Adult Idiopathic Scoliosis and Degenerative Scoliosis

Though diagnosed mostly in kids, scoliosis can also affect adults

Written by Kevin R. O’Neill , MD, MS

Many people think of scoliosis as a childhood spinal disorder, but adults can have the disease as well. In simple terms, adult scoliosis occurs when an abnormal side-to-side spinal curve of 10-degrees or greater is diagnosed in a person age 18 or older. There are two primary types of adult scoliosis: adult idiopathic scoliosis and adult degenerative scoliosis. This article covers of both types.

Adult Idiopathic Scoliosis
Most scoliosis cases—both in children and adults—are idiopathic. That means there is no known cause. Adult idiopathic scoliosis is a continuation of the disease from childhood. The scoliosis may have started during your teenage years and gone unnoticed, not progressing until you reached adulthood. This form of scoliosis can effect both the thoracic and lumbar portions of the spine.

Adult Degenerative Scoliosis
Unlike adult idiopathic scoliosis, adult degenerative scoliosis develops during adulthood and is caused by the degeneration of spinal structures. In this form, degeneration—or aging of the discs and joints in the spine—occurs asymmetrically, causing tilting and even slipping between the vertebrae. As this cascades from one level to the next, a curve of the spine can develop. This form of scoliosis primarily affects the lumbar spine.

Symptoms of Scoliosis
Adults with scoliosis—regardless of whether it is from an idiopathic or degenerative cause—often have similar and overlapping symptoms. Beyond the curvature itself and resulting effects on a patient’s appearance, scoliosis can also have a variety of other symptoms that are generally related to degeneration of the spine.

Diagnosing Adult Scoliosis
Regardless if you have adult idiopathic scoliosis or adult degenerative scoliosis (or a combination of the two), the diagnostic process is the same. Your doctor will conduct a comprehensive clinical examination, including a thorough review of your personal and family medical history, physical exam (your doctor will examine your posture, for example), and a neurological exam. However, imaging tests are the primary diagnostic method used to confirm scoliosis.

X-rays are the most common imaging test doctors use when determining the nature of your scoliosis. Your doctor will take full-length x-rays of your spine, pelvis, and hips, so you will stand during the scan. To best see the full magnitude of your curve, your doctor will take x-rays from different positions, such as back to front (posterior-anterior, or PA) and lateral (side). You may also be asked to take a side-bending (anterior-posterior, or front to back) x-ray to help assess your spine’s flexibility. If you have ever had previous X-rays of your back or spine, it is very useful to have these available for comparison.

If you have leg pain or weakness or altered sensation—or any other symptoms of neurological dysfunction—your spine specialist may order a magnetic resonance imaging (MRI) scan to detect whether your spinal cord or nerves are being compressed. Patients with a history of previous spine fusion surgery or unable to have MRI scans may require a CT scan.

Nonsurgical Treatment for Adult Scoliosis
Most adults with scoliosis do not require surgery. Nonsurgical treatments for patients with scoliosis are focused on treating the symptoms related to scoliosis, and are not necessarily intended to change or correct the spine curvature. These treatments are generally the same as treatments for patients without scoliosis.

Nonsurgical treatment for adult scoliosis may include:

Spine Surgery for Adult Scoliosis
Spine surgery to treat adult idiopathic or degenerative scoliosis is performed to:

The goals of surgery in scoliosis are to remove any significant areas of nerve compression, improve the degree (size) of the curvature (scoliosis, lordosis, AND kyphosis), and stabilize the spine though a spinal fusion. This will generally involve placing instrumentation, such as screws, rods, or cages.

Surgery is often performed over several vertebral levels and is often more complex than common surgeries for degenerative conditions, which are performed over only a few levels. For that reason, patients should seek a surgeon who has subspecialized training and experience in treating scoliosis in adults.

Increasingly, minimally invasive techniques are used to accomplish the goals of surgery while allowing faster patient recovery and reducing complications. The decision to perform open, traditional surgery versus minimally invasive—or a hybrid of the two types—is made based on the individual patient’s needs, as well as the comfort level of the surgeon in using the various available techniques. The key is to maximize the speed of recovery while not compromising the long-term results of the surgery.

Spinal Decompression
If you have symptoms related to spinal cord or nerve compression, part of the goal of surgery is to relieve that compression and eliminate those symptoms.

Improving Spine Alignment
A primary goal of surgery for scoliosis is reduction of the curvature and misalignment of the spine. There are different surgical techniques available to the surgeon to allow correction of spinal curvatures.

Spinal Fusion With Instrumentation
For scoliosis surgery, instrumentation (screws, rods, hooks, and/or cages) is placed into the spine in order to maintain the corrected alignment and promote spinal fusion. The instrumentation provides the initial support for the spine until the fusion process has successfully occurred.

Spinal fusion is a process in which the individual vertebral bones are stimulated to heal together permanently, in a process that occurs just like a fractured bone healing. Bone graft material is used during the surgery to help promote this process. The bone graft is packed into and around the surgical area, such as between two vertebral bodies and around the screws and rods.

There are different types of bone graft, and your surgeon will discuss these with you and help select the best type(s) for you. The fusion healing process can take several months before the fusion is solid. Depending on the procedure and surgeon preference / experience, some patients may wear a brace or use a bone growth stimulator following surgery.

Physical Therapy
Physical therapy (PT) is an important part of postoperative care. Your physical therapy will begin during your hospitalization. It may be provided in your home and later on an outpatient basis. The goals of physical therapy include posture training, stretching movements for flexibility of the legs, and active exercise to help you gain strength and build endurance. PT is an important investment in your long-term health and teaches you how to safely move following surgery.

Adult Scoliosis and Quality of Life
Receiving news that you have scoliosis as an adult can be tough to hear, but your life can still be filled with the activities you’ve always enjoyed. With a range of proven treatment options for both the idiopathic and degenerative forms of the disease, scoliosis doesn’t have to come between you and the way you want to live.

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