Degenerative scoliosis of the spine: diagnosis, classification and surgical approach in older patients

Adult scoliosis is a deformity of the spine with an angle of more than 10° (according to Cobb) in people with a fully formed bone system. Due to the aging of the population, improvement of surgical techniques, creation of new implants and progress in anesthetic aids, the problem of degenerative scoliosis has been more and more frequently considered from the viewpoint of a surgical approach. There are many theories about the factors that contribute to the formation of degenerative scoliosis. The conservative therapy of degenerative scoliosis includes non-steroidal anti-inflammatory drugs, bracing, epidural and paravertebral injections with glucocorticosteroids and physical therapy. In case the conservative therapy is ineffective and there is a significant decrease in the quality of life, the issue of the surgical intervention is raised individually for each patient. Currently, the role and the volume of the surgical intervention in individuals with this pathology remains debatable. The choice of a surgical technique depends on a thorough assessment of clinical symptoms, neurological status, data of instrumental methods and a mandatory estimation of the parameters of the global vertebral-pelvic balance. Therefore, in this article, we pay special attention to the surgical algorithms based on the choice of the decompression type and the fusion length. We describe the generally accepted criteria for selecting the level of spondylosynthesis. Special attention is paid to the risk factors of the surgical treatment, as well as associated complications.