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What You Should Know About Adult Scoliosis
Scoliosis is defined as a curve of the spine of 10 degrees. Adult scoliosis is broadly defined as a curve in your spine of 10 degrees or greater in a person 18 years of age or older. Adult scoliosis is separated into 2 common categories:
- Adult Idiopathic Scoliosis patients have had scoliosis since childhood or as a teenager and have grown into adulthood. We do not yet know the cause of idiopathic scoliosis, but there is a lot of genetic work going on in an attempt to answer this question.
- Adult "De Novo" or Degenerative Scoliosis develops in adulthood. Degenerative scoliosis develops as a result of disc degeneration. As the disc degenerates, it loses height. If one side of the disc degenerates more rapidly than the other, the disc begins to tilt. As it tilts, more pressure is placed on one side of your spine and gravity tends to cause the spine to bend and curve. The more discs that degenerate, the more the spine begins to curve.
Both types of adult scoliosis can progress over time. If the curves reach 30 to 40 degrees, the deformity may be noticed by a hump or prominence in the area of the spine that is involved. Curves that reach 50 degrees or greater, may progress more rapidly then those that are less than 50 degrees. Adults with large curves may have symptoms of back pain, and if it progresses above 80 degrees in the thoracic spine, they may complain of shortness of breath with activity. The shortness of breath is due to the affect on lung function. Rarely does adult scoliosis alone cause paralysis or other severe neurologic problems, but it can be associated with lumbar stenosis (narrowing of the spinal canal or tube where the nerves lay), which can result in nerve irritation, leg pain and possibly weakness. Patients can also develop a posture that is pitched forward, and be unable to stand up straight. This can be occur with scoliosis and with age as the discs degenerate.
Scoliosis can be recognized and diagnosed with a clinical exam, but xrays are necessary to fully evaluate the magnitude and type of scoliosis present. For a proper scoliosis evaluation, full length, whole spine xrays need to be performed. An MRI may also be recommended if there are symptoms of leg pain that may be associated with stenosis or if there is concern about possible spinal cord compression or abnormalities.
The treatment of adult scoliosis is very individualized and based on the specific symptoms and age of the patient. Many patients have scoliosis and have very minor symptoms and live with it without treatment. Patients with predominant symptoms of back pain would typically be treated with physical therapy. Patients with back pain and leg pain may receive some benefit from injection treatment to help relieve the leg pain. If lumbar stenosis (narrowing of the spinal canal) is present and is unresponsive to non-surgical treatment, then a decompression( removal of bone and ligaments pressing on the nerves) may be recommended. If the scoliosis is greater than 30 degrees, a fusion procedure will most likely be recommended along with the decompression. The fusion is recommended to prevent the curve from progressing when the spine is destabilized by the bone removal that is necessary to decompress the nerves. Fusions are usually accompanied with metal rod and screw placement into the spine to help correct and stabilize the scoliosis and help the bone heal or fuse together. The length of the fusion, or the number of spine levels included, depends on the type of scoliosis and the area of the spine involved. The goal of adult scoliosis surgery is to first remove pressure on the nerves, and second to keep the scoliosis from progressing further.