Debate: Determining the Upper Instrumented Vertebra in the Management of Adult Degenerative Scoliosis.

The determination of fusion levels for degenerative adult scoliosis requires a detailed evaluation of the spinal deformity and an analysis of the degenerative changes of the entire spinal pelvic axis. Many patients with degenerative lumbar scoliosis do not need surgical treatment, and their low back pain can be managed by conservative measures.[13] However, there is a well-defined group of patients who present with severe intractable low back pain, spinal stenosis with radiculopathy or neurogenic claudication, and progressive spinal deformity in the coronal and sagittal plane. Dr. Suk raises the possibility that the choice of the UIV in adult degenerative scoliosis may have a similar impact on long-term spinal construct durability, and adjacent segment degeneration in the adult degenerative scoliosis patient. [Extracted from the article]