Adult Scoliosis Correction
Adult scoliosis refers to an abnormal curvature of the spine in a patient who has finished growing. Scoliosis is an abnormal curvature of the spine that affects approximately seven million people in the United States. The curvature can be to the right or the left side and also involves a twisting or rotation of the bones of the spine.
Adult scoliosis can develop as the result of an untreated childhood curvature. Adult scoliosis can also develop in a patient without any previous history of a scoliosis. When adult scoliosis develops in a patient with a previously straight spine, it is called adult degenerative scoliosis. Adult scoliosis typically arises from a combination of spinal degenerative conditions including disc degeneration, compression fracture, osteoporosis, and spinal stenosis.
Symptoms of scoliosis may include back pain, leg length discrepancy, uneven hips, or abnormal gait. The patient may notice that one shoulder is higher than the other, a prominent shoulder blade, or visual curvature of the spine. Some patients with scoliosis first notice that clothes no longer fit correctly. As the curvature leads to degeneration of the discs and spinal bones, a number of other symptoms can occur such as pain, difficulty standing or sitting upright, spinal stiffness, nerve damage, truncal imbalance, rib prominence, spinal instability and even cardiac or pulmonary (heart and lung) problems.
Many patients with adult scoliosis do not have any specific symptoms and never require surgical treatment. A number of non-operative treatment options are available to help treat pain and maximize function. The physicians at the Virginia Spine Institute evaluate each patient's overall physical well being to determine an appropriate exercise and physical therapy routine. For most patients, a combination of aerobic fitness, weight bearing exercises and core muscle strengthening are used. Physical therapy, spinal mobilization techniques, or chiropractic treatment can be beneficial for treating symptoms of scoliosis however; none of these treatments are effective in reducing the size of the curvature.
Medication management can include the use of anti-inflammatory medications or pain medications. Spinal injections targeted at areas where arthritis is causing pain or nerve irritation can be beneficial.
Surgery to correct adult scoliosis is an option when nonsurgical treatments do not relieve pain or symptoms. Surgery is also needed for progressive curves or curves causing nerve compression with symptoms such as numbness, weakness, or pain. In general, curves greater than 45° and curves with severe degenerative changes are best treated with surgical reconstruction. Surgical reconstruction involves some correction of the curvature with the goal to relieve pain and prevent the curvature from worsening in the future.
Surgery to correct adult scoliosis may be performed from the back of the spine (posterior approach), the front or side of the spine (anterior or lateral approach), or a combination of both anterior and posterior surgery. Before deciding on the approach, the doctors at the Virginia Spine Institute review the patient's x-rays, imaging tests, and clinical examination multiple times to formulate the surgical plan. The best surgical approach depends on the type of curvature, the patient's symptoms, and any previous surgery.
Adult scoliosis correction surgery utilizes spinal implants, rods and screws, to correct scoliosis and hold the spine stable while the bones heal. Spine fusion is achieved using bone graft taken from the patient's spine intra-operatively in the area of surgery and for some patients bone morphogenetic protein is used to increase the chance that the spine will correctly fuse. When the spine fuses, those segments of the spine heal together and are no longer mobile. For patients with scoliosis, the surgeons try to fuse the smallest number of vertebrae possible. This helps preserve the greatest amount of motion in the spine. The final recommendation is based on the desire to design the least invasive and safest procedure for each patient.
A 31 year old woman was diagnosed with scoliosis at age 9. She was treated in a brace until she was 16 years old. Over time, her curvature progressed and she began having increasing back pain with pain radiating into her leg. After a complete evaluation, the doctors at Virginia Spine Institute performed a staged operation to correct her scoliosis. The first surgery was performed through a small incision below her belly-button and the second through an incision in the back. After the operation, she had correction of her scoliosis, a good standing posture and has returned to her previous job teaching horseback riding.
A 70 year old woman developed worsening posture and shortness of breath. She saw her pulmonologist for a lung evaluation and was told that her worsening scoliosis was causing her trouble breathing. She saw Dr. Good at Virginia Spine Institute and was diagnosed with a double curvature in her thoracic spine. Both curves measured over 60°. Dr. Good performed a scoliosis reconstruction surgery with partial correction and fusion of both curves. X-rays taken post-operatively showed improvement in her scoliosis and her breathing has since returned to normal.
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