Multidimensional Management of Degenerative Scoliosis: A Comprehensive Narrative Review Integrating Diagnostic Assessment, Surgical Decision-Making, and Patient-Centered Outcomes.

Degenerative scoliosis (DS) is a common spinal deformity in aging populations and an important contributor to low back pain, neurological symptoms, and functional decline. Unlike adolescent idiopathic scoliosis, DS develops in a previously non-scoliotic spine through progressive asymmetric degeneration of the intervertebral disks, facet joints, and supporting spinal structures. Despite its growing clinical burden, management remains heterogeneous, with decision-making often fragmented across radiographic assessment, treatment planning, and postoperative outcome evaluation. Building on previous reviews of DS, this article provides a structured clinical update that organizes contemporary evidence across diagnostic assessment, individualized treatment selection, perioperative risk optimization, and patient-centered outcomes. A narrative literature review was conducted to evaluate current concepts in DS diagnosis, risk stratification, treatment strategies, and patient-centered outcomes. Relevant literature from major biomedical databases was identified and qualitatively synthesized according to clinical relevance. Current evidence supports a comprehensive assessment of DS that integrates deformity morphology, spinopelvic alignment, segmental degeneration, neurological status, bone quality, and patient-specific risk factors. Beyond coronal Cobb angle measurement, advanced imaging and alignment parameters may provide complementary information for phenotyping and treatment planning. The literature increasingly supports individualized treatment selection based on deformity severity, sagittal imbalance, physiological reserve, neurological status, and functional goals, with options ranging from nonoperative care to minimally invasive or more extensive reconstructive procedures. Surgical planning may also incorporate alignment objectives, biomechanical considerations, complication risk, frailty, and patient-reported outcomes. DS management is evolving from deformity correction-centered strategies toward a multidimensional, patient-centered paradigm. This narrative review synthesizes current evidence across diagnostic evaluation, individualized treatment selection, surgical planning, and outcome assessment while recognizing that many management strategies remain supported by heterogeneous evidence and require patient-specific consideration. Future research is needed to refine predictive models, personalized alignment strategies, and emerging technology-assisted approaches.