Definition
Presentation of scoliosis deformity after skeletal maturity
- must be > 21 years at first presentation
- any of usual causes
Typically
- thoracolumbar / lumbar
Epidemiology
Idiopathic
- most common cause of adult scoliosis
- incidence is ~ 5% in population
- 5000 adults having IVPs - 4% had lumbar scoliosis >10°
Symptoms
Pain / Progressive deformity
Examination
As per scoliosis examination
Xray
Standing PA & lateral
- Cobb angle
- balance
- degenerative change
NHx
<30° don't progress
Progression seen in
- >60° & thoracic
- lumbar portion of double major curve
- progression is usually 1° per year
- some progress faster especially lumbar with severe degenerative changes
Respiratory compromise seen curve > 60o
Increased mortality when curve >90°
Weinstein & Ponsetti
- Ppogression from 1o per month to 1o per year for curves > 30o
- Average 13o over 40 years
Management
Non-operative
Analgesics, bracing, physical therapy, injections
Operative
Indications
1. Progressive deformity
- progressive thoracic curves >60° (young adults)
- thoracic curve >80° with decreased pulmonary function (older patients)
- lumbar curves with rotatory subluxation & pain or stenosis
2. Pain not relieved by non-operative measures
- surgery for relief of pain alone ~ 50% successful
Options
1. Decompression alone
- stenosis with no major coronal or sagittal deformity & no rotational deformity
- flexion / extension & side bending radiographs show minimal movement
- should not destabilise spine as long as not performed at apex
2. Decompression & Posterior instrumented fusion
3. Decompression with Anterior & Posterior Instrumented Fusion
- severe deformities in both coronal & sagittal planes
- curve >80° or kyphosis > 70°
- not correctable on side bending or hyperextension lateral radiographs
- need anterior release / ACDF first
- then posterior decompression and instrumented fusion