Adult Scoliosis

Written by Stewart G. Eidelson, MD

Adult scoliosis occurs when the spine curves abnormally to the left or right. The majority of scoliosis cases are termed idiopathic, meaning of undetermined cause. Although scoliosis is usually considered a disorder affecting adolescents, it is also found in adults.

Adult scoliosis is most often caused by:

1. Progression of the disease from childhood such as when scoliosis is not treated early or goes unnoticed during childhood. The scoliotic curves may be thoracic, lumbar, or both.

2. The asymmetric degeneration of spinal elements. Disorders such as degenerative disc disease and compression fractures (eg, osteoporosis) may cause changes in the height of vertebral bodies and their shape. A region of the spine may begin to lose its symmetry—meaning, each side is vertically straight—and bend to the left or right.

3. A combination of numbers 1 and 2.

X-ray demonstrates thoracolumbar scoliosis:
in this case, scoliosis developed later in life (adult onset scoliosis)

Symptoms of Adult Scoliosis
Back pain is the primary symptom of adult scoliosis, especially in lumbar scoliosis. However, if the scoliotic curvature involves the thoracic spine, and is severe, the patient may experience breathing difficulties, and the function of the lungs and/or heart may be compromised. In some cases where the thoracic curvature is small, back pain may be thought to be caused by spinal osteoarthritis.

Again, depending on the spinal level(s) affected and the severity of adult scoliosis, certain physical characteristics may exist or develop, including:

Adult Scoliosis Diagnosis
The diagnosis of adult scoliosis involves a thorough review of the patient's personal and family medical histories. The physician tests for spinal joint and/or peripheral vascular disease as these are known to cause back pain similar to scoliosis. In severe cases of scoliosis, the patient's cardiopulmonary (heart and lung) function may be evaluated.

The neurological examination includes an assessment of the following symptoms:

Imaging Studies Help Diagnose Scoliosis
Full-length x-rays may be taken with the patient is standing. The x-rays capture different aspects of the patient's spine, such as back to front (posterior/anterior abbreviated AP) and lateral (side). Side-bending x-rays help assess spinal flexibility. The spine surgeon or neurosurgeon may order CT or MRI imaging, especially if the patient exhibits neurological dysfunction and/or spine surgery is a consideration.

Adult Scoliosis Curve Classification
Spinal curves are classified according to pattern (shape) and magnitude (severity). Tests that may be utilized to describe scoliotic curvature, include:

Non-surgical Treatment for Adult Scoliosis
Many patients with adult scoliosis do not require surgery. Conservative non-surgical treatment for adult scoliosis may include:

Spine Surgery for Adult Scoliosis
Surgery may be considered if any of the following conditions exist:

Spine surgery to treat adult scoliosis may include the removal of one or more intervertebral discs (discectomy) and removal of bone (osteotomy) followed by spinal instrumentation and fusion to stabilize the spine. Spinal instrumentation provides immediate spinal stability using different devices such as rods and screws. Bone graft stimulates new bone to grow into and around bone and instrumentation. In time, bone graft fuses (eg, joins) surgically treated spinal levels together.

The surgeon may recommend and prescribe a bone growth stimulator to "stimulate" new bone growth and bone healing following a spinal fusion surgery.

Spine surgery to treat adult scoliosis is followed by physical therapy either in a rehabilitation facilty, on an outpatient basis, or at home to help the patient build strength and endurance.

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Surgery for Scoliosis