The term 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 spine curves abnormally to the right or left side and also involves a twisting or rotation of the bones of the spine. As the vertebrae rotate, this may cause clinical change in the appearance of the patient's back and may also lead to painful degeneration of the spine leading to back pain or nerve pain or in severe cases alter lung and heart function.
Adult scoliosis can develop as the result of a childhood curvature that was never treated. It can also develop in a patient without any previous scoliosis history. Adult scoliosis that develops in a patient with a previously straight spine is called adult degenerative scoliosis. Adult scoliosis typically arises from a combination of degenerative spinal conditions including disc degeneration, compression fracture, osteoporosis, and spinal stenosis.
For patients with scoliosis, the spine develops an abnormal curvature.
Many patients with adult scoliosis do not have any specific symptoms. Scoliosis symptoms vary based on the curve severity. Some patients first notice that their clothes no longer fit correctly. As the curvature leads to disc degeneration and changes in the bones of the spine, a number of symptoms can occur. Symptoms may include back pain, spinal stiffness and even nerve pain. The abnormal curvature may cause uneven hips or an abnormal gait and patients may have a leg length discrepancy. Patients may notice that one shoulder is higher than the other, a prominent shoulder blade, or uneven skin folds. There may be difficulty with standing or sitting upright and problems with balance. In severe cases the curvature can progress to affect heart or lung function in the thoracic spine.
Most patients never require surgical treatment. For patients with symptomatic scoliosis, a number of non-operative treatment options are available to help treat pain and maximize function. Our Spinal Specialist at Virginia Spine Institute evaluate the patient's overall physical well being to determine an appropriate exercise and physical therapy routine. For most patients, a combination of aerobic weight bearing and core muscle strengthening exercises are recommended. Physical therapy, spinal mobilization techniques, or chiropractic treatment can be beneficial for treating symptoms. While these treatments reduce pain and improve mobility, none of these treatments have been shown to effectively reduce the size of a curvature. Medication management for some patients with scoliosis can include the use of anti-inflammatory or pain medications. Spinal injections can be performed to treat areas where arthritis is causing pain or causing nerve irritation.
Surgery to correct adult scoliosis is an option if nonsurgical treatments do not relieve pain or symptoms. Surgery is also needed for patients whose curves are progressing over time or have curvatures leading to nerve compression causing 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 for adult scoliosis involves some correction of the curvature. Goals of surgery are to relieve pain and prevent the curvature from worsening in the future.
Surgery to correct adult scoliosis may be performed from several approaches. Before deciding on the best surgical approach, our surgeons at Virginia Spine Institute review patient's x-rays, imaging tests, and clinical examination multiple times to formulate a surgical plan. Our surgeons always try to fuse the smallest number of vertebrae possible. This helps preserve the greatest amount of motion in the spine. The final recommendation for each patient is based on the desire to prepare the least invasive and safest procedure for each patient.
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