Degenerative Adult Scoliosis
Scoliosis developed in adulthood can be "secondary" to other spinal conditions that affect the vertebrae. Other conditions such as degeneration, osteoporosis (loss of bone mass), or osteomalacia (softening of the bones) can cause scoliosis. Scoliosis can also appear following spinal surgery for other conditions. The surgery may cause an imbalance in the spine that leads to scoliosis. Most of these secondary causes of scoliosis are considered degenerative adult scoliosis.
Degenerative adult scoliosis usually begins as low back pain. While there may also be a deformity that causes the back to look abnormal, usually pain is what motivates patients to seek treatment. The pain is probably not coming from the curve, but rather from the degeneration occurring in the spine.
A combination of the degeneration of the spine and scoliosis deformity may cause pressure on nerves and possibly even the spinal cord. This can lead to weakness, numbness, tingling and pain in the lower extremities. In severe cases, pressure on the spinal cord may cause loss of coordination in the muscles of the legs, making it difficult to walk normally.
The degeneration and the scoliosis may have caused a condition called spinal stenosis, a narrowing of the spinal canal. Spinal stenosis results from spinal degeneration that has led to the growth of bone spurs. Eventually the spurs take up space in the spinal canal, causing it to become smaller. This leads to bone pressing on the spinal cord and its nerve roots. The lack of space lessens the nerves' supply of blood and oxygen, which can lead to numbness and pain in both legs.
The treatment for degenerative scoliosis is usually conservative. Treatment commonly includes medication, exercise, and bracing to support the spine.
If osteoporosis is present, then treatment of the osteoporosis may also slow the progression of the scoliosis. The current recommendations include increasing your calcium and vitamin D intake, hormone replacement therapy, and weight-bearing exercises.
Mild pain medications may be prescribed to use as needed. Usually strong pain medications, such as narcotics, are not recommended due to the risk of addiction.
Learn more about medications used to treat back pain.
Physical Therapy and Exercise
Adults with scoliosis may work with a physical therapist. A well-rounded rehabilitation program assists in calming pain and inflammation, improving mobility and strength, and helping them do daily activities with greater ease and ability.
Exercise has not proven helpful for changing the curves of scoliosis. However, it can be helpful by addressing pain, posture, and spine stabilization. Therapy sessions may be scheduled each week for four to six weeks.
The goals of physical therapy are to help
- learn ways to manage the symptoms of scoliosis
- improve spine posture
- maximize spine stabilization
The use of a spinal brace may provide some pain relief, but in adults the brace will not cause the spine to straighten. Once you have reached skeletal maturity, bracing is used for pain relief rather than prevention. If there is a difference in the length of your legs (or if the scoliosis causes you to walk somewhat crooked), special shoe inserts, called orthotics, or a simple shoe lift may reduce your back pain. Learn more about braces used to treat back problems.
Surgery may be recommended in some cases of degenerative scoliosis, especially if you have nerve problems that are becoming steadily worse, uncontrollable pain, or spinal stenosis. If the nerve roots are being irritated or pinched because of the scoliosis, surgery may be necessary to remove the pressure.
Surgery to relieve pain from scoliosis is a controversial topic. Spinal surgery is serious and can lead to complications. Not all physicians consider pain reason enough to recommend surgery. If the pain is chronic and debilitating, you can discuss this option with your doctor. The options for surgery include laminectomy and spinal fusion.
Laminectomy is a surgical procedure used to free up or "decompress" the spinal nerves.
It is sometimes called lumbar decompression, or a decompressive laminectomy of the lumbar spine. The surgeon removes a small section of the bone on the back of the spine (lamina). This takes pressure off the nerve roots. Bone spurs or fragments from a degenerated disc that are pressing on the nerve are also removed.
Laminectomy is commonly combined with a spinal fusion to straighten the spine and stop the progression of the curve. After taking away the damaging pressure, two or more of the vertebrae are fused together to provide spinal stability. Once the bones are fused, they become one long column. Because these fused spinal vertebrae are no longer made up of separate bones and joints, there will be no movement or flexibility in that area.