From the Research
The treatment for marked thoracolumbar scoliosis and rotoscoliosis in a 29-year-old female should prioritize a hybrid approach combining single-rod anterior instrumentation and shorter posterior instrumentation to the sacrum, as it demonstrates good long-term results with less morbidity and fewer complications compared to traditional anteroposterior surgery 1. This approach is supported by a retrospective consecutive case series of surgically treated patients with adult lumbar or thoracolumbar scoliosis, which showed significant improvement in thoracolumbar/lumbar curves and lumbosacral fractional curve, with a lower major complication rate compared to traditional anteroposterior surgery 1. Key considerations in the treatment of adult scoliosis include:
- Conservative management as the first line of treatment, including physical therapy and pain management
- Surgical intervention for severe cases, with a focus on spinal fusion with instrumentation to correct and stabilize the curve
- Individualized decision-making based on curve severity, symptoms, progression rate, and impact on quality of life
- Recovery from scoliosis surgery requiring 6-12 months for full recovery, with physical therapy beginning about 6 weeks post-operation While other studies have explored minimally invasive surgery for thoracolumbar spinal deformity 2, combined "hybrid" open and minimally invasive surgical correction of adult thoracolumbar scoliosis 3, and complications and radiographic correction in adult scoliosis following combined transpsoas extreme lateral interbody fusion and posterior pedicle screw instrumentation 4, the hybrid approach described in 1 is the most recent and highest quality study, making it the preferred treatment option. Additionally, rod derotation techniques can be a valuable tool in the surgical arsenal for the treatment of scoliosis, allowing for the transformation of a pathological scoliotic curve to normal physiological kyphosis or lordosis 5. However, the primary focus should remain on the hybrid approach outlined in 1, which offers a balanced and effective treatment strategy for marked thoracolumbar scoliosis and rotoscoliosis in a 29-year-old female.