Scoliosis is a three-dimensional spinal deformity characterized by lateral curvature and vertebral rotation, but its anaesthetic implications extend far beyond the spine. Behind the visible deformity lies a diverse range of pathophysiological changes, associated conditions and perioperative risks. Severe thoracic scoliosis may cause restrictive respiratory impairment and pulmonary hypertension, while neuromuscular and syndromic conditions introduce additional respiratory, cardiac and pharmacological considerations. In adults with degenerative scoliosis, risk is more commonly determined by frailty, multimorbidity and the complexity of surgery. Safe anaesthetic management requires comprehensive preoperative assessment and careful planning for a prolonged procedure in the prone position. Intraoperative priorities include securing the airway, invasive arterial monitoring, meticulous positioning, maintenance of spinal cord perfusion and preparation for potentially major blood loss. Total intravenous anaesthesia facilitates reliable somatosensory and motor evoked potential monitoring during deformity correction. Blood-conservation strategies, multimodal analgesia and individualized postoperative care are also essential. This review explores the pathophysiology of scoliosis and summarizes the key practical considerations for its perioperative anaesthetic management.
