Do all patients with adult scoliosis need instrumented fusion from T10 to the pelvis?

In this review article, the authors describe the thought process, alternatives, and approaches to adult spinal deformity. Although fusion of the entire major curve of scoliosis is certainly reasonable and necessary in certain cases, the authors discuss conditions in which shorter constructs may be considered. They also discuss when it is important to fuse both the major and fractional curves and when shorter constructs are not ideal. Factors that favor choosing an upper instrumented vertebral level in the upper thoracic, lower thoracic, or lumbar spine are discussed. Case examples are presented, and decision-making considerations are discussed.