{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T23:15:17Z","timestamp":1783379717224,"version":"3.54.6"},"reference-count":43,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T00:00:00Z","timestamp":1783382400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Adult Degenerative Scoliosis (ADS) is an age-related, progressive, three-dimensional spinal deformity driven by asymmetric degeneration of the intervertebral discs, facet joints, and supporting soft tissues. With population aging, ADS is increasingly recognized as a major contributor to pain, disability, loss of independence, and healthcare utilization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This narrative review synthesizes evidence around three core challenges in the clinical management of ADS: (1) diagnostic difficulty due to heterogeneous etiology and symptom overlap with other degenerative conditions, (2) multidimensional chronic pain requiring multimodal, longitudinal strategies, and (3) high-stakes surgical decision-making that must balance deformity correction against complication risk and patient expectations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and key content<\/jats:title>\n                    <jats:p>We integrate contemporary concepts from adult spinal deformity classification and alignment targets, clinical and imaging assessment, and both nonoperative and operative treatment pathways. Particular emphasis is placed on standing full-spine radiographs and spinopelvic parameters, the mixed mechanical and neurogenic pain phenotypes that typify ADS, and stratified surgical strategies ranging from decompression alone to long-segment fusion with osteotomy. We also summarize major complications (e.g., proximal junctional kyphosis, pseudarthrosis, implant failure, infection) and their implications for counseling and risk mitigation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>ADS care benefits from a patient-centered, individualized, and multidisciplinary strategy. Future work should prioritize accurate prognostic models, minimally invasive and alignment-restoring techniques with lower morbidity, and durable approaches for long-term pain control and function preservation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1807406","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T22:40:34Z","timestamp":1783377634000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Adult degenerative scoliosis: challenges in diagnosis, pain management, and surgical decision-making"],"prefix":"10.3389","volume":"13","author":[{"given":"Shuiwang","family":"Zhao","sequence":"first","affiliation":[{"name":"Dazhou Vocational College of Chinese Medicine","place":["Dazhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaxin","family":"Liu","sequence":"additional","affiliation":[{"name":"Rehabilitation Medicine 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