Adult Scoliosis - A Continuation from Childhood

Scoliosis of the spine, artwork
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When we hear about scoliosis, most of the time the conversation centers around how this deformity affects teens and adolescents. Surely, finding out you have scoliosis is a major challenge for a young person.

But scoliosis also affects adults.  It does so in one of two ways - either as a continuation of scoliosis that developed early in life or as an entirely separate condition, known as adult degenerative scoliosis.

This article will give you basic information about adult idiopathic scoliosis. The term "idiopathic" refers to the fact that the experts - your doctor, researchers in the spine field, and others in the know - can't tell what causes it.  Idiopathic scoliosis is the most common type of scoliosis and affects both children and adults

A Quick Definition of Scoliosis

Regardless of what type of scoliosis we're talking about or at what age it's experienced, scoliosis is a deformity in which the spine develops curves that go the side.  It can involve just one curve either to the right or to the left, or, you might have what is known as an "S" curve scoliosis.  An "S" curve consists of two scoliotic curves - one at the top that goes either right or left  and a corresponding bottom curve into the direction opposite to the one on top.

Idiopathic scoliosis in adults looks similar to that in children. You may notice that one of your shoulders is positioned higher than the other, and you may also have a rib "hump" on one side of your mid-back.

 A rib "hump" is basically a marked elevation on one side of your rib cage.  This generally occurs on the convex side of the curve, because the spine in that area pushes the ribs backward.

Scoliosis Diagnosis and Treatment

Scoliosis is measured most often by x-ray and a subsequent Cobb angle analysis of the films.

 If your curve or curves are 50 degrees or greater your surgeon will likely recommend an operation. For curves of lesser degrees, usually bracing, exercise and conservative (non-surgical) care is given. Spinal epidural injections may be given, as well.

Generally speaking, scoliosis curves that develop early in life don't get much bigger than 30 degrees, according to the Scoliosis Research Society (SRS.)  The SRS says that adolescent idiopathic curves that measure 30 degrees or less tend not to progress much as the patient ages. But if your curve was 50 degrees when you were young, progression between .5 to 2 degrees per year is possible. In this case, it's important to have your scoliosis monitored regularly by a spine specialist.

Scoliosis That Continues into Adulthood Has Special Considerations

Now that you know about idiopathic scoliosis in young people, let's try to understand the unique features of this condition as they affect the aging population. 

Scoliosis or not, senior citizens and the elderly tend to develop degenerative changes in the spine.

So if you're a senior and you have adult idiopathic scoliosis, you'll likely have more symptoms than a teen with idiopathic scoliosis, according to the SRS.  

These extra symptoms are related to arthritis and may occur in the areas of the spine that are most prone to degeneration—which tend to be where the openings are. The openings are there to allow the spinal cord and spinal nerves to pass.  Such openings include the spinal canal, where a condition known as central canal stenosis may develop, and the intervertebral foramina, which are located on the sides of the spinal column at every level.  

The spinal nerve roots exit out the foramina before branching into individual nerves that serve the rest of the body.  In the foramina, another type of stenosis may develop called neuro foraminal stenosis. Stenosis is a term that refers to the narrowing of these spaces due to degenerative changes in the bone. 

The intervertebral disc is another area that often undergoes degeneration.

Osteoporosis, a disease in which you lose bone mass faster than you can produce it, may hasten the effects of degenerative scoliosis, according to a study published in the European Spine Journal. Osteoporosis increases the degree of the curve(s), the researchers say.

The researchers add that when you have osteoporosis and adult idiopathic scoliosis,  the facet joints and their capsules, along with the intervertebral discs and spinal ligaments will likely become destabilized, and may develop stenosis. Osteoporosis tends to affect post-menopausal females the most.

Spinal compression fracture is another health issue that affects elderly people more than others. If you sustain this injury, your natural inclination may be to lean or stoop forward. The stooping is a condition known as hyperkyphosis.  The same may be true if you have stenosis, because a forward bending of the spine tends to be more comfortable.  

The problem is that a forward leaning posture can throw you off balance, and cause you to keep your hips and knees bent chronically in order to compensate.  Bent knees and hips help keep you upright in this case.  Along with other adult idiopathic scoliosis symptoms, this compensation may lead to a gradual decline in your ability to function or carry our your normal daily routine.

Surgery for Adult Scoliosis

Conservative treatment—treatment that does not involve surgery—is often tried when your curve is less than 50 degrees. But if the conservative route fails to relieve your symptoms, your back or leg pain is disabling, your spinal imbalance is disabling, and/or you find you're severely restricted in terms of movement and function, you may need the surgery.  

Adult scoliosis surgery does a number of things, according to the Scoliosis Research Society.  It may help restore balance, reduce pain, correct your alignment, stabilize your spine and/or relieve pressure on your nerves. The SRS lists the following procedures as the most common:

  • Microdecrompression is a minimally invasive procedure that helps relieves pressure on nerves. Age-related degenerative changes can lead to stenosis, or narrowing in the openings in the spinal column, and that such narrowing can irritate your nerves.  The Scoliosis Research Society warns that microdecompression may increase your curve degrees, especially if you go into the procedure with curves that are greater than 30 degrees.  They also say that this type of surgery is generally done only at one vertebral level—not multiple levels.
  • Fusion may be done to stabilize the spine in a more straight position.  Fusion uses bone graft material, either synthetic, from your own bone or from a cadaver (it's sterilized before it gets to you) as a temporary bone substitute. Then, after the procedure, there's a healing period. Success is determined after this period by how well the adjacent bones fuse together.
  • Surgical stabilization is similar to a fusion in that it places your spine in a "more correct" alignment and allows it to fuse that way.  The difference is that surgical stabilization employs the use of instrumentation—screws, plates, hooks, rods and the like to help re-position your spine.
  • Osteotomy involves cutting and realigning spinal segments.  Spinal segments consist of two adjacent vertebrae (spinal bones) and the disc that resides between them.  And osteotomy may involve more than one spinal segment.

Sources:

Aebi, M. The Adult Scoliosis Eur Spine J. 2005 Dec. http://www.ncbi.nlm.nih.gov/pubmed/16328223

Scoliosis Research Society.  Scoliosis.  SRS website. http://www.srs.org/patients-and-families/conditions-and-treatments/adults/scoliosis

University of Washington Department of Radiology.  Scoliosis.  UW Dept of Radiology http://rad.washington.edu/about-us/academic-sections/musculoskeletal-radiology/teaching-materials/online-musculoskeletal-radiology-book/scoliosis/

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