Treatment of scoliosis in the adult

With the increasing awareness in both the medical community, as well as the general public of the progressive nature of adult scoliosis, more patients with this condition are coming to the attention of the spinal surgeon. With recent technical developments, the surgical armamentarium currently available has certainly improved, yet these patients remain a challenging population of patients. Infantile, juvenile, and adolescent idiopathic scoliosis are defined by their age of presentation. Similarly, adult scoliosis is defined as a presentation of scoliosis after skeletal maturity. Yet most studies in the literature define adult scoliosis arbitrarily as scoliosis existing in a patient age 18 or older. The majority of these patients, therefore, have curves which have persisted through adolescence into adult life with etiologies which mirror those of a younger patient population. Degenerative scoliosis related to osteoporosis and iatrogenic causes are additional etiologies of deformity which more typically present in adult patients. The indications for treatment in the adult patient are similar to those in the adolescent: progression of the deformity, pain, deterioration of pulmonary function, and perhaps cosmesis. The complications encountered during the surgical management of these patients is quite high (50-80%) when compared to their adolescent counterparts. Complications include pseudoarthrosis, loss of lumbar lordosis, thromboembolic disease, instrumentation failure, neurologic deficits, and wound infections. Therefore, even with the recent advances in surgical technique the decision of whether or not to operate on a given patient remains the single most critical decision.