Indications for Adult Spinal Deformity Surgery

Abstract

Shifting demographics and aging populations have resulted in a rise in adult spinal deformity (ASD). ASD refers to abnormal spinal curvature in the coronal, axial, or sagittal planes in patients over the age of 18. A recent publication found that the prevalence of ASD ranges from 2 % to 32 % in the general population but exceeds 60 % for adults greater than 60 years of age [1]. With a simultaneous shift in expectations for quality of life (QOL), the demand for treatment of ASD has dramatically increased. ASD is most commonly caused by untreated adolescent idiopathic scoliosis, adult-onset degenerative scoliosis, or primary sagittal imbalance [2]. While some cases of ASD can be managed with conservative care and nonoperative procedures, many ASD cases require surgical intervention. Unlike adolescent idiopathic scoliosis (AIS), there is no widely accepted classification system that provides guidelines for the surgical treatment of ASD [3]. Therefore, the decision to undergo surgical treatment of ASD must carefully consider clinical symptoms, radiographic parameters, coexisting medical comorbidities, and the patient’s physiologic status. The potential benefits and risks associated with the surgical treatment of ASD must also factor into the treatment decision. This chapter provides an overview of current indications for the surgical treatment of ASD and highlights the significance of using a combination of both clinical symptomatology and radiographic imaging to propose the optimal treatment plan for patients with ASD.