Degenerative (De Novo) Adult Scoliosis

De novo scoliosis is a term used in adult patients who have no history of scoliosis as adolescents but then develop a coronal plane deformity that is associated with degenerative changes in the spinal column. It rarely presents before 40 years of age. Differentiation from degenerative idiopathic scoliosis may be difficult. The coronal curve usually involves the lumbar and less commonly the thoracolumbar junction. Osteoporosis, degenerative disk disease, compression fractures and spinal canal stenosis have all been implicated in the development of degenerative scoliosis. Patients with degenerative lumbar scoliosis present with complaints ranging from debilitating back or lower extremity pain and spinal imbalance to incidental findings on lumbar radiographs. When surgical treatment is indicated, careful preoperative evaluation and surgical planning should always be done. There are increased risks of complications in this population. The deformities are often more rigid; however extensive posterior release in addition to solid pedicle fixation will allow the surgeon to address most of these deformities through a posterior approach. Anterior approach may be reserved to add structural support at the lumbosacral junction. Despite the high risk of complications in patients undergoing reconstructive surgery for de novo scoliosis, most studies suggest a significant improvement in quality of life and a high rate of patient satisfaction.