Adult Scoliosis

 Adult Degenerative Scoliosis

Also known as de novo (new) scoliosis. This type of scoliosis begins in the adult patient due to degeneration of the discs, arthritis of the facet joints and collapse and wedging of the disc spaces.

It is typically seen in the lumbar spine (lower back), and usually accompanied by straightening of the spine from the side view (loss of lumbar lordosis).

Disc degeneration and spinal stenosis associated with adult degenerative scoliosis can cause the following symptoms:

• Back pain
• Numbness
• Shooting pain down the legs

• X-rays, front and standing, must include all segments of the spine as well as the pelvis and hips to measure alignment, curvatures, and balance. For the side x-rays, hips and knees must be straight. Focused x-rays of the cervical, thoracic, and lumbar spine may also be necessary.
• Magnetic resonance imaging (MRI) or computerized tomography (CT), advanced imaging techniques to assess patients with lower extremity symptoms or other neurologic signs or symptoms.

Nonoperative treatment is appropriate for the majority of adults with degenerative scoliosis who don't have disabling symptoms. Treatments include:

• Periodic observation
• Over-the-counter pain relievers
• Exercises aimed at strengthening the core muscles of the abdomen and back and improving flexibility
• Braces with short-term use of for pain relief (long-term use in adolescents is discouraged because braces can weaken the core muscles)
• Epidurals or nerve block injections for temporary relief of leg pain and other symptoms

Stronger pain medications can also be habit-forming and must be used with caution. If narcotics are needed to control the pain, see a scoliosis surgeon to learn more about the pain generators.

Surgical treatment is reserved for patients who have:

• Failed all reasonable conservative (non-operative) measures.
• Disabling back and/or leg pain and spinal imbalance.
• Severely restricted functional activities and substantially reduced overall quality of life.

The goals of surgery are to restore spinal balance and reduce pain and discomfort by relieving nerve pressure (decompression) and maintaining corrected alignment by fusing and stabilizing the spinal segments. When patients are carefully chosen and mentally well-prepared for surgery, excellent functional outcomes can be achieved which can provide positive life-changing experience for a given individual patient. When larger surgeries—those greater than 8 hours—are necessary, surgery may be divided into 2 surgeries 5 to 7 days apart. Surgical procedures include:

• Decompression surgery removes the roof of the spinal canal (laminectomy) and enlarging the spaces where the nerve roots exit the canal (foraminotomy), resulting in decompressed nerve roots and pain relief. Typically only used at one or two vertebral levels in patients with leg pain from stenosis and smaller curves (< 30 degrees). In patients with more than two levels of stenosis and larger curves >30 degrees, a decompression without fusion has a risk of destabilizing the spine and causing the curve to worsen.
• Surgical stabilization involves anchoring hooks, wires or screws to the spinal segments and using metal rods to link the anchors together. They stabilize the spine and allow the spine to fuse in the corrected position, and is always performed with the addition of a fusion.
• Fusion uses the patient's own bone or using cadaver or synthetic bone substitutes to "fix" the spine into a straighter position
• Osteotomy is a procedure in which spinal segments are cut and realigned
• Vertebral column resection removes entire vertebral sections prior to realigning the spine and is used when an osteotomy and other operative measures cannot correct the scoliosis