This retrospective review of 298 adults from a prospective multicenter deformity registry asked which radiographic parameters actually predict patient symptoms. It correlated seven radiographic measures — including curve magnitude, location, coronal balance, and sagittal balance — against three validated outcome instruments (SF-12, SRS-29, ODI). Patients were analyzed separately based on whether they had prior spinal fusion.
For decades, adult scoliosis surgery focused on Cobb angle correction — the assumption being that a larger, more crooked spine causes more symptoms. This paper dismantled that assumption: Cobb angle does not predict symptoms, but sagittal balance does, consistently, across every outcome measure and in both surgical and nonsurgical patients.
When you see an adult scoliosis patient in clinic, the lateral 36-inch film matters more than the AP. If the C7 plumb line falls anterior to the sacrum, expect significant pain and disability. And plan your surgery around restoring sagittal alignment, not maximizing coronal Cobb correction. A coronal shift over 4 cm is worth addressing in an unoperated patient, but do not let incomplete coronal correction deter you from achieving sagittal goals.
This paper is foundational to the SRS-Schwab adult deformity classification and the modern emphasis on sagittal vertical axis (SVA) as the primary surgical target in adult spinal deformity correction.
This retrospective review of 298 adults from a prospective multicenter deformity registry asked which radiographic parameters actually predict patient symptoms. It correlated seven radiographic measures — including curve magnitude, location, coronal balance, and sagittal balance — against three validated outcome instruments (SF-12, SRS-29, ODI). Patients were analyzed separately based on whether they had prior spinal fusion.
For decades, adult scoliosis surgery focused on Cobb angle correction — the assumption being that a larger, more crooked spine causes more symptoms. This paper dismantled that assumption: Cobb angle does not predict symptoms, but sagittal balance does, consistently, across every outcome measure and in both surgical and nonsurgical patients.
When you see an adult scoliosis patient in clinic, the lateral 36-inch film matters more than the AP. If the C7 plumb line falls anterior to the sacrum, expect significant pain and disability. And plan your surgery around restoring sagittal alignment, not maximizing coronal Cobb correction. A coronal shift over 4 cm is worth addressing in an unoperated patient, but do not let incomplete coronal correction deter you from achieving sagittal goals.
This paper is foundational to the SRS-Schwab adult deformity classification and the modern emphasis on sagittal vertical axis (SVA) as the primary surgical target in adult spinal deformity correction.