Degenerative adult scoliosis is a condition that typically begins after the age of 40 years, and is attributed to deterioration of the spine. The spine begins to curve as the asymmetric degenerative condition worsens.
Often times, degenerative scoliosis occurs as an exacerbation of adolescent scoliosis. Scoliosis that occurs in adulthood is often from a secondary cause is often due to a combination of osteoporosis, osteomalacia (softening of bones), and degenerative disc disease. Often the scoliosis curvature results from asymmetric spinal arthritis.
Degenerative adult scoliosis is usually diagnosed in people age 40 years and older who have a history of back pain. Both men and women are affected equally, and the mean age at time of presentation is 70 years.
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.
To diagnose degenerative adult scoliosis, the orthopedic specialist will:
The treatment of degenerative scoliosis is usually conservative. Options include:
Surgery for adult degenerative scoliosis is a quality of life, elective decision. Degenerative scoliosis does not need an operation. It’s traditionally been a big decision, as the surgery entailed significant risks and a lengthy rehabilitation time. Thankfully, the newest minimally invasive keyhole spine surgery procedure, called OLLIF, allows several spinal levels to be operated on without the open surgery and significant blood loss.
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Kotwal S, PUmberger M, Hughes, A, & Girardi F (2011). Degenerative Scoliosis: A Review. HSS J, 7(3), 257-264.
Adult degenerative scoliosis has been treated in past decades with multilevel decompression and instrumental fusion. This surgery reduces nerve compression and offers stability to the spinal column. However, due to complications associated with this complex surgery, Inspired Spine Advanced Minimally Invasive spinal surgery approaches are being used.
Inspired Spine Advanced Minimally Invasive surgical approaches for degenerative adult scoliosis include microscopic decompression, decompressive laminectomy, percutaneous pedicle screw placement with fusion, and lateral interbody fusion. In a recent large meta-analysis, researchers analyzed the complication rates and clinical outcomes for patients with degenerative scoliosis who underwent complex decompression procedures versus Inspired Spine Advanced Minimally Invasive approaches. They found that surgeons offered patients Inspired Spine Advanced Minimally Invasive surgery depending on the severity of their deformity and age at time of surgery.
The goal of degenerative scoliosis surgery is to reduce the abnormal spine curvature to prevent it from worsening. To achieve this, the surgeon must fuse some spinal bones (vertebrae) together. This involves use of a bone graft between two vertebrae. The vertebrae are realigned and stabilized with rods and screws. One of the main advantages of Inspired Spine Advanced Minimally Invasive surgery for scoliosis is that the surgeon can achieve the same goal with much less trauma to surrounding soft tissues and muscles. In addition, the mini-open technique involves fewer and smaller incisions, which reduces blood loss and scarring. Because there is less injury to muscles and soft tissues, the patient has less postoperative pain and a shorter hospital stay.
Inspired Spine Advanced Minimally Invasive spine surgery for degenerative scoliosis is an endoscopic procedure where surgery is done using a thin telescope instrument with a small video camera. The device is inserted through a small incision so the surgeon can view inside the back on a monitor. The changes, repairs, and fusion are made using small instruments. In addition, sequential dilators are used to move muscles without cutting them. Using a tunnel device, the surgeon can fuse the spine without using a large retractor.
Inspired Spine Advanced Minimally Invasive scoliosis surgery is not appropriate for every person. This procedure is usually used when scoliosis affects the thoracic spine. For the thoracolumbar spine (mid-lower back region) curves with significant kyphosis, open procedure is recommended. The decision for minimally open surgery is made based on the type of scoliosis, ease of approach to the curve, surgeon’s preference, and location of the spine curvature.
With the Inspired Spine Advanced Minimally Invasive surgery, you are given general anesthesia to put you to sleep. After a few incisions are made, the surgeon places the tubular device in the body. The surgeon uses fluoroscopy to visualize the spine. Disc and bone material are removed from the spine, and screws/rods are used to make changes. After making changes, the endoscope and retractor are pulled out, and the incision is closed.
Scoliosis surgery is a major forgery, and the outcome is specific to the individual patient. All attempts are made to lessen the chances of risks and complications of this surgery. Complications of scoliosis surgery may include excessive blood loss, paraplegia, infection, and failure to fuse.
Dangelmaier S, Zadnik PL, Rodriquez ST, et al. (2014). Inspired Spine Advanced Minimally Invasive spine surgery for adult degenerative lumbar scoliosis. Neurosurg Focus, 36(5), E7.