Treatment The treatment of adult scoliosis is determined primarily by the patient’s symptoms. The physician must have a thorough understanding of the patient and be aware of the effects of the deformity (and related symptoms) and the patient’s expectations for treatment. What is an acceptable level of function for one patient may be intolerable for others. Non-surgical treatment should be preferred except for patients with significant combined neurological impairment or severe progressive scoliosis. Typical non-surgical therapies include physical therapy (strengthening of the low back muscles), activity modification, medications, and analgesia (including injections). Every effort should be made to use non-operative therapies to address the pain associated with the deformity. When to consider surgery? Simply put, surgery is used for severe or progressive deformities, or for severe cases that are not well treated with non-surgical treatments. In general, surgery is considered in younger adults with scoliosis above 50°, where the risk of continued progression of the deformity is higher. If surgery is considered for severe deformities or for patients for whom conservative treatment has failed, a careful analysis of the risks and benefits of surgery is required before a surgical plan is developed. Although minimally invasive techniques are occasionally used for adult scoliosis deformities, many procedures for adult spinal deformities involve a wide range of scope and risk and must be carefully considered. Age, co-morbidities, previous surgical history, degree of imbalance, expected fusion segment, and degree of functional degeneration may all influence the success and complications of the procedure. Despite significant surgical results, the risk of perioperative or postoperative complications is as high as 40%. Nonetheless, a recent large multicenter study of adult spinal deformities showed that the basic outcome assessment of patients 2 years after follow-up surgery was significantly better than before surgery. If surgical treatment is contemplated and the ratio of risks to benefits of surgery is considered feasible, careful preoperative preparation is required. The choice of medications, physical condition and post-surgical preparations (family support and rehabilitation programs) are all critical. Self-transfusion prior to surgery can also be helpful based on blood loss during surgery. Psychological preparation of the patient is also important. Surgery for adult spinal deformities is a major test for the entire medical team and the patient, who takes several months to recover and cannot see the results of the surgery in a short period of time. Complications may arise, and some patients require staged surgery and prolonged hospitalization. However, despite the need to take these serious factors into account, surgical treatment can significantly improve the patient’s quality of life when performed under detailed planning and for the appropriate patient.