Degenerative Adult Scoliosis
Degenerative Adult Scoliosis
Degenerative adult scoliosis is a condition that begins after the age of 40 years, and is attributed to deterioration of the spine. Osteoporosis will weaken the spinal bones (vertebrae), which causes abnormal spine curvature. The spine begins to sag as the degenerative condition worsens, creating a scoliotic curve.
What causes degenerative adult scoliosis?
Scoliosis that occurs in adulthood is often from a secondary cause. Conditions that contribute to degenerative adult scoliosis include osteoporosis, osteomalacia (softening of bones), and degenerative disc disease. In addition, scoliosis can appear after spinal surgery for other problems, such as a herniated disc.
Who gets degenerative adult scoliosis?
Degenerative adult scoliosis is usually diagnosed in people age 40 years and older who have a history of back pain. Diagnosis requires a lumbar curve of 10 degrees or more. Both men and women are affected equally, and the mean age at time of presentation is 70 years.
What are the symptoms of degenerative adult scoliosis?
Degenerative adult scoliosis usually begins as low back pain. Over time, and as the curvature worsens, a deformity causes the back to look peculiar, such as humpback (kyphosis). In addition, pain of the spine causes bony prominences to put pressure on spinal nerves, which can lead to arm or leg weakness, numbness, and tingling. Other symptoms include walking with a limp, leg length discrepancy, and breathing problems.
How is degenerative adult scoliosis diagnosed?
To diagnose degenerative adult scoliosis, the orthopedic specialist will:
- Take a medical history – Since scoliosis often runs in families, the doctor will ask questions about family members’ health issues. The doctor will also inquire about your symptoms, existing medical problems, and date of onset of back pain.
- Perform a physical examination – The doctor will examine your spine, assess nerve function, and evaluate muscle strength.
- Use diagnostic tests – X-rays are used to measure curve progression and size of rib hump. The doctor will use magnetic resonance imaging (MRI) scans to look at the spinal cord and nerves, and a computed tomography (CT) scan can help get a better picture of vertebrae bones.
How is degenerative adult scoliosis treated?
The treatment of degenerative scoliosis is usually conservative. Options include:
- Medications – Strong pain medications are usually reserved for severe pain. Other options include anti-inflammatory agents and acetaminophen. For nerve-related pain, anticonvulsants and antidepressants are used.
- Spine braces and orthotics – The use of a spinal brace will provide pain relief, but does not straighten the spine. For leg length discrepancy, orthotics and shoe inserts are used.
- Epidural steroid injection (ESI) – When nerve roots are impinged, the doctor may inject the epidural space (around the spinal cord) with a steroid agent. This offers 3-6 months of pain relief.
- Physical therapy – Adults with this condition can benefit from a well-rounded rehabilitation program. The therapist uses various pain relief measures and exercises to improve mobility and strength, as well as help with activities of daily living. The goals of physical therapy are to improve spine posture, manage symptoms of scoliosis, and maximize spinal stabilization.
Will I need surgery?
For some patients with degenerative scoliosis, surgery is an option. The surgeon can remove portions of the spinal bones that impinge on the nerve roots. A lumbar laminectomy involves decompression of the spine with spinal fusion, which will straighten the spine. This surgery is done to take away pressure and provide spinal stability.
How common is degenerative adult scoliosis?
The prevalence of adult scoliosis is reported at 5-30%, depending on which study you read. In a recent clinical study of elderly volunteers, the prevalence of the condition was reported at 60%.
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Kotwal S, PUmberger M, Hughes, A, & Girardi F (2011). Degenerative Scoliosis: A Review. HSS J, 7(3), 257-264.