Adult degenerative scoliosis is an increasingly common problem with our aging population. Historically, this condition was thought of as a lateral deviation of the spine in the coronal plane. Recent evaluation of the pathologic process, biomechanics, and spinal anatomy has demonstrated that rotation in the axial plane and the loss of lordosis in the sagittal plane are important components of the deformity. Therefore, evaluation and treatment must address all three planes of deformity. There is a tendency for degenerative scoliosis to occur more frequently with advanced age. This poses additional challenges for the patient as well as the treating physician. In addition to their spinal deformity, this patient population has a higher prevalence of cardiopulmonary and other medical comorbidities that must be evaluated and addressed before considering strenuous activity or surgical intervention. Bone density strength also becomes a concern when considering spinal instrumentation as the bone implant interface is the weakest link.
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