ArticleMusculoskeletal surgery2026
The «SPA-CE» classification for glenoid bone loss in reverse shoulder arthroplasty: a CT-based analysis of 211 shoulders.
Article in Musculoskeletal surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundGlenoid bone loss represents a major challenge in primary reverse shoulder arthroplasty (RSA), directly influencing implant fixation, positioning, and reconstructive strategy. Existing classification systems describe glenoid morphology but do not provide a unified framework for treatment-oriented decision-making. The SPA-CE classification was developed as a CT-based system integrating defect depth, location, and version abnormality.
methodsA retrospective analysis of 211 consecutive primary RSA procedures was performed. Preoperative CT scans were used to classify glenoid morphology according to the SPA-CE system and the Walch classification. Reconstructive strategies were analyzed in relation to SPA-CE types. The distribution of morphologic patterns and their association with surgical techniques and underlying diagnosis were assessed.
resultsThe most common SPA-CE pattern was simple central (SC), observed in 62.1% of cases. Overall, simple (S) defects predominated (75.4%), whereas plastic (P) defects accounted for 24.2% and advanced (A) defects were rare (0.5%). Defects managed without structural reconstruction (SC and SEI) accounted for 73.9% of shoulders, whereas 1.4% required version correction without lateralization (SEII), 24.2% required lateralization (plastic types), and 0.5% required patient-specific reconstruction. A consistent relationship was observed between SPA-CE types and reconstructive strategies. In contrast, substantial variability in SPA-CE patterns was identified within individual Walch groups, particularly in Walch B2 glenoids. Underlying diagnosis influenced defect morphology: post-traumatic conditions, fractures, and rotator cuff tears were predominantly associated with SC defects, whereas osteoarthritis demonstrated the widest distribution of SPA-CE patterns, including complex and reconstructively demanding defects.
conclusionThe SPA-CE classification provides a structured, CT-based, and treatment-oriented framework for the assessment of glenoid bone loss in RSA. It demonstrates a consistent relationship with reconstructive strategies and may improve preoperative planning and surgical decision-making.
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