The Challenge of the Lumbosacral Fractional Curve in the Setting of Adult Degenerative Scoliosis.

Adult degenerative scoliosis treatment is complicated by its predilection for an elderly patient population that often exhibits multiple unrelated medical comorbidities. As spine surgeons attempt to treat this disease process with less invasive solutions, the fractional curve at L4, L5, and S1 is often overlooked or undertreated secondary to required increased perioperative morbidity associated with its treatment. A treatment strategy to identify, address, and treat the fractional curve with either open or minimally invasive techniques can lead to improved patient outcomes and decreased revision rates in this complicated pathologic process.