Adult Scoliosis
Get information about the diagnosis and treatment processes of adult scoliosis.
Adult Scoliosis
Get information about the diagnosis and treatment processes of adult scoliosis.
What Is Adult İdiopathic Scoliosis?
Adult scoliosis may be an illness that began in childhood and continues to progress. While painless during childhood, it may present pain in adulthood. The cause of this type of scoliosis beginning in childhood is unknown, and it is named adult idiopathic scoliosis.
What Is Adult Degenerative Scoliosis?
Adult degenerative scoliosis is the type of scoliosis that develops due to wear and aging of the spine. It generally occurs after age 50. In older women, osteoporosis may cause a curve to form or worsen an existing one. Osteoporosis describes the weakening of bone due to a decrease in calcium, and also named bone resorbtion.
Degenerative scoliosis caused by wear may affect any of the areas in the spine including the neck, thoracic, and lumbar, however the lumbar area is the most commonly involved. The spine is bent to the side, and also rotates around itself. These deviations may result in asymmetric appearances in the waist, hips, and shoulders.
The stability and balance of the spine may be disrupted in patients with severe adult degenerative scoliosis. This, in turn, may cause the spine and the chest to deviate to the side depending on the curve, and will cause the chest to bend to the front due to decreased anatomic angle in the sagital plane of the lumbar region. These deformations will increase the severity of the curve, and a vicious circle may form because the deformations will increase as the severity increases. This progression often occurs slowly.
Spinal curves have a concave and convex side. In the concave side, compressive forces cause excessive loading on spinal facet joints; they also cause the nerves to be compressed within the canals located on the same side. Also, excessive bone formation in the joints caused by wear of the spine, or reactive thickening in the soft tissues will also increase nerve compression Therefore patients with degenerative scoliosis may have back or lower back pain, pain distributed along the nerve tract (radiculopathy), and loss of power in muscles innervated by the nerve.
In adult idiopathic scoliosis, there may be severe pain due to degeneration in facet joints. Respiratory functions may be compromised by the extreme deformities in the thoracic cage, and this may result in early fatigue and respiratory problems in patients.
The treatment decision of adolescent scoliosis is made based on the deformity, however treatment of adult scoliosis mostly depends on the symptoms.
What Are the Signs of Adult Acoliosis?
What are the signs?
Patients often notice chest deformity and disturbed balance. At the same time, they may be aware of the condition by signs such as shortening in their height (clothes no longer fit). However, it is often the back pain and loss of ability which bring the patients to the doctor. Difficulty in standing up after a long period of sitting, difficulty in the initial steps of walking, spasm in back and lower back muscles, progressive decrease in walking distance over the years, and leg fatigue are the chief complaints. Patients with severe nerve compression may experience weakness or numbness in the legs. In adult idiopathic thoracic (in the upper back) scoliosis, patients may have difficulty in breathing and experience early fatigue.
Idiopathic vs. Degenerative Scoliosis
What is adult idiopathic scoliosis?
Adult scoliosis may be an illness that began in childhood and continues to progress. While painless during childhood, it may present pain in adulthood. The cause of this type of scoliosis beginning in childhood is unknown, and it is named adult idiopathic scoliosis.
What is adult degenerative scoliosis?
Adult degenerative scoliosis is the type of scoliosis that develops due to wear and aging of the spine. It generally occurs after age 50. In older women, osteoporosis may cause a curve to form or worsen an existing one. Osteoporosis describes the weakening of bone due to a decrease in calcium, and also named bone resorbtion.
Degenerative scoliosis caused by wear may affect any of the areas in the spine including the neck, thoracic, and lumbar, however the lumbar area is the most commonly involved. The spine is bent to the side, and also rotates around itself. These deviations may result in asymmetric appearances in the waist, hips, and shoulders.
The stability and balance of the spine may be disrupted in patients with severe adult degenerative scoliosis. This, in turn, may cause the spine and the chest to deviate to the side depending on the curve, and will cause the chest to bend to the front due to decreased anatomic angle in the sagital plane of the lumbar region. These deformations will increase the severity of the curve, and a vicious circle may form because the deformations will increase as the severity increases. This progression often occurs slowly.
Spinal curves have a concave and convex side. In the concave side, compressive forces cause excessive loading on spinal facet joints; they also cause the nerves to be compressed within the canals located on the same side. Also, excessive bone formation in the joints caused by wear of the spine, or reactive thickening in the soft tissues will also increase nerve compression Therefore patients with degenerative scoliosis may have back or lower back pain, pain distributed along the nerve tract (radiculopathy), and loss of power in muscles innervated by the nerve.
In adult idiopathic scoliosis, there may be severe pain due to degeneration in facet joints. Respiratory functions may be compromised by the extreme deformities in the thoracic cage, and this may result in early fatigue and respiratory problems in patients.
Can Lumbar Slippage Be Seen with Adult Scoliosis?
In some conditions, due to the severe deformation and loading of the spine, one of the vertebrae may slip forward, backward, or to the side. These deformities that can occur in addition to adult degenerative scoliosis are named spondylolisthesis when displacement is to the front, retrolisthesis when displacement is to the back, and listhesis when displacement is to the side. These movements may result in pain, they may also cause leg pain or muscle weakness due to compression of the nerve and/or spinal cord.
How Is Adult Scoliosis Diagnosed?
How is it diagnosed?
Since the type and severity of the symptoms are the most significant factors that affect the treatment plan in patients with adult scoliosis, detailed information to your physician is necessary. Your doctor may then order the following studies:
Treatment of Adult Scoliosis
The selected method for the appropriate treatment of adult scoliosis is determined according to the intensity of the pain and curve, and whether the curve is progressive. Generally, the initial treatment methods are nonsurgical.
Exercises that will increase the physical condition, and also stabilization, strengthening and stretching exercises assisted by a physiotherapist may relieve muscle spasm and decrease the pain. However, these exercises do not have a proven role in preventing the progression of scoliosis. A brace treatment may be initiated along with exercise. However, brace treatment should be considered ancillary to exercise and physical therapy. Long-term brace treatment may provide more harm than benefit.
Analgesics can be prescribed in addition physical therapy and exercises to help with pain management. Also, non-steroidal anti-inflammatory drugs may be added to treatment for removing the irritation or inflammation caused by facet joints or nerve compression.
If degenerated facet joints cause the patient’s pain or the pain is radicular due to nerve compression, spinal injections may be the alternative treatment method. Please refer to the section on spinal injection for detailed information on this topic.
These non-surgical treatment methods may be applied separetely or in combination. There is no general agreement in the literature regarding which one should be initiated first or which one is superior. Each patient needs special evaluation and decision. Your doctor will choose the most effective treatment method according to your complaints and condition.
When is Surgical Treatment Necessary?
Pain, loss of function and balance are more predominant in adult scoliosis compared to the severity of the curve and the cosmetic problems caused by the curve. Surgery may still be necessary despite the absence of pain, in order to stop further progression of scoliosis that has been clearly shown to be progressive.
Surgical management can be an effective alternative treatment method in patients who have undergone long periods (6 weeks to 6 months) of nonsurgical treatments, and continue to have pain and severe loss of ability despite these treatments. Surgery may be chosen for patients with severe narrow canal or nerve compression that causes loss in bladder or bowel control, or muscle power.
The treatment of adult scoliosis surgery is more difficult compared to younger patients. The operation length and number of surgical procedures may be greater. Surgical treatment may become even more difficult if the patient has associated heart and lung diseases, diabetes, and osteoporosis. Good preperation of the patient and taking necessary precautions will yield fairly optimistic results.
What is the Surgical Treatment?
The surgical treatment aims to correct the curve, enough to achieve balance, fusion of the vertebrae, and elimination of nerve compression (decompression). Your doctor will decide on the extend of the procedures. While in some patients a long fusion and decompression is necessary , others may require a shorter decompression and fusion.
A small fraction of patients can be relieved of their symptoms with only a limited decompression.
Postoperative Period
Following the operation, patients may need to stay in the intensive care unit for one night. On the first day after surgery, the patient will be allowed to sit at the bedside, and leg exercises will be initiated. The patient is mobilized on the same or following day.
The patient remains in the hospital for seven to 10 days after surgery for adequate recovery and rehabilitation. After discharge, the patient is taken into an exercise program.
Your doctor will schedule periodic postoperative visits.
