VR may be an effective treatment method for specific disorders, although the generalizability of this literature is hindered by several methodological limitations, such as small samples and the absence of appropriate control participants.

➤ Symptoms that suggest that the sacroiliac joint (SIJ), as opposed to pathology of the lumbar spine or hip, may be a source of pain include pain with position changes, such as standing from a seated position or sitting on a hard surface. Radiation to the groin or Fortin area also suggest sacroiliac joint as a source.➤ A constellation of findings, including pain referral patterns, provocative maneuvers, and response to injections, should be utilized when assessing SIJ pathology.➤ While its effectiveness remains unsubstantiated, manipulation of the SIJ is noninvasive and warrants consideration as an initial treatment modality.➤ The diagnostic validity of local anesthetic and/or corticosteroid injections is difficult to assess as the criteria for a positive response are not uniform in the literature, and evidence to support intra-articular injections for therapeutic purposes is weak.➤ SIJ fusion appears to be emerging as an acceptable treatment for patients with recalcitrant SIJ dysfunction; however, only a few long-term outcome studies have been done.➤ New minimally invasive fusion techniques appear to decrease the morbidity of open procedures with at least comparable outcomes.

Purpose of Review The purpose of this review is to provide an updated review of adult degenerative scoliosis (ADS). Epidemiology, classification, pathophysiology, and natural history are discussed along with a summary of commonly used outcome measures. Operative vs non-operative outcomes and new surgical techniques are discussed. Recent Findings The SRS-Schwab classification (2012) combines clinical and radiographic evaluation including overall global alignment. Current evidence regarding risk factors and efficacy of non-surgical modalities are discussed. Recent studies have reported surgical management to provide superior outcomes to non-operative modalities. New surgical techniques provide promising early data in regard to decreasing perioperative morbidity. Summary ADS is a potentially debilitating condition that occurs with asymmetric spinal degeneration. This can produce global sagittal malalignment and central and foraminal stenosis and can lead to significant impairment often necessitating surgery. The surgeon must be aware of the perioperative risks in this population and implement appropriate age-specific alignment goals to achieve the best outcome for patients.

Patients with lumbar fusion are at increased risk for post-operative dislocations requiring revision. Together, lower pelvic incidence and decreased sacral slope are associated with increased risk of dislocation in these patients.

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