Adult Scoliosis

Discussion

• cardiopulmonary problems (thoracic curves > 60-65 deg alter PFT's;
  • curves > 90 deg may cause myelopathy & may affect mortality;
• progression is unlikely in curves < 30 deg
  • single major thoracic curves > 60-80 deg are likely to increase in size even after growth was complete;
  • rate of progression is about one degree per year;

Indications for Fusion

• adult patients with scoliosis, chronic pain & curve > 60 deg;
• because of higher complication rate in adults, radiograph or cosmetic appearance alone are not indications for surgery;

Treatment

• combined anterior release w/ fusion in addition to posterior fusion & instrumentation are indicated for rigid curves & curves > 70 deg;
• must preserve normal thoracic Kyphosis & lumbar lordosis w/ fusion;
• fusion to the sacrum is associated with more complications (pseudo-arthrosis, instrumentation failure, loss of normal lordosis, & pain;

Complications

• pseudoarthrosis (15% with posterior fusion only);
• instumentation failure;
• infection (5%)
• neurologic deficit

• Results of surgical treatment of adults with idiopathic scoliosis.
• Adult idiopathic scoliosis treated by anterior and posterior spinal fusion.
• Adult scoliosis. Current concepts of treatment.
• Surgical management of scoliosis in the adult.
• Adult idiopathic scoliosis treated by posterior spinal fusion and Harrington instrumentation.
• Fusion to the sacrum for nonparalytic scoliosis in the adult.
• Surgical treatment of adult scoliosis. A review of two hundred and twenty-two cases.
• Osteoporosis in unstable adult scoliosis.
• Scoliosis and pregnancy
• Adult idiopathic scoliosis treated with Luque or Harrington rods and sublaminar wiring.
• Treatment of scoliosis in the adult thoracolumbar spine with special reference to fusion to the sacrum
• Results of operative treatment of idiopathic scoliosis in adults.