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Adult Scoliosis: Treatment and Recovery

Part 3 of 3

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Edgar G. Dawson, MD
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Non-Surgical Treatment
The following symptoms of scoliosis may be used to determine treatment options: persistent pain that cannot be alleviated, deformity progression, and reduced cardiopulmonary (heart and lung) function (rare). Conservative non-surgical treatment may include: moist heat, medication for pain and inflammation, and exercise. Bracing is rarely used to help control pain. It will not correct or cure scoliosis. Most patients with adult scoliosis do not require surgery.

Spine Surgery
Most patients with adult scoliosis do not require surgery. Surgery may be considered if any of the following exist:

1. Thoracic (mid-back) curve greater than 50 degrees with persistent pain

2. Progressive thoracolumbar (mid and low back) curve

3. Lumbar (low back) curve with persistent pain

4. Decreased cardiopulmonary (heart and lung) function due to thoracic curve

5. Appearance, deformity

Pain control is the usual reason for surgery for scoliosis in adults. The spinal surgeon decides the procedure(s) that will provide the most benefit to the patient. Surgical intervention may include the removal of an intervertebral disc (e.g. discectomy) combined with spinal instrumentation and fusion. Spinal instrumentation utilizes rods, bars, wires, screws, and other types of medically designed hardware. Combined with fusion, instrumentation stabilizes spinal segments, enhances fusion, and provides a more permanent solution. These procedures may enable the patient to sit upright thereby reducing the risk for cardiopulmonary complication and may increase mobility. This type of surgery can be performed safely on adults with spinal deformity, usually with excellent results.

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Recovery
Whether the treatment course is conservative or surgical, physical therapy may be incorporated to build muscle strength, increase range of motion and flexibility. It is important to closely follow the instructions given by the physician and/or physical therapist.

Any doubts concerning vocational and recreational restrictions should be discussed with your physician and/or physical therapist. They will be able to suggest safe alternatives.

Posted on: May 20th, 2002
Last Updated on: February 1st, 2010
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Peer Reviews by Leading Specialists

What is this?
Harry N. Herkowitz, MD
In most cases, adult de novo scoliosis should be treated non-operatively. Surgery is indicated as outlined in this review with the addition of patients with significant nerve compression due to spinal stenosis. The indications for instrumentation - fusion and whether the approach should be posterior or anterior or posterior and anterior is not clear-cut. In patients with lumbar spinal stenosis and a “stiff curve” with satisfactory sagittal and coronal balance, only decompression is necessary. If the curve is flexible, progressive, or poor sagittal/coronal balance, then an instrumented fusion is indicated. The indications to go both anterior and posterior relate to the size of the curve and the need to obtain a solid fusion. It must be noted that many of these patients with adult onset scoliosis who have stenosis are an older age group who have higher surgical risks. Therefore, complications are more frequent and outcomes may be less than optimal.

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