Adult Degenerative Scoliosis

Certain types of spinal curves are normal and necessary to absorb and distribute body weight at rest and during movement.  However, scoliosis is an abnormal side-to-side curvature of the spine.  Although scoliosis is usually associated with children and adolescents, adults can have scoliosis too.

Adult scoliosis is defined as abnormal curvature of the spine in a patient older than age 18.  If childhood scoliosis was not discovered or untreated, the abnormal curve may become larger as the patient ages and degenerative spinal changes occur.  Scoliosis that develops during adulthood, without a history of childhood curvature, it is usually classified as adult degenerative scoliosis.  Adult degenerative scoliosis usually affects the thoracic (mid-back) and/or lumbar (low back) spine.

 
Figure 1: Posterior views of the thoracic spine.
Normal spine (left) and scoliosis (right) illustrated.

 

Degenerative Causes of Adult Scoliosis

Age-related body changes are normal, although genetics (uncontrollable) and lifestyle (controllable) can slow down or accelerate the process.  From the start of life, change begins at the cellular level.  While most cellular activity is essential for health and well-being, sometimes a degenerative disorder of the spine develops.  Perhaps injury from a past car accident or everyday tasks have led to long-term spinal stress that cascades to cause symptoms such as back or neck pain.

Common degenerative spinal conditions that may contribute to the development of adult degenerative scoliosis include:

While the degenerative process is not completely understood, even by the most knowledgeable scientists or medical research experts, it is known that small changes in spine structures can lead to greater alterations.  In other words, each disorder listed above can become detrimental and contribute to spinal instability and functional problems.


Figure 2: Examples of Degenerative Disorders

 

Symptoms of Adult Degenerative Scoliosis

Symptoms related to adult degenerative scoliosis may progress or contribute to abnormal spinal curvature and in some cases, deformity.  Symptoms may include:

  • Trunk imbalance; listing to one
  • Spinal instability
  • Rib prominence on left or right side
  • Humpback (hunched back)
  • Leg length discrepancy, irregular walking pattern
  • Pain
  • Difficulty sitting, standing
  • Stiff or rigid
  • Nerve damage
  • Cardiopulmonary (heart and lung) problems; difficulty breathing

 

Accurate Diagnosis Essential

Doctor Frazier carefully analyzes your written medical history and opens up discussion by asking you many questions about your symptoms, when symptoms started, treatments tried, hereditary disorders, existing conditions, and lifestyle.

During the physical and neurological examinations, Dr. Frazier evaluates movement limitations, problems with balance, location of pain.  He reviews possible loss of arm or leg reflexes, muscle weakness, loss of feeling and/or abnormal sensations such as numbness or tingling.

Diagnostic tests may be necessary to reveal more information about your symptoms and to confirm your diagnosis.  To ensure the most accurate diagnosis, Dr. Frazier has access to a complete range of advanced diagnostic equipment including high-speed Magnetic Resonance Imaging (MRI), Computerized Tomography (CT scan), bone densitometry (DEXA), myelography, and discography.

 

Nonsurgical Treatment

Seldom is spine surgery necessary to treat adult degenerative scoliosis.  Usually, nonsurgical care targets control, management, and relief of symptoms.  Nonsurgical interventions include:

  • Monitor curve for progression
  • Medications to treat inflammation and pain
  • Moist heat
  • Physical therapy to improve posture, flexibility and strength
  • Bracing to control pain
  • Injection therapies such as epidural steroid injections, trigger point injections, nerve root blocks, facet joint injections to relieve symptoms

 

When Spine Surgery May Be Recommended

A surgical recommendation may be made after nonsurgical treatments are exhausted, certain symptoms progress, and/or pain is unrelenting.  Of course, your individual treatment is adjusted to ease symptoms, restore and maintain function, and help you to lead an active and productive life.

In general, spine surgery to treat adult degenerative scoliosis may become necessary if:

  • Pain is unrelenting, disabling and unresponsive to nonoperative treatment
  • Scoliotic curvature is greater than 45-degrees, becomes progressive
  • Cardiopulmonary problems develop or worsen

 

Surgical Treatment of Adult Degenerative Scoliosis

If Dr. Frazier recommends spine surgery, he will carefully explain to you:

  • Why he recommends spine surgery
  • How surgery may be of benefit
  • Possible risks and complications
  • When (how soon) is surgical treatment needed
  • Procedure name and type
  • How to prepare for surgery
  • Surgery aftercare and recovery

Understanding your diagnosis and particulars about your spine surgery is essential to making an informed treatment decision.  Dr. Frazier and his professional staff have a deep commitment to patient education and welcome all questions.