Scoliosis is the lateral or sideways curvature of the spinal cord in one or multiple places. Scoliosis is common in childhood or adolescents between the age of 10 and 18. However, it may develop in adults when it begins after puberty because the curve is discovered after complete skeletal growth.
It is defined as an abnormal spine curvature, commonly known as adult deformity. The spine curves more than usual, forming a “C” or “S” shape. Adult scoliosis may also occur due to degenerative changes to the spine, conditions that weaken the spine, and neuromuscular disease.
Types of Adult Scoliosis
There are two major types of adult scoliosis: adult idiopathic scoliosis and adult degenerative scoliosis.
Adult degenerative scoliosis (“de novo” or new) occurs in patients over 60 years old. It occurs due to the natural degeneration of the spine discs, arthritis in the joint facets, and wedging of the disc spaces. It affects the lower back, accompanied by the straightening of the spine from the side view.
Adult idiopathic scoliosis progresses into adulthood from childhood. The cause of idiopathic scoliosis is unknown. The curves occur in the lower and upper spine.
Other less common types of adult scoliosis include:
Traumatic scoliosis occurs when severe trauma from accidents may cause spinal deformities.
Pathological scoliosis develops when tumors are pressing on the spine. The pressure caused by tumors can cause a curvature to develop.
Parts of the spine that are curved in scoliosis include the following:
- Lumbar spine (lower back)
- Cervical spine (neck)
- Thoracic spine (chest and upper back region)
Symptoms
Symptoms are similar in both types of adult scoliosis. They may include the following:
- Leg Pain, numbness, and weakness
- Walking difficulty
- Uneven hips or shoulders
- Lower back bump or deformity
- Shortness of breath
- Feeling tired
- Height loss
- Bone spurs (bony bumps in the spinal joints)
- Feeling full while eating prematurely
- Difficulty in standing up straight or sitting upright
- One side of the rib cage jutting forward
- Clothes not fitting properly
Diagnosis
A physician asks the following questions to gain patient history and eliminate other possible conditions:
- Date of onset- a date for a noticeable change to the spine.
- Family history
- Absence or presence of pain
- Bladder or bowel and motor function dysfunction- may indicate nerve damage
- Measured curve progression
Physical exams and diagnostic tests may also be performed, including X-rays, Computed tomography (CT) scan, Myelogram, and magnetic resonance imaging (MRI) scan.
Nerves may also be tested through muscle strength checks, sensation, and reflexes.
A positive diagnosis is confirmed when the patient has a curve that exceeds 10 degrees.
Treatment
There are two treatment options for scoliosis: surgical and nonsurgical interventions; however, most patients don’t require surgery.
Nonsurgical Treatments
Nonsurgical options include the following:
- Chiropractic therapy
- Posture therapy
- Physical therapy
- Scoliosis bracing
- Pain medication like nonsteroidal anti-inflammatory drugs (NSAIDs)
Nerve block injections or epidural injections may be administered for patients who do not get relief from oral medication.
Surgical Treatments
Some cases of adult scoliosis may require surgery. It is the last resort because several risks and complications may arise from the surgery.
Surgery is designed to stabilize the spine, relieve nerve pressure and restore balance. The goal of surgery is to prevent the spine from curving further and relieve pain. It is recommended for:
- Patients with curves exceeding 50 degrees and their ability to function daily are impaired.
- Patients who do not respond to nonsurgical treatments after a certain period
- Patients who cannot stand upright when performing their daily activities
- For patients whose lung or neurologic function is worsening or deteriorating
Types of Surgery
Spinal fusion is the most common surgical option for scoliosis. The procedure stabilizes the spine; surgery fuses spinal bones using bone grafts. Metallic implants hold the spine in place. Fusion is combined with other surgical procedures that include:
- Surgical stabilization– In patients with severe scoliosis, rods and screws are attached and linked together in the spine then fusion follows.
- Decompression fusion – The pressure is relieved by removing nerves causing pressure in the spine, followed by fusion. It is performed for mild scoliosis to relieve leg pain (spinal stenosis).
- Vertebral column resection– This procedure involves the removal of entire vertebrae sections. The surgery is performed to correct severe, rigid spinal deformities.
- Osteotomy– This is a surgery that cuts or reshapes the bones. Osteotomy is performed to repair damaged joints. The surgeon cuts the vertebrae to bend the spine into the desired position then fusion follows. Osteotomy is performed to correct deformity more than the screws and rods can accomplish.
Recovery from surgery takes between four to six weeks. The healing process takes several months to a year, depending on the severity of the condition.
Here at American Neurospine Institute, we have expertise in treating scoliosis to minimize pain and discomfort through customized treatment plans. Contact us today for more information on scoliosis treatments.
