The Hip
Home » Bones » Spine » Adult Scoliosis

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 & curvesĀ > 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