Adult degenerative scoliosis: Determination of fusion and decompression parameters

Adult degenerative scoliosis is a progressive disease that develops from the asymptomatic degeneration of intervertebral discs and facet joints. The clinical spectrum of adult scoliosis ranges from asymptomatic to severe degenerative stenosis with neurogenic claudication and radicular symptoms. Adult degenerative scoliosis involves a complex three-dimensional deformity, and although the surgical advances in the treatment of adult scoliosis are vast, controversies still exist. Debate between selective decompression vs. decompression and fusion vs. limited fusion, identification of proximal fusion levels, and choosing distal fusion levels, including fusion to the pelvis, all remain sources of controversy. This article will provide a review on surgical indications for surgical decompression and fusion, with an emphasis on choosing proximal and distal fusion levels for the treatment of adult degenerative scoliosis.