Management of thoracolumbar curves in adolescent idiopathic scoliosis

The surgical management of thoracolumbar/lumbar (TL/L) curves in adolescent idiopathic scoliosis (AIS) has evolved significantly over the past two decades. Anterior spinal fusion (ASF), which had been the preferred option, has largely been replaced by posterior spinal fusion (PSF) with pedicle screw constructs due to excellent correction, better control over the sagittal alignment, and decreased morbidity. This transition has refined focus on the selection of the optimal upper (UIV) and lower instrumented vertebrae (LIV), as these are key to achieving long-term correction while avoiding complications such as proximal junctional kyphosis (PJK) and coronal imbalance (CIB).