Adult degenerative scoliosis

No. This curve does not come from adolescence, it is produced by wear: first the natural lumbar curve flattens and then the vertebrae tilt and shift. The origin is different and so is the treatment.

Usually not. A curved spine may not hurt if it is balanced; what causes fatigue and pain is the head no longer lining up over the pelvis. The underlying problem is usually that loss of sagittal balance — the one seen from the side — so correcting the sideways tilt alone falls short.

That is a reasonable worry and it shapes the strategy. As these are usually older patients, I favour low-aggression options — lateral and oblique routes, percutaneous fixation — and, when appropriate, I spread the correction over more than one operation rather than proposing a single long procedure.

They often come together, and frequently the correction itself resolves part of the compression: by restoring disc height through a lateral or oblique route, the canal and foramina gain calibre without removing bone. How much can be solved that way depends on where the narrowing is.