||BACKGROUND:: The Schwab-SRS classification of adult spinal deformity (ASD) is a validated system that provides a common language for the complex pathology of ASD. Classification reliability has been reported; however, correlation with treatment has not been assessed. OBJECTIVE:: To assess the clinical relevance of the SRS-Schwab classification based on correlations with health-related quality of life (HRQOL) measures and the decision to pursue operative versus non-operative treatment. METHODS:: Prospective analysis of consecutive ASD patients (age≥18yrs) collected through a multi-center group. The SRS-Schwab classification includes a curve type descriptor and three sagittal spinopelvic modifiers (sagittal vertical axis, pelvic tilt, pelvic incidence/lumbar lordosis mismatch). Differences in demographics, HRQOL (ODI, SRS-22, SF-36), and classification between operative and non-operative patients were evaluated. RESULTS:: 527 patients (mean age 52.9 years, range: 18.4-85.1) met inclusion criteria. Significant differences in HRQOL were identified based on SRS-Schwab curve type, with thoracolumbar and primary sagittal deformities associated with greater disability and poorer health status than thoracic or double curve deformities. Operative patients had significantly poorer grades for each of the sagittal spinopelvic modifiers, and progressively higher grades were associated with significantly poorer HRQOL (p<0.05). Patients with worse sagittal spinopelvic modifier grades were significantly more likely to require major osteotomies, iliac fixation, and decompression (p≤0.009). CONCLUSION:: The SRS-Schwab classification provides a validated language to describe and categorize ASD. The present study demonstrates that the SRS-Schwab classification reflects severity of disease state based on multiple measures of HRQOL, and significantly correlates with the important decision of whether to pursue operative versus non-operative treatment.