Adult Degenerative Scoliosis

Adult degenerative scoliosis (de novo scoliosis) is an abnormal lateral spinal curvature that develops in adulthood — typically after age 50 — as a direct result of asymmetric degeneration of intervertebral discs and facet joints. Unlike adolescent idiopathic scoliosis, which begins in a structurally normal growing spine, adult degenerative scoliosis arises in a previously normal adult spine when differential degeneration on one side of a segment causes progressive angulation and rotation. The lumbar and thoracolumbar spine is most commonly affected. The clinical impact of adult scoliosis extends beyond the coronal plane deformity. Sagittal alignment — the forward or backward tilt of the spine as viewed from the side — is increasingly recognized as the most important determinant of symptoms and outcomes. Sagittal imbalance, defined as excessive forward trunk lean (positive sagittal vertical axis), is strongly correlated with pain, disability, and impaired quality of life. Patients with adult scoliosis commonly present with stenosis symptoms (neurogenic claudication), radiculopathy from foraminal compression at the concavity, and mechanical back pain from deformity-related overload. Decision-making is complex. Conservative management including physical therapy, injections, and bracing addresses symptoms but does not correct deformity. Surgery — ranging from limited decompression to extensive multilevel corrective fusion with osteotomies — is reserved for patients with significant functional limitation, neurological compromise, or progressive deformity. Extensive deformity correction carries substantial risks and requires specialized surgical expertise.