Adult Degenerative Scoliosis

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Scoliosis, or abnormal curvature of the spine, is often only associated with adolescents. However, adults can have scoliosis too. Adult scoliosis is defined as abnormal curvature of the spine in a patient over the age of 18. Sometimes adult scoliosis results from untreated childhood curvature that has progressed. When scoliosis develops during adulthood without a history of childhood curvature, it is usually classified as adult degenerative scoliosis.  

Symptoms

Changes to the body caused by the aging process may result in degenerative spinal conditions.  When parts of the vertebral column begin to age, some people begin to experience back or neck pain.  Common degenerative spinal conditions include:

• Spinal stenosis
• Degenerative disc disease
• Osteoporosis
• Vertebral compression fractures

Sometimes, the effects of these conditions cause the spine to curve to the left or right.  Abnormal curvature can cause:
 

• Trunk imbalance; the patient appears to be list to one side
• Spinal instability
• Rib prominence on either side
• Humpback
• Irregular gait caused by leg length discepancy
• Pain
• Difficulty sitting or standing
• Spinal stiffness, rigidity
• Nerve damage
• Cardiopulmonary (heart and lung) problems

Video:Scoliosis
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Diagnosis

The accurate diagnosis of adult degenerative scoliosis or other forms of scoliosis should be made by a physician expert in spinal disorders.

• Medical History 
  The physician asks you about your symptoms, their severity, onset, treatments you tried, and if other family members have scoliosis.

• Physical Examination
  Movement limitations and problems with balance are evaluated.  He tests your reflexes, muscle strength, sensation, and signs of neurologic dysfunction. The exam includes bending sideways, forward and backward at the waist, and walking.  The doctor may measure both legs to see if there is any difference in length.

• Diagnostic Tests
  Standing X-rays (front to side) are usually taken and sometimes X-rays are taken where the patient bends in order to evaluate spinal flexibility. In some cases, a CT scan, an MRI, or myelography are needed.

Treatment

Most cases of adult scoliosis are treated without surgery.  Treatment may include:
 

• Observation of the curve for possible progression
• Pain and anti-inflammatory medications
• Back exercises for posture and strength
• Moist heat
• In some cases, bracing may be used (but only to control pain, not to correct the deformity)

Surgical correction of adult degenerative scoliosis is uncommon.  However, it may be necessary if:
 

• Non-operative treatment fails and pain persists
• Curvature is progressive or excessive (curves greater than 45-degrees)
• Curvature causes cardiopulmonary problems (heart, lung)

If spine surgery is necessary, it may include spinal instrumentation with fusion.  Instrumentation (i.e., rods, screws) and fusion (bone graft) join two or more vertebrae and stabilizes the spine. The surgeon discusses surgical procedures that may be helpful and their associated risks and benefits if you are a candidate for surgery.  

Many cases of adult scoliosis need no treatment at all.  Adult scoliosis may in some cases  be helped by lifestyle changes, such as losing weight, improved diet, smoking cessation, and regular exercise.