Adult Idiopathic Scoliosis and Degenerative Scoliosis

Though diagnosed mostly in kids, scoliosis can also affect adults.

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.

adult lumbar degenerative scoliosis x-rayAdult degenerative scoliosis in the patient's low back is shown on this x-ray. Photo Source:

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.

  • Arthritis and/or disc degeneration can lead to back pain.
  • Spinal stenosis (an abnormal narrowing of the spinal canal) can cause back pain that is worse when standing or walking (a condition called neurogenic claudication).
  • Nerves can sometimes be compressed, and may cause radiculopathy and sciatica with pain, numbness, tingling, or weakness in the leg.
  • In severe cases (curves generally more than 90-degrees), the scoliosis can result in diminished lung function.

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.

Non-surgical Treatment for Adult Scoliosis

Most adults with scoliosis do not require surgery. Non-surgical 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.

Non-surgical treatment for adult scoliosis may include:

  • Observation by a spine specialist
  • Moist heat
  • Medications for pain, inflammation, and/or muscle spasms
  • Physical therapy and exercise to increase flexibility and strengthen spinal muscles (eg, core musculature)
  • Spinal bracing to temporarily relieve pain
  • Injection treatment to reduce leg pain

Spine Surgery for Adult Scoliosis

Spine surgery to treat adult idiopathic or degenerative scoliosis is performed to:

  • Relieve pressure on the spinal cord and/or nerve roots to reduce pain
  • Stop the scoliosis from worsening (eg, increased curve size)
  • Reduce the scoliotic deformity
  • Stabilize the spine; stop deformity progression
  • Restore spinal alignment
  • Improve breathing in patients with severe thoracic scoliosis (curves greater than 90-degrees)

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.

normal spine compared to spinal curvature problems, scolisis, kyphosis, lordosisThe normal spine compared to different types of abnormal spinal curvature disorders, such as lordosis, kyphosis and scoliosis. Photo Source:

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.

  • Direct decompression procedures (such as a laminectomy or a foraminotomy) usually involve removing spinal structures (eg, degenerated disc, osteophytes, ligaments) to free up space around cramped spinal nerves.
  • Alternatively, correction of the scoliosis and restoration of the normal height of any collapsed discs may be used to increase the space for the nerves and alleviate symptoms. This is called indirect decompression.

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.

  • Removal of the discs between vertebrae may be performed with insertion of spacers or cages, which can loosen the spine to allow correction of the curvature.
  • If the spine curvatures are not very flexible on their own, wedges of bone may need to be removed to increase the flexibility and allow the correction to take place. Removal of wedges of bone is called osteotomies.

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 post-operative 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.

Updated on: 02/20/19
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I'm an Adult: Why Do I Have Scoliosis Now?
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I'm an Adult: Why Do I Have Scoliosis Now?

To help shed light on the distinctions between adult and childhood scoliosis, SpineUniverse spoke with Kevin R. O’Neill, MD, MS, a spine surgeon who specializes in both adult and pediatric scoliosis.
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