Most cases of adult scoliosis are idiopathic (the cause is unknown). Often, adult scoliosis is the result of changes in the spine due to aging and degeneration. The causes of adult scoliosis are further categorized into several types:
Scoliosis is often painless. Patients with scoliosis commonly see a spine specialist because they notice a problem with the way their back looks. They may notice some of the following things about their body:
Back pain can eventually develop as the condition progresses. The deformity may cause pressure on the nerves and possibly even on the spinal cord. This can lead to weakness, numbness and pain in the lower extremities. In severe cases, pressure on the spinal cord may cause loss of coordination in the muscles of the legs, making it difficult to walk normally. If the chest is deformed due to the scoliosis, the lungs and heart may be affected, leading to breathing problems, fatigue and even heart failure. Fortunately, these severe symptoms are rare.
Whenever possible, nonsurgical treatments are chosen first. Spinal surgery will generally be a last resort due to the risks involved. Conservative treatments commonly include medication, bracing, physical therapy and exercise. If osteoporosis is present, treatment of the osteoporosis may also slow the progression of the scoliosis. This can be accomplished in several ways. The current recommendations include increasing calcium and vitamin D intake, hormone replacement therapy and weight-bearing exercises. Learn more about preventative measures for osteoporosis.
Mild pain medications may be prescribed to use as needed. Usually strong pain medications, such as narcotics, are not recommended due to the risk of addiction.
A spinal brace may provide some pain relief. In adults, it will not cause the spine to straighten. Once you have reached skeletal maturity, bracing is used for pain relief rather than prevention. If there is a difference in the length of your legs (or if the scoliosis causes you to walk somewhat crooked), special shoe inserts, called orthotics, or a simple shoe lift may reduce your back pain. Learn more about braces used to treat back problems.
Physical Therapy and Exercise
Adults with scoliosis may work with a physical therapist. A well-rounded rehabilitation program assists in calming pain and inflammation, improving mobility and strength and helping them do daily activities with greater ease and ability.
Exercise has not proven helpful for changing the curves of scoliosis. However, it can be helpful by addressing pain, posture and spinal stabilization. Therapy sessions may be scheduled each week for four to six weeks.
The goals of physical therapy are to help
Surgery for adult scoliosis has some significant risks. That is why it is only recommended when the expected benefits far outweigh the risks. Surgery is generally only considered in patients who have continual pain, difficulty breathing, significant disfigurement, or a steadily worsening curve. Surgery will not be recommended for most cases-particularly in patients with curves of less than 40 degrees. Curves above 100 degrees are rare, but they can be life-threatening if the spine twists the body to the point where pressure is put on the heart and lungs.
Surgery may be needed in the following situations
When adult scoliosis requires surgery, your surgeon can choose from a number of different procedures. Each case of scoliosis is somewhat different and may require a very specialized approach for optimal results. Surgery is suggested to solve the problems brought on by the scoliosis and not just to straighten the spine. The goals of most surgical procedures for adult scoliosis include
To achieve these goals, the spine surgeon may suggest an operation on the back of the spine, the front of the spine or both. The goal is to first straighten the spine and then to fuse the vertebrae together into one solid bone. Two different types of surgical methods can be used to accomplish this. One is called lumbar fusion with pedicle screws and rods. The second method is to insert special cylinders between the vertebrae to be fused, a procedure called lumbar fusion with intervertebral cages.
Both procedures usually require some type of metal screws, plates, or rods, in order to help straighten the spine and hold the vertebrae in place while the fusion heals and becomes solid. The screws are placed into the vertebra. The rods or plates then attach to the screws to connect everything together. Tightened together, they form an internal brace to hold the vertebrae in alignment while the fusion heals.
Like all surgical procedures, operations on the back may have complications. Because the surgeon is operating around the spinal cord, back operations are always considered extremely delicate and potentially dangerous. Take time to review the risks associated with spine surgery with your doctor. Make sure you are comfortable with both the risks and the benefits of the planned procedure.
One possible complication specific to the surgical treatment of adult scoliosis is flat-back deformity. The lumbar (lower) spine naturally has a slight inward curve called lordosis. When the vertebrae in the lumbar spine are fused together, this lordosis curve may be lost, leaving the patient with a “flat-back” deformity. The loss of curve may not appear right after surgery. If the surgery is performed on a young person, the loss of lordosis may not even appear until sometime between the ages of 30 and 50.