Degenerative Scoliosis

Degenerative scoliosis, also called adult scoliosis or adult-onset scoliosis, is a condition where the spine curves into an S shape. This form of scoliosis occurs from degeneration of the facet joints, which lie between the vertebrae (bones of the spine).

This is similar to the cause of osteoarthritis, but with degenerative scoliosis, the pressure of the deteriorating facet joints makes the straight spine start to curve and shift. Degenerative scoliosis occurs in approximately 5% of the adult population, and it is common among people over the age of 65 years.

The spine consists of seven cervical (neck) bones, twelve thoracic (mid-back) bones, five lumbar (low back) bones, and the sacrum and coccyx bones. The spinal bones are referred to as vertebrae. The vertebrae stack on top of one another, and discs cushion these bones.

The normal spine curves inward (lordosis), the thoracic spine curves outward (kyphosis), and the lumbar spine also curves inward. The spinal cord travels through a canal made by the vertebrae, and nerve roots branch off this structure. The facet joints are small joints that allow back movement. These joints are lined with cartilage.

Symptoms of Degenerative Scoliosis

Many patients with degenerative scoliosis report pain in the back. However, not everyone experiences discomfort. Usually, pain begins when the curvature worsens. Other symptoms of degenerative scoliosis include numbness and weakness of the legs and/or feet, stiffness of the back, breathing problems, and muscle soreness.

Patients with degenerative scoliosis often develop stenosis, which is narrowing of the spinal cord canal. When this area narrows, there is pressure on the nerves, which leads to pain, numbness, and tingling. Sometimes, the patient will have slippage of one vertebra onto another. This is called spondylolisthesis, and it can lead to nerve root compression and pain.

Degenerative Scoliosis Diagnosis

To diagnose degenerative scoliosis, the doctor will take a medical history and conduct a physical examination. He/she will examine the spine for curvature and take x-rays to gage the degree of curvature. If nerve impingement or complications are detected, the doctor may order a magnetic resonance imaging (MRI) scan to assess the spine.

Treatment Options

  • Epidural steroid injection (ESI) – With this procedure, the doctor injects a long-acting steroid into the space near the spinal cord.

 

  • Selective nerve root block (SNRB) – Often used to diagnose back pain, this involves injecting an anesthetic near the nerve root of the spine.

 

  • Lumbar sympathetic nerve block (LSNB) – For severe back pain, the doctor will inject an anesthetic and a neurolytic substance into the sympathetic nerves. This destroys the nerves as a long-term option for pain relief.

 

  • Intrathecal pump implant – For advanced pain, an intrathecal pump implant is an option. The implant is placed near the spine to deliver pain medication into the cerebrospinal fluid. With this method, there is no unpleasant gastrointestinal side effects.

 

  • Spinal fusion – This surgery is done to straighten the spine and is reserved for severe degenerative scoliosis. The doctor can place bone graft between the vertebrae in the area occupied by the disc. Plastic or metal rods, screws, hooks, and/or wires are attached to the curved portion of the vertebrae, and small pieces of the bone are placed over the spine. The bone pieces grow together and attach to the vertebrae to fuse them into proper alignment.

 

Resources

Everett CR & Patel RK (2007). A systematic literature review of nonsurgical treatment in adult scoliosis. Spine, 1(32) S130-134.

Kobayashi T, Atsuta Y, Takemitsu M, Matsuno T, & Takeda N (2007). A prospective study of de novo scoliosis in a community based cohort. Spine 31(2).

Ploumis A, Transfledt EE, & Denis F (2007). Degenerative lumbar scoliosis associated with spinal stenosis. Spine Journal, 7:428–436.