Principles for Selecting Fusion Levels in Adult Spinal Deformity With Particular Attention to Lumbar Curves and Double Major Curves

In Brief Study Design. Review article. Objectives. To identify decision-making principles for selecting fusion levels in adult spinal deformity, with particular attention to lumbar curves and double major curves. Summary of Background Data. Although numerous articles have been published on the selection of fusion levels for adolescent idiopathic scoliosis (AIS) curves, relatively less attention has been paid to the selection of fusion levels for the operative management of adult scoliosis. Methods. This is a literature review pertaining to the surgical management of adult scoliosis. Results. Selection of fusion levels for adult scoliosis can be difficult; however, certain biomechanical and surgical principles can consistently be applied. Conclusion. An appreciation of both the coronal and sagittal plane components of spinal deformity is mandatory to achieve optimal results with surgical stabilization of adult scoliosis. Operative treatment of adult spinal deformity is generally undertaken for pain, progressive deformity, and/or neurologic deficit. Certain biomechanical and surgical principles can be applied with consistent surgical outcomes when approaching the adult patient with scoliosis.