane standing radiographs. With increasing type (from I to III), self-reported pain and disability increased. This result was reflected in the treatment approach as well, with surgical rates increasing from types I to III. Further refinement is important to develop an all inclusive and sufficiently descriptive system.