Adult Scoliosis

Scoliosis is the medical term used to describe a condition where there is curvature of the spine of 10 degrees or more. Adult scoliosis refers to people who are over the age of 18 years who have spinal curving. There are two common types of adult scoliosis: idiopathic and degenerative.Degenerative_Scoliosis

Adult idiopathic scoliosis means the scoliosis has developed during adolescence and persists into adulthood. De novo or degenerative scoliosis develops during adulthood, and is related to degenerative disc disease. The discs of the spine lose height and begin to tilt, putting pressure on one side of the spine. With gravity, the spine tends to curve and bend, causing an S-shaped curve.

Symptoms of Adult Scoliosis

Many patients with mild degenerative scoliosis do not even know their spines are curved. However, when the curvature reaches 20 degrees or more, pain often occurs. This is related to the spine pressing against other body structures, such as the lungs, muscles, and diaphragm.

With severe progressive adult scoliosis, the thoracic (middle) spine region curves and causes shortness of breath, as the vertebrae bony projections put pressure on the lungs. Many people have a posture that pitches forward, as the spinal curve makes standing up straight impossible. Depending on the severity of the adult scoliosis, several physical characteristics evolve, such as:

  • Obvious deformity of the spine
  • Lack of body symmetry (one shoulder or hip is lower)
  • Trunk imbalance
  • Walking difficulties (one leg is longer than the other)

Diagnosis of Adult Scoliosis

Scoliosis is diagnosed by clinical examination and x-rays. For proper scoliosis evaluation, the doctor will take full-length x-rays of the entire spine. If the patient has symptoms of leg pain or nerve impingement, a magnetic resonance imaging (MRI) scan is done to assess for a condition called stenosis. With spinal stenosis, the bony vertebrae press on the spinal cord (compression).

 

Treatment of Adult Scoliosisdegenerative scoliosis2

The treatment of adult scoliosis is based on the patient’s symptoms and severity of the condition.

  • Pulsed radiofrequency treatment – This involves passing alternating radiofrequency energy through the tissues to inactivate pain-carrying nerve fibers. This procedure results in decreased pain of the region targeted.

 

  • Facet joint injections – Usually given in a series of three, these shots contain a long-acting local anesthetic and an anti-inflammatory steroid. The medication is instilled into the facet joint of the vertebrae. Approximately 75-85% of patients report significant pain relief and functional improvement with the facet joint injection.

 

  • Facet joint denervation – This procedure is best for patients with severe low back pain, and it involves injecting a medication into the facet joint of the spine to disable the sensory nerve. Radiofrequency energy goes through a special needle to coagulate and destroy nerve tissue.

 

  • Lumbar sympathetic block – With this procedure, injection needles are positioned to provide long-acting anesthetic medication to first diagnose the pain and then treat it. A neurolytic substance (phenol or alcohol) is instilled to destroy the lumbar sympathetic nerves. These blocks have been proven to be effective for providing significant pain relief in over two-thirds of patients.

 

Resources

 

Daffner SD & Vaccaro AR (2003). Adult degenerative lumbar scoliosis. American Journal of Orthopedics, 32(2), 77-82.

(PMID:12602636).

Birknes, JK, Harrop JS, White AP, et al. (2008). Adult degenerative scoliosis: a review. Neurosurgery, 63(3), 94-103.