Adult Scoliosis  

Background 

• Coronal imbalance – 10 degrees 
• Sagittal (see preivous) SVA 5cm positive or negative 

Coronal Deformity Types 

• Residual AIS 
  • Classic patterns 
  • More segments 
• Degenerative de novo adult scoliosis 
  • Non classic pattern 
  • Fewer vertebral segments, smalle curve 

Presentation 

• Back pain  
  • Spondylosis, discogenic 
• Neurogenic claudication 
  • Stenosis 
• Radicular 
  • Concave side 

Imaging 

• PA 3 foot standing 
• Lateral  
  • Sagittal assessment 
• DEXA – bone density for surgical planning 
• MRI 
  • Central stenosis 
    • Trefoil canalxs 
  • Facet hypertophy 
  • Pedicular enlargment 
  • Foraminal encroachment 
  • Disc degeneration 

Management 

• Weinstein et al 2008 SPORT Trial (one arm of it) 
  • Surgery > Non Op at 4 years 
• Non operative 
  • Oral meds (NSAIDS) 
  • PT core strengthening 
  • Cortiosteroid inj and nerve root block 
    • Dx and therapeutic 
• Operative 
  • Curve >50 
  • Sagittal deformity 
  • Failred non op back pain 
  • Thoracic >60 pulmonary 
  • Thoracic >90 mortality 

Complication 

• 13.5% overall 
• 10% major with irreverisible affect 
• VTE very bad 
• Pseudoarthrosis 
• Dural tear 
• Infection 
• Implant failure (sacrum) low cortical to cancellous bone ratio 
• Neurologic (PSO is 18%) 

Prognosis 

• Convex side symptoms 
• Sagittal plan balance is the most reliable predictor of clinical symptoms in adults with spinal deformity 
• Worse outcomes 
  • Post op sagittal imbalance 
  • Preop obesityy 

PMMA inj at top and bottom 

• Inc fusion 
• Dec junctional failure 

TL kyphosis corelated to VAS scores 

PI does not correlate with anything but matching LL <10 of PI does 

Sagittal imbalance correlated with severity of symptoms 

Sagittall imbalance prognosticates surgical success (PI within 10 LL)