Adult Degenerative Scoliosis
What is Scoliosis?
The spine has subtle natural curves. Sometimes people have different types of curves, for example side-to-side spinal curves that can twist the spine. This condition is better known as “scoliosis”. On an x-ray image with a front or rear view of the body, the spine in a scoliotic patient looks like an “S” or a “C” rather then a straight line. These curves can make a person’s shoulders or waist appear uneven. These curves unfortunately can not be corrected simply by learning to stand up straight. One can not cause scoliosis; it does not come from carrying heavy items on your back, playing demanding sports, or by having poor posture.
Types of Adult Scoliosis
There are two types of Scoliosis in Adults. Adult Idiopathic Scoliosis and Adult Degenerative Scoliosis.
Adult Idiopathic Scoliosis is a continuation of adolescent idiopathic scoliosis. Sometimes a spine curvature of an idiopathic nature that started during teenage years may progress during adult life. Curves may increase in size up to 2 degrees per year. Adolescent curves less than 30 degrees are unlikely to progress significantly into adulthood, while curves over 50 degrees are likely to get bigger, which is why adult scoliosis specialists should monitor the curves over time.
Adult Degenerative Scoliosis begins in the adult patient due to degeneration of the discs, arthritis of the facet joints and collapse and wedging of the disc spaces.
Adult idiopathic scoliosis is normally seen in the upper thoracic and lower lumbar spine, with the same common appearance as that in teenagers, such as a prominence of the lower back on the side of the curvature, shoulder asymmetry, or a rib hump. The curves can get worse in the older patient due to degeneration of the discs and/or sagittal imbalance. In addition, arthritis commonly affects joints of the spine and can lead to the formation of bone spurs.
Adult Degenerative scoliosis is typically seen in the lumbar spine (lower back), and usually accompanied by straightening of the spine from the side view (loss of lumbar lordosis).
Adults with scoliosis have more symptoms than teenagers because of degeneration in the joints and discs which lead to spinal stenosis (narrowing of the openings for the spinal sac and nerves. Some patients may lean forward to attempt to open up space for their nerves. Other patients may lean forward because of loss of their natural curve (lordosis, sway back) in their lumbar spine (low back). This imbalance can cause a patient to compensate by bending their knees and hips to try and maintain an upright posture. Adult patients may have a variety of symptoms, which can lead to gradual loss of function. These symptoms include:
- Stiffness and lower back pain are the 2 most common symptoms
- Cramping, numbness, and shooting pain in the legs
- Fatigue resulting from strain on the muscles of the lower legs and back
Scoliosis Imaging Evaluation
The common imaging to evaluate scoliosis include the following:
- Standing x-ray of the entire spine looking both from the back as well as the side so your doctor determine the curve magnitude, measured in degrees using the Cobb method.
- MRI (Magnetic resonance imaging) study of the spine is rarely used for patients experiencing minimal symptoms with scoliosis. An MRI is may be ordered if you have leg pain, your doctor finds neurologic abnormalities on physical examination, or if you have significant pain or an “atypical” curve pattern.
The majority of adults with scoliosis do not have disabling symptoms and can be managed with simple measures including the following:
- Periodic observation
- Over-the-counter pain medication
- Exercises to strengthen the core muscles of the abdomen and back while improving flexibility
- Braces, in short-term use for pain relief only.
- Nerve block injections or epidurals for temporary relief if the patient has persistent leg pain and other symptoms due to arthritis and pinched nerves.
- Narcotics can also be habit-forming and must be used with extreme caution. If narcotics are needed to control the pain, see a spine surgeon to learn more about what may be causing of pain.
Spine surgery is reserved for patients who have:
- Failed conservative or non-operative treatment.
- Disabling back and/or leg pain and spinal imbalance.
- Severely restricted daily function and significantly reduced quality of life.
The goals of scoliosis spine surgery are to restore spinal balance and reduce pain and discomfort by decompressing or relieving nerve pressure while maintaining proper spinal alignment by fusing and stabilizing the spinal segments. Patients are carefully chosen and mentally well-prepared for the surgery. Excellent outcomes can be achieved which can provide a positive life-changing experience.
Surgical procedures include:
Decompression relieves pressure on the nerves; A tiny incision is made and a microscopic assists the surgeon in guiding surgical tools to the operation site. This type of procedure is typically used only at one or two vertebra level, and carries a risk of causing the curve to worsen, especially in larger curves greater then 30 degrees.
Surgical stabilization involves anchoring hooks, wires or screws to the spinal segments and using metal rods to link the anchors together. They stabilize the spine and allow the spine to fuse and heal in the corrected position.
Fusion uses the patient’s own bone or using cadaver or synthetic bone substitutes to “fix” the spine into a straighter align
Osteotomy is a procedure in which spinal segments are cut and realigned
Vertebral column resection removes entire vertebral sections prior to realigning the spine and is used when an osteotomy and other operative measures cannot correct the scoliosis.