De Novo Scoliosis: Causes, Symptoms, Diagnosis and Treatment

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Adult scoliosis is in its own category of medical problems and regarded separately from the type of scoliosis that shows up in children. In fact, adult scoliosis is a term that collectively includes all deformities affecting spines that have stopped growing (called "skeletally mature").

Overall, scoliosis cases range between 2 and 32 percent of the adult population, but the condition affects elderly people the most.

 A 2011 review on degenerative scoliosis published by the Hospital for Special Surgery reported that twice as many elderly people live with scoliosis than do their younger counterparts.  Along with the cosmetic concerns related to spinal deformity, adult scoliosis takes its toll on your quality of life—especially as you age because it can lead to disability and a lot of pain.

An adult scoliosis diagnosis falls broadly into one of three categories. One type, known as progressive idiopathic deformity, develops before you stop growing, but, you get symptoms afterwards. Otherwise, it wouldn't be categorized as adult scoliosis. 

Another type, known as secondary degenerative scoliosis occurs as a result of degenerative changes and other problems in the spine that don't directly cause scoliosis, but that can result in it.  

What may lead to primary degenerative scoliosis? Hip issues and/or asymmetrical spinal changes related to either osteoporosis or arthritis are common causes.

 The hip issues include problems in your lumbo-sacral area, a leg length difference or hip arthritis.

What Is De Novo Scoliosis?

Age-related degeneration that leads directly to side to side curvature in one or more areas of the spine is the most common cause of adult scoliosis. This type is called de novo scoliosis.

Novo means "new" and refers to the fact that you've gotten the curve for the first time as an adult.

Another name for a de novo scoliosis is primary degenerative scoliosis.  Most of the time disc and/or facet joint arthritis are responsible,  but thickened ligaments, another age-related spinal change can cause it as well.

Since de novo scoliosis begins when you're an adult, you start life with a straight spine. But as aging takes its toll on the structures of your back—which happens to all of us to some degree or another—part of the column begins to collapse, resulting in a concavity on one side and a convexity on the other.

Signs and Symptoms of De Novo Scoliosis

De novo scoliosis usually shows up in the lumbar spine (your low back area.)  One of the effects you or someone you're close to may notice is a lessening of your natural low back curve. This can be seen from the side view as a straightening of the spine.  Keep in mind, though, that a decreased lumbar curve angle is not a definitive sign of de novo scoliosis.

 A flattened low back curve, as it's often called, is a sign for other spinal conditions as well.

De novo scoliosis can present in other ways, too. For example, you may experience chronic back pain or nerve symptoms.  Authors of a study on surgery for de novo scoliosis estimate that 70 percent of people with this condition get pain, nerve sensations such as tingling, burning, numbness (a loss of sensation, actually) or electrical shock that can be felt down just one leg. Another nerve symptom that may be experienced by people with de novo scoliosis is weakness affecting one leg.

Much of the discomfort experienced by someone with de novo scoliosis is asymmetrical, where only one side of the body is affected. To a large extent, this is because the degeneration in discs and facet joints happens on just one side per area affected.  But there may be more than one area affected, which could result in more than one scoliotic curve in your spine.  

Another reason for the asymmetry may be that due to spinal injury or degenerative changes, the disc space becomes wedged—for example, if you have sustained a vertebral fracture—and this may cause that area to collapse on one side. 

So not only might you get nerve pain or "deficits" but your back pain may be asymmetrical, as well.  In fact, authors of a 2016 review on how scoliosis progresses that was published in the European Spine Journal say back pain as a symptom is more predominant than nerve affectations in most cases of de novo scoliosis.

And finally, another abnormality that can develop is spinal stenosis: central canal stenosis, neuroforamina  stenosis or stenosis in the lateral recess.  Once you reach the point where signs of stenosis are viewed on X-ray or CT scan, your spine is considered to be unstable. You may also experience neurogenic claudication, which feels like a cramping.  Neurogenic claudication is the classic symptom of spinal stenosis.

Even though experts have determined that degenerative changes in discs, disc spaces, facet joints and/or​ spinal ligaments are the usual causes of de novo scoliosis, in the beginning, it can be difficult for your doctor to pinpoint the source of the curve.  But as the curve progresses, it gets easier.  Part of this boils down to the asymmetry in your spine;  if you have degeneration on one side, this may lead to loading on one side only.  This, in turn, can spur progression of both the degeneration and the deformity.  (The deformity may be scoliosis, but it can also be kyphosis.)  

Experts have also determined that osteoporosis increases the speed of progression of denovo scoliosis.  This is especially true in post-menopausal women, who are at the highest risk for this bone disease.  Osteoporosis can destroy facet joints, facet joint capsules, discs and/or ligaments, which, as we've discussed, can and do lead to spinal instability and stenosis.​

Diagnosing De Novo Scoliosis

A number of tests exist for diagnosing de novo scoliosis.  When these are used, your doctor will correlate their findings with the results of her physical exam, and in this way confirm what you have. The exact test(s) you may undergo are divided into two main categories (although it's possible that your doctor will order one or more from each category.) The categories are:

  • Diagnostic imaging tests, which may include x-rays, CT scans or MRIs. X-rays measure the degree of scoliosis curves and as well as pelvic alignment.  An MRI assesses any nerve symptoms you may experience - these are things like pain, weakness and/or electrical sensations that go down one leg.
  • Invasive tests, including discograms, injections into facet joints or nerve roots, and others.

While it's true that doctors often order a full battery of tests as part of the de novo scoliosis diagnostic process, it's possible that the results won't fully correspond to the symptoms you experience.

Treatment for De Novo Scoliosis

Ideally, treatment for de novo scoliosis will be tailored to your specific symptoms.  The goal of treatment, of course, is to manage symptoms and minimize or correct any deformity you may have.  As with adult idiopathic scoliosis (scoliosis in skeletally mature individuals that started in childhood but have progressed in adults,) non-operative treatment works well for most people with the de novo variety.  The Scoliosis Research Society says the exception is if your symptoms are disabling.  

The non-surgical approach may include observation (to catch any progression as soon as possible), the use of over the counter pain relievers, core strengthening exercise, flexibility exercise, the use of braces for pain relief and/or injections to relieve leg pain temporarily.  

Once you start talking surgery, things get complex. For one thing, the possibility of complications from the procedure is high.  There's good news, though. The authors of the European Spine Journal article mentioned above says such surgeries are on par with other established orthopaedic procedures (for example, hip replacement) for the same age group(s).  Plus, the authors comment that as long as the surgical procedure (and the decision to have the surgery) are selected based on you as an individual, the results tend to be satisfying for patients.

Issues that arise can include one or more of the following: your age, medical condition, if you're having a fusion, the length of fusion of it, the condition of the spinal segments that are adjacent to the area being operated on, the condition of your lumbosacral joint (L5-S1,) if you've had scoliosis surgery previously, and/or how long you've had chronic back pain or chronic muscle imbalances.  The authors say that the longer you've had chronic back pain, the less is your chance that surgery will make a positive difference in symptom management and how you feel.

And no matter which surgery you have, the aging process continues.  So as you get older and as time moves on, the surgical focus may go towards minimally invasive spine procedures.  The reason is two-fold.  First, advances in technology are allowing surgeons to do more with less (or at least smaller) equipment.  Second, and this may be related to the trend toward minimally invasive procedures, the authors of the European Spine Journal article suggest that the focus on overall deformity and degeneration may soon start to give way to a more precise focus on the exact cause of the scoliosis curves.  

Procedures used by surgeons in cases of de novo scoliosis include decompression surgery (also known as a laminectomy), surgery to correct the deformity, stabilization surgery, which uses hardware such as screws, rods and plates to fix your spine, fusion surgery which removes the movability between two adjacent bones, or some combination of these techniques.


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