Treating Adult Onset Scoliosis Starts with Nonsurgical Approaches

Scoliosis in adults is often due to degenerating discs in the spine. Nonsurgical treatment usually works well.

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Scoliosis: It’s not just for kids. Although this condition, which is an abnormal curvature of the spine to the left and/or right, is often associated with children and teens, adults in midlife and beyond can develop it, too. 

Scoliosis is a spine curve to the left or rightKyphosis and lordosis are natural curves in the spine, but scoliosis is abnormal.

The spine is made of small bones called vertebrae that are stacked on top of each other with fibrous intervertebral discs between acting as cushions. A healthy spine has normal curves. The neck (cervical spine) and lower back (lumbar spine) hollow out and curve in toward the front of the body, which is called lordosis. The mid-back (thoracic spine) bows out—kyphosis.

Despite these curves, the spine is more or less straight up and down. Scoliosis is a curve to the left, to the right or both. Adult onset scoliosis, also known as degenerative scoliosis or de novo scoliosis, results when discs dry out and degenerate. Wear and tear of the spine over time causes one or more discs to collapse unevenly, disrupting the spine’s normal parallel alignment.

“Even just one worn out disc that collapses more to one side the other can cause the spine to tilt and lose its normal straight alignment,” says Baron Lonner, MD, Chief of Minimally Invasive Scoliosis Surgery at Mount Sinai Hospital in New York City. A telltale sign of degenerative scoliosis is walking with a crooked gait with one hip thrust to the side, which may or may not be painful. “That is a result of this asymmetric collapse of one or two or three discs or more,” Lonner says. 

Childhood vs Degenerative Scoliosis

Degenerative scoliosis isn’t the same as adolescent scoliosis that was left untreated. Adolescent scoliosis is usually idiopathic--the cause is unknown, but of genetic origin—and develops after age 10. Degenerative scoliosis, on the other hand, is a disease of aging and starts in midlife. Research indicates that roughly 10 percent of adults will develop degenerative scoliosis in their 40s. By age 80, it may affect as much as 60 to 70 percent of the population.

“Generally, the curves of adult onset scoliosis are not quite as large as the adolescent onset scoliosis that present for treatment in adulthood,” Dr. Lonner says. Moreover, scoliosis that developed in childhood and hasn’t been treated typically affects the thoracic spine (ribbed portion of the spine) in more than 50% of cases. With adult onset scoliosis, the lumbar spine is the most susceptible to aging and disc degeneration.

Diagnosing Adult Scoliosis

Scoliosis X rayX-rays can help spine specialists diagnose scoliosis.It’s possible to have adult onset scoliosis and not know it. However, it’s usually back pain that sends people with adult onset scoliosis to their primary care doctor’s office to seek treatment. Patients with adult onset scoliosis may also experience sciatica—shooting pain down the leg, from the buttocks to the feet, caused by compressed nerve roots in the lower back.

Still, “most people with back pain don’t have degenerative scoliosis. They may have degenerative disc disease or they may just have a strain of their back,” Dr. Lonner says. When worn-out discs cause back pain without causing a left or right curve, the diagnosis will likely be degenerative disc disease.

Degenerative scoliosis is diagnosed with an X-ray of the spine that shows scoliosis and degenerative disc disease. Your doctor may also order an MRI if you have weakness in your legs or sensory loss and/or loss of reflexes.

If the weakness is severe, you should be referred for an MRI immediately for an expedited evaluation. “But more commonly, patients who seek treatment for adult onset scoliosis experience some leg pain and perhaps some weakness that has gradual onset,” Dr. Lonner says.

Nonoperative Treatments for Degenerative Scoliosis

If you have adult onset scoliosis but no pain or weakness, your doctor may simply recommend core-strengthening exercises and low-impact aerobics, such as walking or swimming, to maintain good conditioning and core strength. Pain from adult onset scoliosis often responds well to nonoperative treatment, including:

  • Rest, initially
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen
  • Physical therapy and exercises to improve your core strength and posture
  • Epidural steroid injections, also known as a nerve block for leg pain (sciatica) relief
  • Bracing (lumbar corset) to support your back during physical activity.

“The idea is to try to minimize the need for surgery with nonsurgical treatment,” Dr. Lonner says. Therapies can be mixed and matched, depending on your circumstances. If symptoms persist or worsen despite these nonoperative treatments; for example, your still having trouble walking because of leg weakness or continue to experience severe sciatica, you may be a candidate for surgery.

Your spine specialist may order an MRI to look for areas of nerve compression and surgery may be recommended. Significant leg weakness can be an emergency situation, requiring urgent or emergent surgery to decompress the nerve and regain leg strength.

Surgical Solutions for Degenerative Scoliosis

For degenerative scoliosis or degenerative conditions of the spine, however, “most patients won’t require surgery,” Dr. Lonner says. But if you’re among the small subset of patients who don’t respond well to nonoperative treatment, surgery may provide relief. The surgical options will be tailored to your symptoms.

Surgery for adult onset scoliosis often involves one or both of these therapies:

  • Nerve decompression: The treatment options involves relieving the pressure on a compressed nerve by surgically removing a small portion of the bone (usually a laminectomy) over the nerve root and/or disc material pressing on the root (called a microdiscectomy) to give the nerve root more space and provide for healing of an inflamed and compressed nerve.
  • Spinal fusion surgery. The goal of spinal fusion surgery is to create an environment in which the affected vertebra fuses with the vertebra adjacent to it, to restore proper spinal alignment and eliminate painful movement.

Scoliosis surgeryQuit smoking before scoliosis surgery.

“We can perform spinal fusions several ways, including the eXtreme Lateral Interbody Fusion (XLIF) or Oblique Lateral Interbody Fusion (OLIF),” Dr. Lonner says. With this technique, the surgeon accesses the spinal disc and fuses the lumbar spine (low back) by making small incisions from the side (lateral) rather than from the front (anterior) or the back (posterior).

The discs are removed and metallic or plastic cages are placed, helping to re-align the spine to correct the scoliosis and deformity and provide structural support. Spinal fusion surgery for adult onset scoliosis usually also involves implants, such as screws and metal rods to stabilize the spinal joints placed from a posterior or back approach.

“We use instruments and screws and rods to stabilize the spine while the spine welds together biologically,” Dr. Lonner says.

This can be done through a minimally invasive approach using small incisions. Minimally invasive surgery can result in less trauma to the muscles during surgery, less blood loss, and lower infection rates and offer the easiest path to recovery. But patients with severe malalignment and deformity may require more extensive traditional open surgery with larger incisions.

“We try to avoid that, but it’s part of the armamentarium and consideration for these patients,” Dr. Lonner says. Depending on the surgical approach, patients may be hospitalized for two to five days, or sometimes longer.

Help Yourself Heal

If you’re a candidate for degenerative scoliosis surgery and you’re a smoker, you can help yourself by first becoming a nonsmoker. “Smoking is the hub of many problems. Smokers have a greater risk of anesthesia problems, including lung difficulties around the time of surgery, both within the operation and thereafter,” Dr. Lonner says.

Smoking also increases the risk of surgical infection and impacts healing and fusion. Bottom line: Fusion surgery is more likely to be successful in non-smokers than smokers.

“I don’t operate personally on patients who are smoking because it affects the success of the operation,” Dr. Lonner says. “With regards to the spine operation, the patient has a choice to stop smoking to improve their outcome. It’s imperative that patients take on that as their responsibility so they have the best chance of getting a good result. We’re in this together. We want patients to do well and they have to be part of the solution.”

Do you have adult onset scoliosis that’s causing pain or other symptoms? Find a spine specialist to help you manage your condition.

Updated on: 04/03/20
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Spine Surgery for Adult Scoliosis
Baron S. Lonner, MD
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Spine Surgery for Adult Scoliosis

Surgical treatment of adult scoliosis involves decompression, correction and fusion. Together, these procedures relieve nerve compression, reduce the size of the scoliosis or spinal deformity, and permanently stabilize the spinal curves.
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