Adult degenerative scoliosis insights, challenges, and treatment outlook

Purpose of review To examine established treatment options and explore recent evidence in controversies in treating adult degenerative de-novo scoliosis. Recent findings Recent reviews demonstrate there are few well designed studies investigating nonoperative treatment of adult scoliosis. In operative treatment, short-term evidence suggests some variability in determining the rostral extent of a fusion construct. Stopping short of S1 at the caudal end leads to a significant revision rate secondary to breakdown of L5–S1 intervertebral disc. Extension to the iliac wings protects the sacrum from insufficiency fractures in osteoporotic patients without creating degeneration of the sacroiliac joints. The role of total disc arthroplasty is not supported by publications to date. Careful attention to reestablishing sagittal balance and lumbar lordosis, ensuring a solid fusion, and complete neural element decompression, improve outcomes and reduce risk of unplanned further operative intervention. Summary Reestablishing both coronal and sagittal balance enhances success in reconstructing the degenerative scoliotic spine. Extension of a construct to the sacrum and iliac wings in a patient treated with multilevel fusion is a safe option, although there is potentially more variability in determining the proximal extent of the construct.