Overview of operative modalities and their functional outcomes for adult degenerative scoliosis: How to chose wisely!

Adult degenerative scoliosis presents with various symptoms, including back pain, leg pain, claudication, and radiological findings like coronal / sagittal imbalance. So In our study, we have put forth an algorithm to categorise the patients for suitable operative management. This was prospective study of 30 patients. Patients with age 50 and above and ones who had no relief/worsening of symptoms after 6 months of conservative management were included. Patients were categorised into 3 groups. Patients were either treated with Focal Decompression / Decompression and long instrumented fusion with correction of deformity /Decompression only. MODI and SF36 scores were compared at the end of 2 years.11 patients were categorised into group A, 15 into group B and, 4 patients who had significant co-morbidities and had very high risk for surgery were categorised into group 3. There was significant (p <.001) improvement in average MODI scores in both group A and group B at the end of 2 years. Improvement was seen in average MODI scores of patients in group 3, but it was not statistically significant. SF-36 score showed significant improvement in Group A and group B at the end of 2 years (p <.001). Patients from group 3 also showed improvement in average scores, but that was not significant.Not every case needs long stabilization, focal decompression only also gives satisfactory outcome in properly selected patients. In patients operated by Instrumented fusion, Sagittal balance also plays a crucial role in functional outcome.