Adult Scoliosis:treatment and challenges

Jeremy L.Fogelson

doi:10.3969/j.issn.2095-252X.2015.03.003

Abstract：Adult Scoliosis has been a common disease as the society is aging, especially in China. With longer life expectance and higher requirements of life quality from those patients, increasing concerns are being focused on the treatments of adult scoliosis. Non-operative treatments including conservative therapies and interventional procedures, such as epidural injection, facet injections and rhizotomy, are always selected prior to operations as they are of minimal risks compared to surgical interventions, though limited evidence is available. However, when surgical intervention is under consideration, it is signiifcant for us to conifrm that the patient can tolerate the operation otherwise raised postoperative complication rate will be observed. Meanwhile, detailed history, physical examination combined with radiographic studies should be systematically analyzed followed by a proper deformity definition which will assist in surgical management. Furthermore, preoperative patient optimizing is recommended in improving surgical outcome like stopping nicotine use, losing weight and getting osteoprosis and osteoarthritis pretreated. Finally, surgical strategy selection should be individualized depending on the factors both of patients and surgeons while appropriate classiifcation system will also assist in surgical determination. Challenges still exists even though effective operation is employed. Proximal junctional kyphosis ( PJK ) attracts most of attentions which will sometimes become symptomatic and needs revision consequently. Risk factors of PJK have been put forward as well as various preventions like postoperative thoracolo-lumbar-sacral orthosis ( TLSO ) and cervical-thoracic orthosis ( CTO ) reported to be promising. However, further work still should be done in lowering PJK risks;Iliac ifxation is applied to protect sacral screws when the fusion extends to the sacrum. Recent clinical researches have reported that new techniques resulting in maintaining high fusion rate with simultaneously decreased pain which is generated by iliac screws themselves. Neurologic complications occur especially in patients underwent major spinal reconstructions and postoperative pseudarthrosis remains as an issue in spite of many researchers have reported several ways in raising fusion rate like using recombinant bone morphogenetic protein ( rhBMP-2 ) and adding supplemental rods in patients performed with 3 column osteotomy. Generally speaking, adult spinal deformity can be effectively treated by operations but challenges still exist which need further research to meet the updated requirements as improved life quality and cost-effective care.