Decision Making for Surgery in Adult Scoliosis Review of the Current Literature

Abstract

Adult spinal deformity is a challenging condition in spine surgery. Adult scoliosis (AS) is an important health issue with potential to cause severe surgical adverse ramifications in aging population. Deciding who is going under the knife is still a debatable issue with no clear algorithm. This review of the recent literature is representative of the results of modern intervention methods and it references to competent authorities aiming to help clinicians to supply a guideline for surgical decision making in AS. A search in the National Library of Medicine (PubMed) database using keywords AS was performed. Our search yielded 4247 articles published between January 2005 and March 2019. When added the "surgical decision", it accounted for 105 articles. For the literature review, of papers, especially focusing on surgical decision-making, 27 were selected as guiding articles. Non-surgical interventions for symptomatic AS cases lack a high level of evidence. Successful results were reported for local decompression, limited short segment fusion, and deformity correction with long segment fusion surgeries for selected cases. Leading factors for surgery seems to be a symptomatic case with a functional problem (primarily painful radiculopathy), self-image problems, a higher curve, and recently with an extra emphasis on sagittal malalignment. Patient's expectations, pain intensity, functional status, perception of self-image and medical risk stratification, surgeon's experience, and contentment will shape the strategy needed for decision-making for surgery and whether to address either a focal pathology or comprehensive deformity correction. Every case has to be managed according to its own characteristics.

Radio-morphometric evaluation of clinical and sub-clinical forms of scoliosis in postmenopausal women

“…• Partial spinal torsion • Vertebral stenosis • Lateral subluxation of the spine • Imbalance in the level of the sagittal plane 6 As mentioned above, adult scoliosis might be the result of the progressive development of idiopathic scoliosis in children and adolescents or from degenerative ('de novo') scoliosis 7 . The case of idiopathic adult scoliosis, is not stable throughout the individual's life.…”