Scoliosis is abnormal side-to-side curvature of the spine meaning the spinal curve may develop as a single curve (with the shape of the letter C) or as two curves (with the shape of the letter S). In young children, preteens and teenagers scoliosis often does not have any noticeable symptoms which impact the individuals quality of life or activity tolerance and may not be physically noticeable until it has progressed significantly. The two most common forms are degenerative scoliosis (older adults) and idiopathic scoliosis (adolescent). Three treatment options exist approved by Orthopedic Surgeons for combating scoliosis: observation, bracing, or surgery.
Adult scoliosis occurs when the spine curves abnormally to the left or right and may or may not include a rotational component. The majority of scoliosis cases are termed idiopathic, which means because of an undetermined cause. Although scoliosis is usually considered a disorder affecting adolescents, it is also found in adults.
1. A progression of the disease which began in childhood or as an adolescent especially when scoliosis was not treated early or went unnoticed during childhood. The curvature seen in scoliosis may within the thoracic, lumbar, or both.
2. The asymmetric degeneration of spinal elements and disorders such as degenerative disc disease and compression fractures due to osteoporosis may cause changes in the height of the intervertebral discs, vertebral bodies and their shape. A region of the spine may begin to lose its symmetry—meaning, each side is vertically straight—and bend to the left or right and may or may not include a rotational component.
3. There can also be a combination of numbers 1 and 2 causing adult scoliosis.
Symptoms of Adult Scoliosis
Low back (lumbar) pain or mid back (thoracic) pain is the primary symptom of adult scoliosis, especially with lumbar scoliosis. It should also be noted that if the scoliotic curvature involves the thoracic spine, and is quit severe, the individual may experience breathing difficulties directly associated with the physical curvature, and the function of the lungs (diaphragm) and/or heart may be compromised. In some cases when the amount of thoracic curvature is less severe, back pain may be related to or caused directly by spinal osteoarthritis.
Depending on the spinal levels (lumbar, thoracic or both) affected and the severity of adult scoliosis, certain physical characteristics may exist or develop, including:
- Physical deformity
- Lack of spinal symmetry, such as one shoulder or hip may appear higher than the other
- Spinal scoliosis can cause trunk imbalance and may cause an individual to appear to list to one side
- Scoliosis can cause one leg to be longer than the other and cause walking difficulties or gait dysfunction
Adult Scoliosis Diagnosis
Diagnosing of adult scoliosis involves a thorough review of the patient’s personal and family medical histories. The physician tests for spinal conditions and disease processes which are known to cause back pain similar to scoliosis. In severe cases of scoliosis involving the thoracic spine, the individuals cardiopulmonary (heart and lung) function should be evaluated.
The individuals neurologic system should be examined including assessment of the following symptoms:
- Paresthesias/tingling sensations
- Extremity sensation or Numbness
- Extremity sensation and motor function and weakness
- Muscle spasm
- Bowel and/or bladder dysfunction
Imaging Studies Help Diagnose Scoliosis
Full-length spinal x-rays (cervical, thoracic and lumbar) should be taken with the patient is standing. The x-rays allow visualization aspects of the patient’s spine, such as back to front (posterior/anterior abbreviated AP) and lateral (side). Side-bending and flexion/extension x-rays help assess spinal flexibility and stability. The Physical Medicine & Rehabilitation Physician, Orthopedic Surgeon or Neurosurgeon may order CT or MRI imaging, especially if the patient exhibits neurological dysfunction and/or spine procedure or surgery is a consideration.
Adult Scoliosis Curve Classification
Spinal curvature is classified according to the pattern or shape and magnitude/severity. Tests utilized to describe scoliotic curvature include:
- Cobb Angle measurement
- King Classification
- Lenke Classification
- Nash-Moe technique
Non-surgical Treatment for Adult Scoliosis
Patients with adult scoliosis do not always require procedures or surgery. Conservative non-surgical treatment for adult scoliosis may include:
- Moist heat
- Medications for pain, inflammation, and/or muscle spasms
- Physical therapy and exercise
Spine Surgery for Adult Scoliosis
Surgery may be considered if any of the following conditions exist:
- Thoracic (mid back) curve is greater than 50-degrees with persistent pain
- Progressive thoracolumbar (mid and lower back) curve
- Lumbar (low back) curve with persistent pain
- Decreased cardiopulmonary (heart and lung) function
Spine surgery to treat adult scoliosis may include the removal of one or more intervertebral discs (discectomy) and removal of bone (osteotomy) followed by spinal instrumentation and fusion to stabilize the spine. Spinal instrumentation provides immediate spinal stability using different devices such as rods and screws. Bone graft stimulates new bone to grow into and around bone and instrumentation. In time, bone graft fuses (eg, joins) surgically treated spinal levels together.
The surgeon may recommend and prescribe a bone growth stimulator to “stimulate” new bone growth and bone healing following a spinal fusion surgery.
Spine surgery to treat adult scoliosis is followed by physical therapy either in a rehabilitation facility, on an outpatient basis, or at home to help the patient build strength and endurance.