Decision making in adult scoliosis

This report analyzes a series of 350 adult patients whose spinal deformity was treated surgically. Indications included pain, curve progression, cosmesis, structural disabilities, neurologic complications, cardiorespiratory problems, and failed previous surgery. Discography was helpful in assessing complex pain problems, and its use led to improved results of surgery because of more comprehensive preoperative definition of the problem. Pain relief occurred in 70% of patients. Traction, either the halo-femoral or the halo-pelvic type, was used in 62 patients. Complex surgery, including anterior and posterior approaches, is required in curves of large magnitude, especially when curves are rigid. Overall curve correction in this series was 40%.