Adult Degenerative Scoliosis

Scoliosis is a condition characterized by an abnormal sideward curvature of the spine. Adult degenerative scoliosis is defined as abnormal curvature of the spine in individuals over 18 years of age. It can affect the thoracic (mid back) or the lumbar (lower back) region of the spine.

Causes

Adult degenerative scoliosis results from degenerative changes in the spine due to aging. Sometimes, it can result from a progression of an untreated childhood curvature. Degenerative spinal conditions may also cause the spine to curve to the left or the right and cause patients to have difficulty standing upright.

Symptoms

The most common symptom of adult degenerative scoliosis is back pain. You may also notice an abnormal curvature of the spine, entire body leaning to one side or leaning forward, unstable spine, prominent ribs on either side, humpback deformity (abnormal backward curve), abnormal gait, and a rigid and stiff spine.

Degeneration of the spine and the spinal deformity may cause pressure on nerves and the spinal cord, resulting in weakness, numbness, and pain in the lower extremities. If the spinal cord is compressed it may cause loss of coordination in the muscles of the legs making it difficult to walk, stand or sit. Rarely, compression of the nerves may cause impaired bowel or bladder function.

Diagnosis

Your physician will diagnose scoliosis based on your presenting signs and symptoms and physical examination. Your doctor will perform a physical examination and a neurological examination to evaluate your spinal posture, mobility, sensation, reflexes, and the strength of the muscles. Diagnostic tools such as X-rays, computed tomography (CT) or magnetic resonance imaging (MRI) scans may also be used to determine the compression of any nerves.

Treatment

Treatment of scoliosis is based on your physician’s assessment of the spinal curve and your neurological symptoms. Not every patient with degenerative scoliosis requires surgical treatment. Lifestyle changes such as abstinence from smoking, weight loss, eating a healthy diet, and regular exercise are helpful in alleviating the symptoms of degenerative scoliosis. Most cases are treated using non-surgical methods such as anti-inflammatory and pain medications, physical therapy, spinal injections, and braces to control pain.

Spinal reconstruction surgery is an option for individuals with excessive curvature and/or neurologic symptoms that have failed conservative treatments. Surgery for scoliosis involves correction, stabilization, and fusion of the vertebrae responsible for the curve as well as decompression of nerves that are being compressed. The surgery stabilizes the spine, relieves pressures on the nerves, and prevents future curve progression.

Risks and complications

Common complications after spinal reconstruction surgery for scoliosis may include:

  • Urinary tract infections
  • Lung infections such as pneumonia
  • Superficial wound infections
  • Dural tear causing leakage of spinal fluid
  • Blood loss requiring transfusion
  • Confusion and disorientation in the hospital
  • Blockage of the intestine causing abdominal swelling and pain (ileus)
  • Blood clot formation

More rare complications after spinal reconstruction surgery for scoliosis may include:

  • Failure of the bone to join together (pseudarthrosis)
  • Rod breakage
  • Nerve damage causing muscle weakness or numbness
  • Spine Infection
  • Paralysis
  • Blindness
  • Medical complications such as heart attacks, strokes, or respiratory failure that can cause serious injury or even death