Scoliosis refers to curvature of the spine when viewing a person from the back. It is estimated that about 2 to 3% of the population has scoliosis although the majority of cases are very mild. There are 2 main types of scoliosis in adults, and the treatment of each type can vary considerably:
- Adult scoliosis can be a late manifestation of untreated adolescent idiopathic scoliosis. In other words, teenagers who were diagnosed with scoliosis grow up to be adults with scoliosis. In some patients, especially those with curves greater than 40 degrees, there may be very gradual worsening of the curve over many years.
- Scoliosis that develops in adulthood (usually after age 40) as a result of arthritis in the discs and joints in the spine. In some patients, one side of the spine is affected more by arthritis and the discs on this side “collapse”, leading to scoliosis. This typically happens in the lumbar spine. As the arthritis gets worse with aging, the scoliosis may worsen as well. Sometimes the arthritis and scoliosis in combination lead to pinched nerves in the back and patients start experiencing leg pain or numbness. This usually happens after age 50.
Adults with scoliosis can present with a variety of symptoms depending on the cause of the scoliosis (see above), location of the scoliosis (thoracic, lumbar) and presence of pinched nerves. Many patients have back pain only. Patients with lumbar scoliosis and arthritis can have back pain and leg pain/numbness. Some patients with severe scoliosis can have difficulty standing upright. More severe cases can lead to physical deformities such as uneven shoulders, tilting of the trunk to one side, prominence of the ribs, etc.
Scoliosis is diagnosed with X-rays of the spine (called scoliosis X-rays) while the patient is standing. Other tests may be needed depending on the patient’s symptoms, such as MRI or CAT scan.
Initial management options, as in most spine conditions, include anti-inflammatory medications, physical therapy, activity modification and possibly epidural steroid injections. Most patients with adult scoliosis do not need surgery. In patients who do not respond to conservative treatment, the decision for surgery is highly individualized. The decision to do surgery depends on many factors, including patient age, severity of the scoliosis, location of the curve, and the presence of pinched nerves. There are 3 main goals of surgery for adult scoliosis:
- To achieve a stable, balanced spine when looking at the patient from the front and the side. It is critical to recreate spinal balance if the patient cannot stand straight. Patient’s shoulders should be balanced over the pelvis and patient should be able to stand straight after surgical correction.
- To free up pinched nerves. The purpose of this is to relieve leg pain or numbness.
- To fuse the area of the spine that is affected by the scoliosis to prevent any further worsening of the curve.
There are different surgical approaches available to correct scoliosis in adults. In most cases, screws and rods are used to straighten the spine and bone graft is used to fuse the vertebrae that are affected. “Fusion” means the the involved vertebrae are permanently united into a single bone. This prevents any further worsening of the curve.