Adult degenerative scoliosis is an abnormal curvature of the spine in patients older than 18 years of age. This type of scoliosis occurs after childhood, and in patients with no history of childhood scoliosis. Adult scoliosis is most often caused by degenerative disc disease or osteoporosis.
What are the symptoms of adult scoliosis?
Adult scoliosis different from childhood scoliosis. The curvature tends to be more progressive and severe as the patient ages. The symptoms of scoliosis are low back pain, postural changes, as well as tingling, numbness, and pain of the legs (when nerve compression occurs). In addition, patients with degenerative scoliosis report rib prominence, leg length discrepancy, impaired balance and walking, and muscle atrophy.
What are the causes of degenerative scoliosis?
Most patients who develop adult scoliosis have a family history of this condition. In addition, causes include degenerative disc disease and osteoporosis.
How is adult degenerative scoliosis diagnosed?
The doctor will conduct a physical examination and ask questions about your pain. He may order certain diagnostic tests, such as x-rays, magnetic resonance imaging (MRI), and computed tomography (CT) scans. To diagnosed scoliosis, the lateral x-ray must reveal a curve of 10 degrees or more.
How is adult scoliosis treated?
Adult scoliosis is treated using interventional procedures and medications. Some patients require surgery, but this is reserved for severe cases. Treatment options include:
- Epidural steroid injection (ESI) – This is used to treat chronic back pain by reducing irritation and inflammation of the spine related to nerve compression. The doctor injects a corticosteroid into the space around the spinal cord.
- Intradiscal electrothermal therapy (IDET) – This procedure involves treating lower back pain related to degenerative disc disease, which is often seen along with adult scoliosis. The doctor inserts a small catheter near the affected disc, and inserts a heated wire through this catheter. The heat thickens the collagen and closes minor cracks and tears.
- Intrathecal pump implant – With this procedure, the doctor surgically places a small pump in the lower buttock or abdomen. The device delivers pain medication through a catheter treated into the space around the spinal cord.
- Nerve block – For pain related to the lower back, the doctor can use radiofrequency energy or a neurolytic agent to deaden the affected nerves. According to clinical studies, nerve blocks worked for more than 90% of patients, with a long-term success rate of around 50%.
- Spinal cord stimulation – For intractable pain that does not respond to other treatments, spinal cord stimulation is done. The implantable device delivers pleasant electric current sensations to the spinal cord. This blocks pain signals. Approximately 90% of those available for follow-up reported that SCS was successful for treating their pain.
- Medications – Narcotic analgesics are used for patients who do not respond to nonsteroidal anti-inflammatory drugs (NSAIDs). Researchers followed back pain patients for three years.
- Bracing – The doctor may recommend that you wear a brace. This device is customized to fit your body shape and unique condition.
- Surgery – For patients with progressed adult degenerative scoliosis, the doctor will correct the spinal curvature with surgery. The surgical procedure is recommended to decompress the spinal canal when spinal stenosis causes nerve compression and irritation. If the problem is loss of disc space and height, the surgeon may recommend fusion, which uses screws and rods to straighten the curve.
How common is adult degenerative scoliosis?
In a recent study, researchers conducted an evaluation of 75 adult volunteers age 60 years and older. These people had no history of spinal surgery or known scoliosis. Of the study group, 68% had adult scoliosis. Other reports list the prevalence rate as 30-60%, however.
North RB, Kidd DH, Farrokhi F, & Piantadosi SA (2005). Spinal cord stimulation versus repeated lumbosacral spine surgery for chronic pain: a randomized, controlled trial. Neurosurgery, 56(1), 98-106.
Riew KD, Yin Y, Gilula L, et al. The effect of nerve-root injections on the need for operative treatment of lumbar radicular pain. A prospective, randomized, controlled, double-blind study. J Bone Joint Surg Am. 2000 Nov. 82-A(11):1589-93.
Schwab F, Dubey A, Gamez L, et al. (2005). Adult Scoliosis: Prevalence, SF-36, and Nutritional Parameters in an Elderly Volunteer Population. Spine, 30(9), 1082-1085.