Evaluation and treatment of adult spinal deformity. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004.

Spinal deformity is a complex and dynamic process that occurs in both the sagittal and coronal planes of the thoracolumbar spine. Successful treatment is aimed at achieving satisfactory balance in both of these planes. The spinal curvatures in the adult differ greatly from those in adolescents. As a general rule the adult curves tend to be stiffer, whereas adolescent curves are more flexible. In addition to cosmetic concerns, adult patients frequently present with pain and neurological symptoms in contrast to adolescents who usually do not experience this degree of pain or neurological symptoms. The treatment of adult spinal deformity differs substantially from that of adolescent deformity. Surgeries in the former tend to be more complex procedures associated with higher rates of intra- and perioperative complications. The goals of surgery in the adult are to obtain a solid fusion with a balanced spine, to relieve pain, and to prevent further deformity. A secondary goal is to correct the curve, and, in so doing, to improve the cosmetic appearance. In this review the author addresses the basic principles of spinal corrective surgery in the adult and provides insight into the varied treatment options available.