Neurosurgery notes/Spine/Deformity/Classification-Spinal deformity/SRS-Schwab classification

SRS-Schwab classification

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Classification-Spinal deformity
  • General
    • For all types of adult spinal deformity
  • Xray
    • Supine
    • Standing
    • Bending
  • Aim to
    • Describe adult scoliosis
    • Predict health-related quality-of-life (HRQoL) scores after surgery
  • SRS-Schwab Alignment goals
    • PI-LL < 10°
    • PT < 20°
    • SVA < 4 cm
  • Difference AdIS vs SRS-Schwab classification:
    • SRS-Schwab takes into account the Spinopelvic parameters which has a high correlation with pain, disability, and patient-reported outcome measures
    • AdIS has better inter-observer reliability
    • AdIS is only for adult idiopathic scoliosis where as SRS-Schwab is for all types of adult spinal deformity
Doesn’t have a specific scoring but if you have ++ in any sagittal modifiers have poorer functional scores
Doesn’t have a specific scoring but if you have ++ in any sagittal modifiers have poorer functional scores
Coronal curvature only N and L curves are associated with poorer outcomes
Coronal curvature only N and L curves are associated with poorer outcomes
  • Strengths:
    • Highlighted the importance of proper alignment and the relationship between alignment and pelvic incidence
    • Reaching these alignment goals is associated with
      • Better HRQL
      • Fewer mechanical complications
  • Weaknesses/Limitations:
    • It does not account for age or spinal shape
    • Uses fixed levels to determine lumbar lordosis (LL)
    • Hard to be externally validated:
      • Since it was developed based on patient-reported outcome scores (where alignment is only one factor)
    • Even among theoretically well-aligned patients according to this classification, the rates of mechanical complications remain high
    • It ignores qualitative parameters that reflect proper realignment, such as lordosis shape and distribution