Assessing the Need for Decompression for Adult Lumbar Scoliosis
As the number of elderly continues to increase in the USA, the number of people affected by adult deformity is expected to rise. In the USA, as many as 60 % of the elderly demonstrate some degree of adult spinal deformity (ASD) [1]. Adult spinal deformity, including scoliosis and sagittal plane deformities, is a relatively common finding [1–3] and is broadly classified into two subgroups, adult idiopathic and adult degenerative, defined by the primary etiology of the deformity [1, 4, 5]. One of the characteristic features of adult deformity in comparison to adolescent deformity is the increased prevalence of axial pain and radicular pain in adult deformity [6–8]. Adolescent deformity typically presents with cosmetic concerns or deformity progression, while adult deformity presents with pain and disability [9–11]. A combination of degenerative disc disease, facet arthropathy, trunk imbalance, and muscle fatigue is involved in the pathogenesis of pain in adult deformity [12]. Trunk imbalance and muscle fatigue are primarily influenced by sagittal and to a lesser degree coronal imbalance, and degenerative disc disease, facet arthropathy, and central and foraminal stenosis are more likely to directly cause signs and symptoms of nerve root and thecal sac compression such as radicular pain or neurogenic claudication.
