Adult Scoliosis Is a Continuation From Childhood

Scoliosis of the spine, artwork
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Scoliosis commonly affects teens and adolescents. But scoliosis also affects adults. It does so in one of two ways—either as a continuation of scoliosis that developed early in life or as an entirely separate condition, known as adult degenerative scoliosis.

In adult idiopathic scoliosis, the term "idiopathic" refers to the fact it has no known cause. Idiopathic scoliosis is the most common type of scoliosis and affects both children and adults. 

A Quick Definition of Scoliosis

Regardless of what type of scoliosis we're talking about or at what age it's experienced, scoliosis is a deformity in which the spine develops curves that are abnormal. It can involve just one curve either to the right or to the left. An "S" curve consists of two scoliotic curves—one at the top that goes either right or left and a corresponding bottom curve that goes in the opposite direction.

Idiopathic scoliosis in adults looks similar to that in children. You may notice that one of your shoulders is positioned higher than the other, and you may also have a rib "hump" on one side of your mid-back. A rib "hump" is basically a marked elevation on one side of your rib cage. This generally occurs on the convex side of the curve, because the spine in that area pushes the ribs backward.

Scoliosis Diagnosis and Treatment

Scoliosis is measured most often by x-ray; a measurement called Cobb angle can be done during an analysis of the films. If your curve or curves are 50 degrees or greater, surgery may be recommended. Depending on the size and location of the curvature, the age of the patient, and other factors, nonsurgical treatment, including bracing, exercise and observation may be recommended.

According to the Scoliosis Research Society (SRS), four adolescent idiopathic curves that measure 30 degrees or less tend not to progress much as the patient ages. But if your curve was 50 degrees when you were young, progression between .5 to 2 degrees per year is possible. In this case, it's important to discuss your treatment options with a spine specialist.

Scoliosis in Adults Has Special Considerations

Adults with idiopathic scoliosis are more likely have more symptoms than a teen with idiopathic scoliosis, according to the SRS. Older people tend to develop degenerative changes in the spine, and this can be associated with another cause of scoliosis called adult degenerative scoliosis.

This type of scoliosis is related to arthritis and may occur in the areas of the spine that are most prone to degeneration—which can occur where the openings are. The openings are there to allow the spinal cord and spinal nerves to pass. Such openings include the spinal canal and the foramina.

The spinal nerve roots exit out the foramina before branching into individual nerves that serve the rest of the body. Narrowing of these spaces due to degenerative changes in the bone is called stenosis and can lead to pressure on the nerves.

The intervertebral disc is another area that often undergoes degeneration.

Osteoporosis, a disease in which bone mass is decreased, may hasten the effects of degenerative scoliosis, according to a study published in the European Spine Journal.

Osteoporosis tends to affect post-menopausal females the most. Osteoporosis can contribute to progression of the curve(s), the researchers say. With progression, the facet joints and their capsules, along with the intervertebral discs and spinal ligaments, can become destabilized and may develop stenosis.

A spinal compression fracture is another health issue that affects older people more than others. This is associated with osteoporosis and can lead to worsening and progression of degenerative scoliosis.

Surgery 

Treatment for scoliosis in adults can depend on the type, location, and symptoms associated with the deformity. In some cases, your doctor may recommend conservative treatment that does not involve surgery. But in some cases, if your back or leg pain due to the deformity is disabling, your spinal imbalance is disabling, and/or you find you're severely restricted in terms of movement and function as a result of the scoliosis, your doctor may discuss options for surgery.

Scoliosis surgery in adults does a number of things, according to the Scoliosis Research Society. It may help restore balance, reduce pain, correct your alignment, stabilize your spine and/or relieve pressure on your nerves. Surgical procedures include:

  • Microdecrompression is a minimally invasive procedure that helps relieves pressure on nerves. Age-related degenerative changes can lead to stenosis, or narrowing in the openings in the spinal column, and that such narrowing can irritate your nerves. The Scoliosis Research Society warns that microdecompression may increase your curve degrees, especially if you go into the procedure with curves that are greater than 30 degrees. They also say that this type of surgery is generally done only at one vertebral level—not multiple levels.
  • Fusion uses bone graft material, either synthetic, from your own bone, or from a deceased donor, as a temporary bone substitute. Success is determined by how well the adjacent bones fuse together after they heal.
  • Surgical stabilization places your spine in a "more correct" alignment and allows it to fuse that way. Surgical stabilization employs the use of screws, plates, hooks, and rods to help re-position your spine.
  • Osteotomy involves cutting and realigning spinal segments. Spinal segments consist of two adjacent vertebrae (spinal bones) and the disc that resides between them. And osteotomy may involve more than one spinal segment.
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