Adult Scoliosis

Overview  |   Signs and Challenges  |  Conservative Treatment  |  Surgical Correction

Signs and Symptoms

  The most common sign of scoliosis is a prominence in the ribs on one side of the thoracic spine. In the lumbar spine, there is sometimes a prominence on one side, though often not. The prominence or "rib hump" is most apparent when bending forward. Sometimes there seems to be an asymmetry in the waist, with one side being indented more than the other. Clothes begin to fit differently than before.

  If the scoliosis is severe and unstable, spinal imbalance is common. Imbalance implies that patients lean to one side or forward when they try to stand straight upright. They may feel like they are tipping to one side, or have the sense that they are falling forward. Most people with adult scoliosis notice that they are not as tall as they used to be.

  Most young adults with scoliosis do not have significant back pain. The curve usually does not hurt unless or until it becomes degenerative. Sometime in life, however, because arthritis is age related and develops prematurely in this group, the adult with scoliosis is likely to develop back pain. When it occurs, the pain is worse when upright and active, and better when the patient is resting.

  Spinal instability occurs when the disc and facet joints are so worn out that they can no longer maintain normal spinal alignment. Pain comes from the arthritic joints as well as from the adjacent nerves, which are pinched and stretched as a result. Buttock pain can occur due to referred pain from the arthritic spine, or it could be a manifestation of a more significant problem with nerve compression. Spinal nerve roots become pinched when arthritic bone spurs form around them and block their exit route from the spinal column. This condition is called Spinal Stenosis. In addition to buttock pain, other symptoms such as leg pain, numbness, tingling, and weakness are common. If any of these findings are present, advice from a physician should be sought without delay.

  If spinal stenosis or nerve compression in the back is severe enough, control of bowel and bladder function will be lost. This however is a rare event, but when it happens, it is a surgical emergency. If the pressure on the nerves is not relieved quickly, control of bladder and bowel may never be regained. Again, this is a very rare occurrence and we only see 2 or 3 cases each year.

Challenges

  As the spine ages, it becomes stiffer. Flexibility is greatest in the teen years, and usually declines starting in the 40-50 age group. Stiffness of the spinal joints can become severe as bone spurs form and prohibit motion. In some cases, the bone spur formation is so severe that all motion is lost at one or more levels in the spine. We all achieve our maximum bone density at about age 30-35. After age 35-40, there is a slow decline in the amount of bone present in the spine. After age 60, and particularly after menopause in women, the loss of bone becomes visible on x-rays. This is osteoporosis. If the bone loss becomes severe, spontaneous fractures can occur in the spine. These fractures can lead to scoliosis or kyphosis.

  As we get older, our general health can become more of a problem. Chronic disease processes such as high blood pressure, diabetes, and heart disease are prevalent among American Seniors. When scoliosis becomes a problem in seniors, other health issues must be considered when treatment options are considered.

Overview  |   Signs and Challenges  |  Conservative Treatment  |  Surgical Correction