Degenerative scoliosis surgical fixation techniques

Degenerative scoliosis patients present a unique challenge to the spine surgeons. When conservative treatments no longer provide benefit, certain surgical options may improve pain and disability. This article discusses the variety of surgical techniques available for deformity correction, including the following topics: muscle-sparing approaches, such as the presacral, lateral transpsoas, and mini-open ALIF; the role of anterior column support using interbody graft and devices; adjacent-level cement augmentation and proximal junctional kyphosis; the utility and methodology of pedicle screw augmentation with bone cement; and pelvic fixation techniques for protection of the lumbosacral fusion, including a comparison of S2-alar-iliac screws with standard iliac bolts. Finally, three illustrative cases are described with relevant pre- and post-operative images.