**3. Conclusion**

Within the current literature there remain significant deficits in our understanding of the functional effects of ASD and its treatments. It is clear that this condition causes severe disability with significant pain, functional limitations with most ADLs and poor QoL. Non-operative management options do not resolve the spinal imbalance which appears to be the biggest determinant of improved patient outcome and therefore little evidence exists for its efficacy. In contrast, operative intervention has improved patient outcomes, but with high expense and complication rates. Future treatment strategies should therefore focus on enhancing functional outcomes, whilst limiting risk and expense. Furthermore, a holistic biopsychosocial approach should be provided if all factors influencing outcome are to be addressed.
