ADULT DEGENERATIVE SCOLIOSIS
Scoliosis refers to an abnormal curvature of the spine; which can develop in the adult for two reasons. The first is that it may be scoliosis that started when the patient was younger called adolescent idiopathic scoliosis. In other words, this type is not obvious and is often missed. The second type is the degenerative (also called “de novo” which means new) type of scoliosis. As the name implies, it begins in the adult patient usually after age 40 and is thought to be the result of arthritis or degeneration of the spine, with changes in alignment due to degeneration of the discs and the facet joints. This degeneration causes a collapse and wedging of the disc spaces. It is typically seen in the lower back and is usually accompanied by straightening of the spine from the side. Pain, stiffness, numbness and shooting pain down the legs are seen in symptomatic patients (SRS, 2015).
SYMPTOMS and DIAGNOSIS
Since both types of scoliosis can be associated with arthritis, many patients will have back pain and muscle fatigue, as well as possible leg pain. Larger curves (over 40 degrees) should be checked periodically for increase in curve magnitude. Worsening of the scoliosis and/or osteoporosis will cause loss of height along with the other symptoms previously mentioned. Evaluation involves the use of plain X-rays, MRI scans and possibly CT scan. These studies help identify abnormalities in the spine and around the nerve roots and spinal cord that may be associated with the spinal deformity.
Treatment consists of non-steroidal anti-inflammatory medications for pain relief, physical therapy for improving overall function, and exercise to improve strength. If the medications and therapy do not work, steroid or local anesthetic injections in the muscle, joints, or spinal canal may be an option.
Periodic X-rays will show whether the vertebra is changing position.
Surgical treatment is frequently necessary if the curve increases or other symptoms worsen. The type of surgical procedure varies depending on the curve type and size. The most common surgery is a posterior spinal fusion with metal implants and bone graft (from the pelvis or the bone bank), with or without decompression of the nerve roots.
Except for osteoporosis-related scoliosis, most cases of scoliosis cannot be prevented. There is no evidence to suggest that improving posture or doing exercises can prevent adult degenerative scoliosis. Methods to increase bone mass and strengthen bones, including getting enough calcium and vitamin D, and doing regular weight-bearing exercise, may help to prevent cases caused by spinal fractures. In some cases, early detection may prevent the condition from getting worse.
If you have or plan to have children, you should examine your child’s spine regularly starting in infancy, and talk to a health care professional about any concerns. Getting regular school nurse evaluations and pediatric examinations also can identify cases of scoliosis.