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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 & curves > 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

Results of surgical treatment of adults with idiopathic scoliosis.

Adult idiopathic scoliosis treated by anterior and posterior spinal fusion.

Adult scoliosis. Current concepts of treatment.

Surgical management of scoliosis in the adult.

Adult idiopathic scoliosis treated by posterior spinal fusion and Harrington instrumentation.

Fusion to the sacrum for nonparalytic scoliosis in the adult.

Surgical treatment of adult scoliosis. A review of two hundred and twenty-two cases.

Osteoporosis in unstable adult scoliosis.

Scoliosis and pregnancy

Adult idiopathic scoliosis treated with Luque or Harrington rods and sublaminar wiring.

Treatment of scoliosis in the adult thoracolumbar spine with special reference to fusion to the sacrum.

Results of operative treatment of idiopathic scoliosis in adults.