Adult scoliosis

Adult scoliosis is a complex and difficult area of modern orthopaedics. Thanks to modern techniques of both operative and nonoperative care, treatment is now possible for problems thought of as impossible only a few years ago. Most adult scoliosis problems require a great depth of evaluation and decision making before arriving at the best form of treatment. Failure to do these necessary steps can lead to monumental problems. Nonoperative treatment of painful curves is best done with orthotics and not with physiotherapy. The operative procedure of choice for most patients is posterior instrumentation and fusion, striving for stabilization and pain improvement, not dramatic curve or cosmetic change. Pain is usually significantly improved but is almost never totally eliminated. Special procedures, such as anterior correction and fusion as well as combined anterior and posterior procedures, are appropriate only for very special problems. The complication rate for adult scoliosis surgery is far higher than for children and adolescents and usually increases with age. Surgeons should not attempt treatment of adults until thoroughly competent in the treatment of adolescent scoliosis.