Adults with scoliosis (lateral curvature of the spine)
fall into two main categories: those who had scoliosis as a child or
adolescent and those who develop scoliosis after skeletal maturity. The
latter group consists primarily of patients who develop scoliosis of the
lumbar spine (lower back) secondary to degenerative disc disease.
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.
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