The term adult scoliosis refers to an abnormal curvature of the spine after one has finished growing. Scoliosis can be a curvature to the right or left and sometimes can include a rotational component to the spine. With these structural changes over time patients often will notice appearance changes including possibly one shoulder higher than another, ribs more prominent on one side, or possibly asymmetric skin folds.
There are many different types of scoliosis, but the two most common forms of adult scoliosis are worsening of a scoliosis known from adolescence or degenerative scoliosis. In degenerative adult scoliosis asymmetric degeneration of the discs or joints in a patient’s back can lead to unbalanced loading of the spine. This unbalanced loading can worsen a curvature or degree of scoliosis.
Adolescent idiopathic scoliosis is very common, for those patients with known scoliosis we recommend close monitoring over time. Often patients with adult degenerative scoliosis do not know they have scoliosis until their initial examination with radiographs.
Due to the degeneration of discs and spinal anatomy, patients may also experience symptoms associated with stenosis or narrowing around the spinal canal or nerves.
Common symptoms include:
Of note, there are some symptoms where we recommend more urgent evaluation which may be associated with spinal stenosis including progressive weakness, loss of bowel or bladder function, and loss of bowel or bladder control. These symptoms warrant prompt evaluation and management.
When a patient comes to our office we do a full physical exam to not only check their muscle strength and deep tendon reflexes but also evaluate for some of the previously mentioned exam findings associated with scoliosis. We are assessing for changes in patients height over time, overall alignment, asymmetric skin folds which would indicate a curvature being present or possible asymmetry in shoulder or pelvic height.
Radiographs are required to confirm the diagnosis of scoliosis and we utilize full scoliosis x-ray imaging so we can visualize the cervical, thoracic, and lumbar spine. We wish to visualize any structural instability, curvatures, or rotation of the spine. Scoliosis is confirmed when radiographs show a curvature of 10 degrees or higher, this measurement is called a Cobb angle.
We do recommend for scoliosis patients to be monitored by a scoliosis spinal specialist. We anticipate due to natural aging and gravity’s effect on our spine, scoliosis curvatures to worsen over time. If symptoms are mild we may often continue to monitor their curvature or possibly treat with a number of different non-operative modalities. Non-operative treatments often include use of physical therapy or athletic training to strengthen the core muscles supporting our spine. Often if symptoms are significant we will also prescribe medications or order injections. For significant scoliosis or scoliosis that has worsened to where patients have noteworthy symptoms that are interfering with their life, surgical intervention may be discussed.
The goal of spinal deformity surgery in the setting of adult scoliosis is to provide patients with relief of their pain and neurologic symptoms while restoring their overall spinal alignment. Improvement in overall spinal alignment is shown to improve not only long term quality of life but also improve a patient’s self-image.
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Reviewed by: Dr. Christopher Good, MD, FACS.