Perioperative management of the adult scoliosis patient
Scoliosis in adults presents a uniquely different set of challenges to spine surgeons than scoliosis in the pediatric and adolescent population. The outcome of the corrective procedure in adult deformity revolves not only on meticulous surgical planning and technique but also upon optimization of a host of perioperative variables. Medical comorbidities related to advanced age are fairly common and need to be adequately controlled prior to surgery. Attenuated physiological response mechanisms to surgery-related stress in the geriatric population also require careful consideration. Anesthesia-related risk in the elderly, excessive blood loss during surgery, complications arising secondary to prolonged surgical time, the decision to stage a procedure, and maintenance of optimal nutritional status during hospitalization are the factors that play a crucial role in the perioperative management of adult spinal deformity patients. This review elaborates upon all such variables that a surgeon may come across in managing spinal deformity in the elderly and describes strategies to address them.