Scoliosis occurs in roughly 4% of the adult population. Approximately 85% of these adults have idiopathic scoliosis that occurred during the growing years. Most of the remaining 15% have degenerative scoliosis that developed after skeletal maturity.

Scoliosis can get worse during adult years. Curves under 30 degrees are unlikely to progress after skeletal maturity. On the other hand, large curves can gradually get worse. For example, thoracic curves between 50 degrees and 75 degrees progress an average of 1 degree per year. Degenerative curves have been found to progress by an average of 3 degrees per year. Patients with scoliosis and osteoporosis are more likely to have progression of their curves.

What are the signs that a spinal deformity in an adult is getting worse? An adult with progressive scoliosis may notice a loss of height, a change in waistline, leaning more to one side, an enlarging hump on the back, or a change in the way clothes fit. The definitive way to determine whether or not a curve is progressing is to compare x-rays taken over a period of time.

Most adult patients who seek medical attention for scoliosis do so because of pain, worsening deformity, or both. Pain patterns vary. Many patients have pain that is unrelated to their scoliosis. Treatment for these patients is the same as for any other patient with back pain. Pain caused by the scoliosis may be secondary to muscle fatigue, trunk imbalance, degenerative arthritis or nerve compression. Determining if a patient's pain is caused by the scoliosis requires a careful history and physical examination, as well as a variety of diagnostic studies.

Patients with painful scoliosis but no documented curve progression should be managed nonoperatively initially. Treatment may include medication, physical therapy, manipulation, exercise, weight loss, and activity modifications. For older patients who are not considered to be surgical candidates, bracing may be effective for relief of pain not responsive to these other measures. Adult patients cannot expect permanent correction of their deformity with bracing, however.

The indications for surgical treatment of adult scoliosis include curve progression, pain in the area of the spinal curvature not responsive to nonsurgical treatment, loss of neurological function, and in rare cases of severe thoracic scoliosis, respiratory problems.

When compared to surgical treatment of scoliosis in adolescents, surgery in adults is much more challenging with a greater risk of complications. The reasons for this include osteoporosis, stiffer spines, underlying medical problems, and more extensive surgery. Surgical treatment of adult scoliosis should be approached cautiously with a realistic understanding of the expected benefits, as well as the potential complications. Studies have shown that approximately 85% of adult patients with scoliosis and back pain are satisfied with their results after surgery. A successful result following surgery depends on careful patient selection, meticulous preoperative planning, expert surgical techniques, and diligent post-operative care. Few patients are absolutely pain free after surgery, but most are gratified with their reduced level of pain and increased level of activities.