Adult Idiopathic Scoliosis
Adult scoliosis is the abnormal curvature of the spine giving the spine an “S” or “C” shape in a skeletally mature person. Larger curves cause discomfort while smaller curves usually do not cause any problems. In most cases, the exact cause remains unknown. However adult scoliosis can develop as a result of:
- Untreated childhood scoliosis
- Inherent, age-related changes occurring in the body
- Certain diseases affecting the spine
Symptoms of Adult Scoliosis
Scoliosis can lead to physical deformities such as humpback, prominence of the ribs, uneven shoulders, tilting of the trunk to one side and head not in center position. It also causes altered gait, spinal instability and rigidity. Pain is the predominant symptom in patients suffering from scoliosis. A compression of the spinal nerve root can result in lower limb weakness along with numbness or tingling sensation. This may hamper coordination and balance with difficulty in movement, standing or sitting. Rarely, compression of the lower spinal nerves can also lead to loss of bladder or bowel control. This requires immediate medical care. In severe cases, lung and heart (cardiopulmonary) function can be affected.
Diagnosis of Adult Scoliosis
A diagnosis of adult degenerative scoliosis involves:
- A detailed medical and family history of the patient
- Neurological examination with testing of reflexes to evaluate muscle weakness, sensitivity, and other signs of neurological injury
- Physical examination to evaluate the spinal deformity and mobility
Diagnostic imaging techniques such as X-rays, CT scan, MRI scans and myelography may also be used to improve the accuracy of diagnosis.
Most patients with adult scoliosis do not require surgery. Non-surgical treatment includes analgesics and anti-inflammatory medications, spinal injections, and physical therapy. Simple lifestyle modifications such as improved nutrition, smoking cessation and regular exercise may also help in the management of symptoms associated with scoliosis.
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 further curve progression.
The surgery utilizes rods, screws, and other types of spinal instrumentation to straighten the spine. These are fixed to the vertebrae involved in the curve and the correction is performed. Removal of the intervertebral disc (discectomy) and fusion of the involved vertebrae may also be performed during the surgery. Fusion fuses the involved vertebrae permanently into a single solid bone by placing bone grafts or bone graft substitutes in between the affected vertebrae.
There are different surgical approaches to repair the spinal deformity. The choice of the approach depends on the type of scoliosis, location of the curvature of the spine, ease of approach to the area of the curve and the preference of the surgeon.
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
- Medical complications such as heart attacks, strokes, or respiratory failure that can cause serious injury or even death