Biologics for Adult Lumbar Scoliosis
Adult scoliosis, arising either as a sequelae of untreated adolescent idiopathic scoliosis or as a de novo degenerative deformity, has been estimated in as much as 68 % of adults over the age of 60 [1]. Anwar et al. further reported that adult lumbar scoliosis in particular was significantly underreported, particularly in scoliotic curves < 20° [2]. Many patients with adult lumbar scoliosis can be managed nonoperatively. However, in patients with subsequent neurological deficits related to stenosis, significant sagittal imbalance, or chronic pain as a result of the underlying deformity, surgical correction with or without neurologic decompression can offer relief and return to activities of daily living. While the clinical presentation of adult lumbar scoliosis is variable, the disease presents a significant structural and mechanical challenge. Depending on the patients’ symptoms, the surgical goals are to provide neurologic decompression, correct scoliosis curve magnitude, reduce sagittal imbalance, and maintain long-term stability of the construct for those patients with neurological and structural deficits [3, 4]. Operative indications for degenerative lumbar scoliosis are equally as variable as the clinical presentation, though lumbar curves with >30–40° are commonly considered for operative treatment [3, 5]. The Lenke-Silva Treatment Levels I–VI matrix offers distinct procedural options for lumbar scoliosis indications, which range from decompression only to decompression with instrumentation utilizing varying surgical approaches, construct lengths, and need for osteotomy inclusion [3].
