Adult Degenerative Scoliosis

Populational aging increases the incidence of musculoskeletal degenerative processes, such as adult scoliosis (AS). Adult scoliosis is defined as a spinal deformity in the coronal plane with a Cobb angle > 10º. Adult scoliosis may be iatrogenic or result from a degenerative process (scoliosis de novo) or a pre-existing scoliosis.

Adult scoliosis is a potentially limiting condition that affects a heterogeneous group of patients. Clinical treatment proved to be ineffective and surgery is often indicated. The present paper reviews AS pathophysiology, clinical presentation and diagnosis, in addition to surgical indications and the main techniques currently used.

Keywords
scoliosis/physiopathology; scoliosis/therapy; intervertebral disc degeneration; adult

Authorship

Alexandre Fogaça Cristante

Department of Orthopedics and Traumatology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, BrazilUniversidade de São PauloBrazilSão Paulo, SP, BrazilDepartment of Orthopedics and Traumatology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil

https://orcid.org/0000-0002-7797-5274

Ricardo Teixeira e Silva Address for correspondence Ricardo Teixeira e Silva, Departamento de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, R. Dr. Ovídio Pires de Campos, 333, Cerqueira César, São Paulo, SP, 05403-010, Brazil (e-mail: ricardo.teixeira.silva@gmail.com).

https://orcid.org/0000-0003-4405-373X

Guilherme Henrique Ricardo da Costa

https://orcid.org/0000-0002-1409-3178

Raphael Martus Marcon

https://orcid.org/0000-0001-5958-5646

Address for correspondence Ricardo Teixeira e Silva, Departamento de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, R. Dr. Ovídio Pires de Campos, 333, Cerqueira César, São Paulo, SP, 05403-010, Brazil (e-mail: ricardo.teixeira.silva@gmail.com).

Conflict of Interests

The authors haveno conflict of interests to declare.

SCIMAGO INSTITUTIONS RANKINGS

Figures | Tables

Figures (4)
Tables (1)

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Fig. 1
SVA, Sagittal vertical axis; LL, Lumbar Lordosis; TK, Thoracic Kyphosis; SS, Sacral slope; PT, Pelvic Tilt; PI, Pelvic incidence.

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Fig. 2
SRS-SchwabClassification.²⁰20 Schwab F, Ungar B, Blondel B, et al. Scoliosis Research Society-Schwab adult spinal deformity classification: a validation study. Spine (Phila Pa 1976) 2012;37(12):1077-1082 PI, Pelvic incidence; LL, Lumbar lordosis; SVA, Sagittal vertical axis; PT, Pelvic Tilt.

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Fig. 3
A graduated and simplified anatomically based osteotomy classification system by Schwab et al.²²22 Schwab F, Blondel B, Chay E, et al. The comprehensive anatomical spinal osteotomy classification. Neurosurgery 2014;74(01):112-120 Grade 1: partial facet joint; Grade 2: complete facet joint; Grade 3: pedicle and partial body; Grade 4: pedicle, partial body, and disc; Grade 5: complete vertebra and discs; Grade 6: multiplevertebrae and discs.

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Fig. 4
Anterior column realignment classification.²³23 Uribe JS, Schwab F, Mundis GM, et al. The comprehensive anatomical spinal osteotomy and anterior column realignment classification. J Neurosurg Spine 2018;29(05):565-575

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Table 1
Radiographic Parameter Thresholds Predictive of an Oswestry Disability Index Score of 40 ²⁰20 Schwab F, Ungar B, Blondel B, et al. Scoliosis Research Society-Schwab adult spinal deformity classification: a validation study. Spine (Phila Pa 1976) 2012;37(12):1077-1082

Fig. 1 SVA, Sagittal vertical axis; LL, Lumbar Lordosis; TK, Thoracic Kyphosis; SS, Sacral slope; PT, Pelvic Tilt; PI, Pelvic incidence.

Fig. 2 SRS-SchwabClassification.²⁰20 Schwab F, Ungar B, Blondel B, et al. Scoliosis Research Society-Schwab adult spinal deformity classification: a validation study. Spine (Phila Pa 1976) 2012;37(12):1077-1082 PI, Pelvic incidence; LL, Lumbar lordosis; SVA, Sagittal vertical axis; PT, Pelvic Tilt.

Fig. 3 A graduated and simplified anatomically based osteotomy classification system by Schwab et al.²²22 Schwab F, Blondel B, Chay E, et al. The comprehensive anatomical spinal osteotomy classification. Neurosurgery 2014;74(01):112-120 Grade 1: partial facet joint; Grade 2: complete facet joint; Grade 3: pedicle and partial body; Grade 4: pedicle, partial body, and disc; Grade 5: complete vertebra and discs; Grade 6: multiplevertebrae and discs.

Fig. 4 Anterior column realignment classification.²³23 Uribe JS, Schwab F, Mundis GM, et al. The comprehensive anatomical spinal osteotomy and anterior column realignment classification. J Neurosurg Spine 2018;29(05):565-575

Table 1 Radiographic Parameter Thresholds Predictive of an Oswestry Disability Index Score of 40 ²⁰20 Schwab F, Ungar B, Blondel B, et al. Scoliosis Research Society-Schwab adult spinal deformity classification: a validation study. Spine (Phila Pa 1976) 2012;37(12):1077-1082

Radiographic parameter	RadiographicalThreshold	r
PI-LL	11º	0.45
PT	22º	0.38
SVA	46mm	0.47

Abbreviations: PI, pelvicincidence; LL, lumbarlordosis; PT, pelvictilt; SVA, sagittal vertical axis.

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[1] Address for correspondence Ricardo Teixeira e Silva, Departamento de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, R. Dr. Ovídio Pires de Campos, 333, Cerqueira César, São Paulo, SP, 05403-010, Brazil (e-mail: ricardo.teixeira.silva@gmail.com).