Adult scoliosis: evaluation and nonsurgical treatment

Adult spine deformities may result from idiopathic and degenerative etiologies. These two entities may have superimposed on them an iatrogenic component from diskectomies or laminectomies done to relieve localized stenosis or disk herniations. The cumulative effect on the spine may result in painful and even crippling spine deformities. These are common, and their incidence in the adult population ranges from 3% to 30%, depending on the age group. Spine deformities are commonly painful and can be disabling, but they are rarely fatal. It is incumbent on the surgeon to understand the pathology involved in painful spine disorders and to have a reasonable understanding of the prognosis before attempting invasive therapy. An understanding of the risk/benefit ratio to the patient is also necessary. The decision to proceed with surgical treatment is justified in many cases, but it must be based on a thorough understanding of the anticipated benefits from surgical treatment and the risk of serious complications leading to multiple surgeries and results that can be less desirable than the original condition.