Adult Scoliosis

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