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)