Degenerative Adult Scoliosis

Adult spine deformity (ASD) or adult degenerative scoliosis has gained popularity in the last decades due to aging of population and the growing interest of spine surgeons on its treatment. The primary complaint in adult scoliosis population is pain, and patients typically present with a compound of several complaints, including back pain, dorsal or more frequently low back pain, which can irradiate to the lower extremities. Increased pain often suggests significant sagittal and coronal imbalance.. The initial evaluation must include a comprehensive history and a physical examination, followed by radiographic studies for the measurement of the spinopelvic parameters. ASD is classified by two main systems regarding sagittal and coronal alignment, the SRS-Schwab and Obeid classifications. Nonsurgical treatment is the initial indication in the care of adult deformity for a large number of patients, but operative management is usually the best option of treatment to correct the deformity and relieve pain when conservative treatment fails. Surgical treatment contemplates various treatment options, with no consensus on surgical strategy, especially regarding type of approach and levels to be fused. Radicular pain and neurological symptoms can be treated with selective decompression without the correction of spinal malalignment. Long fusions or fusions extending beyond the end vertebrae are preferable for correction of large curvatures. The increasing interest in minimally invasive surgery (MIS) approaches to the anterior column has expanded the indications and use of anterior surgery. Rigid deformities may require osteotomies to flexibilize the curves. Complications in ASD have decreased over time, especially with MIS techniques. Nonetheless, the incidence of complications in adult scoliosis surgery is still high, and the knowledge about the surgical possibilities is of paramount importance to reduce the number of complications and provide a better outcome for patients.