Aebi's 2005 narrative review defines adult scoliosis (Cobb >10° at skeletal maturity) and proposes a four-type etiologic classification — primary degenerative, progressive idiopathic, secondary from pelvic obliquity, and secondary from metabolic bone disease — to guide systematic evaluation and treatment planning in a population that presents primarily with pain, not cosmetic deformity.
When evaluating an adult patient with lumbar scoliosis, use Aebi's four-type framework to identify the underlying driver — because a de novo degenerative curve (Type 1) with stenosis requires a different surgical strategy than a progressive idiopathic curve (Type 2) or an osteoporotic collapse curve (Type 3b).
Pay particular attention to the lumbosacral junction in any planned fusion: leaving an already-degenerated L5/S1 out of the construct risks rapid symptomatic deterioration, while including it demands circumferential fusion to minimize the 5–30% non-union risk.
Aebi's 2005 narrative review defines adult scoliosis (Cobb >10° at skeletal maturity) and proposes a four-type etiologic classification — primary degenerative, progressive idiopathic, secondary from pelvic obliquity, and secondary from metabolic bone disease — to guide systematic evaluation and treatment planning in a population that presents primarily with pain, not cosmetic deformity.
When evaluating an adult patient with lumbar scoliosis, use Aebi's four-type framework to identify the underlying driver — because a de novo degenerative curve (Type 1) with stenosis requires a different surgical strategy than a progressive idiopathic curve (Type 2) or an osteoporotic collapse curve (Type 3b).
Pay particular attention to the lumbosacral junction in any planned fusion: leaving an already-degenerated L5/S1 out of the construct risks rapid symptomatic deterioration, while including it demands circumferential fusion to minimize the 5–30% non-union risk.