Spinal deformities in adults present a different set of challenges than those seen in children or adolescents. Degenerative changes weakened bone quality, and prior surgical interventions often complicate treatment. Dr. Larry Davidson, a leading figure in the field of minimally invasive spinal surgery, has treated many adult patients with complex deformities, highlighting the need for surgical strategies tailored to aging spines. His approach underscores that adult spinal deformity care must balance structural correction with safety, durability and quality of life.

For adults, achieving lasting results often requires a combination of advanced fixation techniques, bone-strengthening strategies and careful management of comorbidities. Minimally invasive methods, biologics to enhance bone healing and personalized rehabilitation plans all play a role in improving outcomes. By addressing both the mechanical challenges of the spine and the overall health of the patient, modern approaches to adult deformity care aim to deliver not just correction, but also long-term stability and restored function.

Understanding Adult Spinal Deformity

Unlike pediatric scoliosis, which often develops during growth, adult deformities are frequently linked to degeneration. Conditions such as arthritis, disc collapse and ligament weakening contribute to abnormal curvatures over time. These changes can lead to scoliosis, kyphosis or combined patterns that affect posture, mobility and comfort.

Adult deformities are often accompanied by back pain, leg weakness, or nerve compression that limits daily activities. For many patients, the impact extends beyond physical symptoms, affecting independence and emotional well-being. The underlying cause of deformity is the first step in planning treatment. Degenerative deformities require different approaches than congenital or adolescent cases, and surgical decisions must reflect these differences.

The Impact of Osteoporosis

Osteoporosis is a common factor in adult spinal deformity. Weakened bones increase the risk of fractures, reduce the strength of fixation, and complicate fusion. Patients with osteoporosis may require specialized implants or bone-strengthening treatments to achieve stable corrections.

Modern instrumentation, such as expandable screws and augmented fixation techniques, has improved outcomes for osteoporotic patients. Cement augmentation, where bone cement is used to reinforce screws, provides additional support in fragile bone. Osteoporosis cannot be overlooked in surgical planning. Assessing bone density and treating it before and after surgery improves stability and reduces the likelihood of hardware failure.

Revision Surgeries in Adult Patients

Many adults with spinal deformity have undergone prior surgeries, creating additional challenges. Scar tissue, altered anatomy and weakened bone structures make revision procedures more complex than initial corrections. Revision surgeries often involve removing or replacing hardware, addressing non-union where fusion has not occurred, or correcting progressive deformities. Each case requires careful evaluation, advanced imaging and meticulous planning.

Surgical Goals in Adult Deformity Correction

The goals of surgery for adult spinal deformity often differ from those in pediatric cases. While younger patients may prioritize cosmetic improvement, adults are typically focused on reducing pain, improving mobility and maintaining independence. Surgical strategies aim to restore balance, relieve pressure on nerves and provide stable fixation that can withstand the demands of aging. Fusion procedures are common, as stabilizing the spine helps prevent further degeneration and protects the surgical corrections. Patient-centered planning is essential. By aligning surgical approaches with each individual’s priorities, surgeons can achieve outcomes that enhance both function and quality of life.

Dr. Larry Davidson notes, “In adult spinal deformity surgery, the goal isn’t a perfect X-ray, it’s restoring comfort, mobility and independence.” This perspective underscores the focus on functional outcomes, emphasizing that surgical success is measured by a patient’s ability to live fully, not just by what imaging shows.

The Role of Advanced Imaging and Navigation

Adult deformity cases often involve complex anatomy altered by degeneration or prior surgeries. Advanced imaging and computer navigation are vital in these situations, providing real-time guidance during hardware placement and correction.

Three-dimensional imaging helps surgeons anticipate challenges, plan implant placement and minimize complications. Intraoperative navigation guides the accurate insertion of rods and screws, even in fragile or distorted bone. Incorporating these tools into practice shows how precision technology enhances safety in complex adult spinal cases.

Rehabilitation and Recovery for Adults

Recovery after adult deformity surgery can be lengthy and influenced by age, bone health and overall fitness. Rehabilitation focuses on restoring strength, balance, and endurance while also addressing pain management and functional independence.

For older adults, rehabilitation often includes adaptive strategies for daily activities to support long-term independence. Multidisciplinary teams of therapists, pain specialists and rehabilitation physicians play a vital role in this process. Setting realistic expectations is important, as adult patients may face longer recoveries than younger individuals. With structured support, however, they can achieve significant improvements in comfort, mobility and overall quality of life.

Risks and Complications

Adult spinal deformity surgery carries higher risks than pediatric procedures. Complications such as blood loss, infection, and non-union are more common in older patients, particularly those with comorbidities like diabetes or cardiovascular disease.

Close monitoring and comprehensive preoperative assessment help reduce these risks. Optimizing patient health before surgery, through nutrition, physical conditioning and medical management, supports better outcomes. Transparency with patients is vital. By discussing potential complications and strategies to address them, surgeons build trust and support informed decision-making.

Athletes and Active Adults

Not all adult spinal deformity patients are elderly. Active adults and older athletes may also require surgery for degenerative deformities. For these patients, the goal often includes returning to activity, while maintaining spinal balance. Modern techniques, such as minimally invasive decompression combined with stabilization, support faster recovery and help preserve mobility. Surgical strategies can be tailored to active adults who wish to continue sports or recreational activities, addressing both correction and performance goals.

Education and Training for Adult Deformity Surgery

Treating adult spinal deformities requires specialized expertise. Surgeons must understand the interplay of degeneration, osteoporosis and prior interventions, while also mastering advanced tools and revision strategies. Training programs now include modules focused specifically on adult deformity care. The future of adult spinal deformity surgery includes continued advances in materials, biologics and minimally invasive techniques. Patient-specific implants and regenerative treatments may improve outcomes further, particularly for those with osteoporosis or complex revisions.

Adult spinal deformities pose unique surgical challenges, including degenerative changes, osteoporosis and complex revision procedures. Advances in surgical tools, imaging and clinical expertise have made it possible to address these deformities, safely and effectively. This experience highlights the importance of tailoring strategies to each adult patient’s needs. Emphasizing patient-centered outcomes allows surgery to address more than just alignment, supporting the restoration of function, independence and confidence for adults managing the challenges of spinal deformity.