What is Adult Scoliosis?
Adult scoliosis refers to a sideways and rotational curvature of the spine that is present after a patient has finished their growth. Scoliosis refers to a left or right curvature of the spine when viewed from behind or in front.
Scoliosis is a very common condition and is present in 2-3% of the population, or 6 to 7 million people in the United States.
Causes of Scoliosis in Adults
Scoliosis causes are categorized into two groups:
Non-structural scoliosis : This type of scoliosis presents as a structurally normal spine with a temporary or changing curve. Causes include:
- Differences in leg lengths
- Muscle Spasms
- Inflammatory conditions such as appendicitis
Structural scoliosis : This type of scoliosis presents with a fixed curve in the spine. Causes include:
- Birth defects
- Injury to the spine
- Neuromuscular diseases such as cerebral palsy and muscular dystrophy
- Connective Tissue Disorders
- Rheumatic Diseases
Scoliosis in adults can be caused by a variety of factors. Sometimes scoliosis in adults is simply scoliosis that developed as a teenager that has persisted into adulthood. This is called adult idiopathic scoliosis.
Other times, scoliosis results from degenerative disc disease with in many people over time can result in curvature of the spine. This type of scoliosis is called adult degenerative scoliosis or de novo scoliosis.
Less commonly, scoliosis can be a result of trauma or spinal fractures, compression fractures from osteoporosis, or congenital anomalies.
Scoliosis Symptoms in Adults
Many patients with adult scoliosis often have no symptoms at all and may not even know that they have scoliosis!
Unlike scoliosis in kids, however, adult scoliosis can become painful with time, especially if the curves progress and become large (greater than 40 degrees).
Scoliosis symptoms in adults are characterized by an imbalance of the spine, asymmetric shoulder heights, a rib hump, or uneven hips.
As the curvature progresses, scoliosis symptoms in adults can also include back pain as a result of degenerated discs, an inability to stand upright, or even nerve pain running down the leg as the scoliosis causes spinal stenosis and compression of the nerves.
Scoliosis Treatment in Adults
Treatment of Scoliosis is based on the physician’s assessment of the spinal curve, its cause, the age of the patient, and how much more the patient may grow. Treatment options include:
- Observation : Your physician may want to see you every 4-6 months to monitor the curve if your scoliosis is mild with a curve of less than 25 degrees.
- Bracing : Your physician may recommend wearing a brace to prevent the curve from worsening while the patient is still growing or if your curve is greater than 30 degrees.
Most patients with adult scoliosis do not require surgical treatment. The initial phases of adult scoliosis treatment focuses on physical therapy, a low-impact regular aerobic exercise program, and core and back strengthening.
The more fit and active a patient is, the less likely it will be that the scoliosis will cause symptoms.
If patients are overweight or smoke cigarettes, a weight loss program and quitting smoking will help reduce scoliosis symptoms.
Chiropractic treatment or spinal mobilization techniques can also help with the symptoms of scoliosis. It is important to note that while these treatments can help reduce the symptoms of scoliosis, none of these methods have been shown to correct or reduce the size of the spinal curvature.
If symptoms are persistent, medications such as anti-inflammatories or nerve-specific medications can sometimes be used to help with symptoms.
Steroid injections performed by physiatrists or anesthesiologists trained in pain management (such as epidural injections, facet injections, nerve blocks, or ablations) can also sometimes help with adult scoliosis symptoms if non-invasive treatments have failed.
Surgery : If the patient is still growing and the curve is over 40 degrees, or is worsening, surgery may be recommended. The most common surgical procedure for Scoliosis is correction, stabilization, and fusion of the curve.
Surgery for adult scoliosis is reserved for when extensive conservative non-operative treatment has failed to relieve scoliosis symptoms.
The goals of scoliosis surgery in adults are to partially correct the scoliosis, restore proper spinal balance to allow the patient to stand upright, and to relieve nerve compression from spinal stenosis.
Spinal reconstruction surgery for adult scoliosis is highly complex and should only be performed by surgeons who are trained in the latest techniques for scoliosis treatment in adults.
There are a variety of approaches that can be used, and the best operation is individualized for every patient’s specific needs and goals after careful review of the patient’s history, physical exam, and imaging studies (x-rays, MRI, CT scans).
The goal of surgery is to perform the least invasive operation that will provide the patient with decreased pain, increased function, and with the least risk of complications.