Scoliosis in adults

Scoliosis is an abnormal lateral curvature of the spine. It is most often diagnosed in childhood or early adolescence, but can also be diagnosed in adults.

The spine's normal curves occur at the cervical, thoracic, and lumbar regions in the so-called “sagittal” plane. These natural curves position the head over the pelvis and work as shock absorbers to distribute mechanical stress during movement.

“Scoliosis that occurs or is diagnosed in adulthood is distinctive from childhood scoliosis, since the underlying causes and goals of treatment differ in patients who have already reached skeletal maturity,” stated Roger Hartl, MD, a spine surgeon and American Association of Neurological Surgeons (AANS) spokesperson. Most adults with scoliosis can be divided into the following categories: 1) Adult scoliosis patients who were surgically treated as adolescents; 2) Adults who did not receive treatment when they were younger; and 3) Adults with a type of scoliosis called degenerative scoliosis.

Degenerative scoliosis occurs most frequently in the lumbar spine (lower back) and more commonly affects people age 65 and older. It is often accompanied by spinal stenosis, or narrowing of the spinal canal, which pinches the spinal nerves and makes it difficult for them to function normally. Back pain associated with degenerative scoliosis usually begins gradually, and is linked with activity. The curvature of the spine in this form of scoliosis is often relatively minor, so surgery may only be advised when conservative methods fail to alleviate pain associated with the condition.

Scoliosis Symptoms/Signs

There are several signs that may indicate the possibility of scoliosis. If you notice one or more of the following signs, the AANS recommends that you schedule an appointment with a doctor.

  • Shoulders are uneven – one or both shoulder blades may stick out
  • Head is not centered directly above the pelvis
  • One or both hips are raised or unusually high
  • Rib cages are at different heights
  • Waist is uneven
  • The appearance or texture of the skin overlying the spine changes (dimples, hairy patches, color abnormalities)
  • The entire body leans to one side

If the doctor suspects scoliosis after performing a physical examination, radiological tests will be ordered to confirm diagnosis. In adults with scoliosis, x-rays are usually recommended once every five years, unless symptoms are getting progressively worse.

In one 20-year study, about 40 percent of adult scoliosis patients experienced a progression. Of those, 10 percent showed a very significant progression, while the other 30 percent experienced a very mild progression, usually of less than one degree per year. Progression of a curve depends on factors such as age of diagnosis, age and efficacy/outcome of original treatment, and both severity and location of the curvature.

Some adults who were treated as children may need revision surgery, in particular if they were treated 20 to 30 years ago, before major advances in spinal surgery procedures were implemented. Back then, it was common to fuse a long segment of the spine. When many vertebral segments of the spine are fused together, the remaining mobile segments assume much more of the load and the stress associated with movements. Adjacent segment disease is the process in which degenerative changes occur over time in the mobile segments above and below the spinal fusion. This can result in painful arthritis of the discs, facet joints, and ligaments.

“Bracing is not an option for adults as a primary treatment because their spines have reached maturity and are no longer growing,” said Dr. Hartl. However, bracing may be used postoperatively in adults to keep the spine straight while it heals.

In general, surgery in adults may be recommended when the spinal curve is greater than 50 degrees and the patient has nerve damage to their legs and/or is experiencing bowel or bladder symptoms. Adults with degenerative scoliosis and spinal stenosis may require decompression surgery with spinal fusion, and a surgical approach from both the front and back.

A number of factors can lead to increased surgical-related risks in older adults with scoliosis. These factors include: advanced age, being a smoker, being overweight, and the presence of other health/medical problems. In general, both surgery and recovery time are expected to be longer in older adults. The benefits of spine surgery should always be weighed against its risks. For more information on scoliosis, please visit: http://www.neurosurgerytoday.org/what/patient_e/scoliosis.asp.

Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a scientific and educational association with more than 7,200 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. All active members of the AANS are certified by the American Board of Neurological Surgery, the Royal College of Physicians and Surgeons (Neurosurgery) of Canada or the Mexican Council of Neurological Surgery, AC. Neurological surgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the entire nervous system, including the spinal column, spinal cord, brain and peripheral nerves.

Comments

  1. cyndy brown cyndy brown United States says:

    OK I was told I have scoliosis I have severe back pain all the time i cant pick up my daughter and I cant play that much with any of my kids because my back hurts real bad it hurts so bad I taste metal in my mouth when it hurts real bad the middle of my back is now numb and I can't fold laundry without my back killing me I am in constant pain they say I have mild scoliosis but i think it is worse then they say can some one help me the doctors in this town are no joke they are stupid and have no brain if my back is going numb dosent that tell me that something is very wrong someone help me please if you can help me please contact me at [email protected] thankyou

    • Jess Jess United States says:

      Well I'm 23 years old and I have two kids. I've been dealing with scoliosis for about 4 years. Their has been times where I couldn't pick up my kids, cook dinner, or do my laundry. But I keep going by taking medicine for back pain. But it finally came to a halt when i couldn't take it anymore. So i went to the doctor he gave me some meds but in three weeks my treatment will start. He's a good doctor. You should go to another doctor!!!!!!

    • Diane Brokaw Diane Brokaw United States says:

      I am 60 and have degenerative scoliosis.  I do core exercises.  

      Strengthen your lower back:
      I start in the morning before I get out of bed.  I start with a stretch.  Pull both knees up to your chest as far as you can.  Hold it for a count to 60.  Then I extend one leg out parallel to the bed for a count of 10, pull that leg back to your chest for another count of 10.  Repeat that 5 times.  Switch legs and and repeat 5 times.  Then bring both legs up to your chest for a count of 10 then extend both legs parallel to the bed for a count of 10.  Repeat that 8 to 10 times.  This last movement is hard when you start, but keep trying, you will get it.  I then repeat all three movements two more times but reduce the count to 2.

      Crunches strength stomach muscles for lower back:
      I put my hands over my head and throw them up through my knees to get into a crunch.  I hold each crunch for a count of 5.  I repeat these 15 times.  I am new at this one, so it will take time before I can do a real crunch.

      All of this has helped me have less pain.  I still am dealing with leg pain.  A specialist has recommend I start going to a pilaties class.  I am looking for one now.

  2. Jaina Jaina United Kingdom says:

    I've had scoliosis since I was 14 and I'm now 26. I use yoga to help me with any pain, tension or tightness. I would recommend visiting a local yoga teacher or contact me personally as I teach yoga and can advise a exercise plan to alleviate any pain. It may not cure scoliosis but yoga will help with your discomfort and will bring some ease into your body.

The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
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