Scoliosis: surgical versus nonsurgical treatment.

UNLABELLED: This article reviews the nonoperative and operative decision making process in idiopathic scoliosis in the adolescent and adult with additional comments about degenerative scoliosis. Because knowledge of the natural history of idiopathic scoliosis is essential for decision making, this will be covered first, as will the current knowledge concerning the long term outcomes of nonoperative and operative treatment. With the natural history as a background, I will discuss how the factors that are important in natural history effect decision making in the adolescent and adult. By using an evidence-based approach, hopefully a better decision-making process will result in improved outcomes. Additional treatment decisions regarding the choice of the specific nonoperative treatment methods as well as surgical decisions (fusion levels, approach, choice of implants) will not be covered. LEVEL OF EVIDENCE: Therapeutic study, level V (expert opinion). See the Guidelines for Authors for a complete description of the levels of evidence.