Abstract
The simple dictum of the late Prof. Alf Nachemson was that ‘surgery should very rarely, if ever, be performed in adult scoliotic patients for lumbar curves when pain is the most serious problem’. Today, the complexity of intercurrent neural symptoms, the advancing age of the population and the increasing demands and expectations of modern living require a somewhat more flexible approach to this increasingly common problem.
Treatment of adult deformity has improved along with our understanding of the radiological features of the condition most likely to be associated with disabling pain and also with our appreciation of the adverse significance of patient co-morbidity. In those patients where conservative measures have failed and where an acceptable quality of life has been lost, surgical management may be undertaken, but must address all the symptomatic aspects of the deformity in one episode of care.
Primary objectives include the restoration of satisfactory sagittal plane correction using the minimum number of operated levels whilst providing adequate spinal stability. Meticulous preoperative planning from a clinical and radiological perspective maximises the possibility of a satisfactory outcome and in this regard patient expectation is of prime importance. The questions of operative approach and levels of fixation are ever present and recent advances in our understanding of distal end fixation are worthy of consideration.
Finally, exemplary cases and our series of 23 patients undergoing surgical treatment of adult scoliosis will be presented. Mean coronal curve correction by anteroposterior approach was 60.4% and by posterior only approach 40.3%.
Patient satisfaction was 77.8% by combined approach and 58.9% by posterior only approach. The rate of reoperation was 66.7% for posterior surgery alone and 11.1% for combined approach corrections.
