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Most cases of adult scoliosis are idiopathic (the cause is not known). Sometimes adult scoliosis is the result of changes in the spine due to aging and degeneration. The causes of adult scoliosis are further categorized into several types.
Usually there is no clear-cut reason why the spine is curved.
Congenital means that you were born with the problem. Many different problems in growth and development can lead to spine problems. Congenital scoliosis may not be recognized or may not be severe enough to require treatment during childhood. Although it is rare, the scoliosis can get worse later in life due to wear and tear around the abnormal area of the spine.
This type of scoliosis is often caused by paralysis from injury to the spinal cord. Paralytic means "the muscles do not work". When the muscles around the spine are not working, the spine may be thrown out of balance and cause a curvature in the spine.
Myopathic means "the muscles do not work properly". Like paralytic curves, this curve results from a muscular or neuromuscular disease, such as muscular dystrophy, cerebral palsy, or polio.
Developed in adulthood can be "secondary" to other spinal conditions that affect the vertebrae. Other conditions such as degeneration, osteoporosis (loss of bone mass), or osteomalacia (softening of the bones) can cause scoliosis. Scoliosis can also appear following spinal surgery for other conditions. The surgery may cause an imbalance in the spine that leads to scoliosis.
Scoliosis is often painless. Patients with scoliosis commonly see a spine specialist because they notice a problem with the way their back looks. People with scoliosis may notice some of the following things about their body.
- One shoulder or hip may be higher than the other.
- One shoulder blade may be higher and stick out farther than the other.
- These deformities are more noticeable when bending over.
- A "rib hump" may occur, which is a hump on the back that sticks up when bending the spine forward. This occurs because the ribs on one side angle more than on the other side.
- One arm hangs longer than the other because of a tilt in the upper body.
Back pain can eventually develop as the condition progresses. The deformity may cause pressure on the nerves and possibly even on the spinal cord. This can lead to weakness, numbness, and pain in the lower extremities. In severe cases, pressure on the spinal cord may cause loss of coordination in the muscles of the legs-making it difficult to walk normally. If the chest is deformed due to the scoliosis, the lungs and heart may be affected, leading to breathing problems, fatigue, and even heart failure. Fortunately these severe symptoms are rare.
Whenever possible, nonsurgical treatments are chosen first. Spinal surgery will generally be a last resort due to the risks involved. Conservative treatments commonly include medication, bracing, and physical therapy and exercise.
If osteoporosis is present, treatment of the osteoporosis may also slow the progression of the scoliosis. This can be accomplished in several ways. The current recommendations include increasing calcium and vitamin D intake, hormone replacement therapy, and weight-bearing exercises. Learn more about preventative measures for osteoporosis.
Mild pain medications may be prescribed to use as needed. Usually strong pain medications, such as narcotics, are not recommended due to the risk of addiction.
A spinal brace may provide some pain relief. In adults, it will not cause the spine to straighten. Once you have reached skeletal maturity, bracing is used for pain relief rather than prevention. If there is a difference in the length of your legs (or if the scoliosis causes you to walk somewhat crooked), special shoe inserts, called orthotics, or a simple shoe lift may reduce your back pain.
Physical Therapy and Exercise
Adults with scoliosis may work with a physical therapist. A well-rounded rehabilitation program assists in calming pain and inflammation, improving mobility and strength, and helping them do daily activities with greater ease and ability.
Exercise has not proven helpful for changing the curves of scoliosis. However, it can be helpful by addressing pain, posture, and spinal stabilization. Therapy sessions may be scheduled each week for four to six weeks.
The goals of physical therapy are to help
- learn ways to manage the symptoms of scoliosis
- improve spine posture
- maximize spinal stabilization
Surgery for adult scoliosis has some significant risks. That is why it is only recommended when the expected benefits far outweigh the risks. Surgery is generally only considered in patients who have continual pain, difficulty breathing, significant disfigurement, or a steadily worsening curve. Surgery will not be recommended for most cases-particularly in patients with curves of less than 40 degrees. Curves above 100 degrees are rare, but they can be life-threatening if the spine twists the body to the point where pressure is put on the heart and lungs.
Surgery may be needed in the following situations:
- Pain The most common reason for scoliosis surgery is pain relief for chronic discomfort that keeps getting worse. About 85 percent of adult scoliosis surgeries are done to relieve severe pain. Surgery will probably not be recommended if the pain is manageable through conservative treatments.
- Progression of Curve Surgery may be suggested if the curvature continues to worsen and the curve gets beyond 40 to 45 degrees to prevent problems that come with severe scoliosis. Surgery will usually be recommended for curves above 60 degrees, as the twisting of the torso can lead to serious lung and heart conditions.
- Cosmetics Surgery is generally not recommended merely for the sake of appearance. But sometimes the scoliosis causes physical deformity that is unbearable to the patient. Surgery may be the only option for correcting the condition. Most cases of cosmetic scoliosis surgery are in young adults that have very noticeable curves.
When adult scoliosis requires surgery, your surgeon can choose from a number of different procedures. Each case of scoliosis is somewhat different and may require a very specialized approach for optimal results. Surgery is suggested to solve the problems brought on by the scoliosis-not just to straighten the spine. The goals of most surgical procedures for adult scoliosis include
- reducing the deformity (straighten the spine as much as possible)
- stopping the progression of the deformity
- removing any pressure from the nerves and spinal cord
- protecting the nerves and spinal cord from further damage
To achieve these goals, the spine surgeon may suggest an operation on the back of the spine, the front of the spine or both. The goal is to first straighten the spine and then to fuse the vertebrae together into one solid bone. Two different types of surgical methods can be used to accomplish this. One is called lumbar fusion with pedicle screws and rods. The second method is to insert special cylinders between the vertebrae to be fused, a procedure called lumbar fusion with intervertebral cages.
Both procedures usually require some type of metal screws, plates, or rods, in order to help straighten the spine and hold the vertebrae in place while the fusion heals and becomes solid. The screws are placed into the vertebra. The rods or plates then attach to the screws to connect everything together. Tightened together, they form an internal brace to hold the vertebrae in alignment while the fusion heals.
Like all surgical procedures, operations on the back may have complications. Because the surgeon is operating around the spinal cord, back operations are always considered extremely delicate and potentially dangerous. Take time to review the risks associated with spine surgery with your doctor. Make sure you are comfortable with both the risks and the benefits of the planned procedure.
One possible complication specific to the surgical treatment of adult scoliosis is flat-back deformity. The lumbar (lower) spine naturally has a slight inward curve called lordosis. When the vertebrae in the lumbar spine are fused together, this lordosis curve may be lost, leaving the patient with a "flat-back" deformity. The loss of curve may not appear right after surgery. If the surgery it is done in a young person, the loss of lordosis may not even appear until sometime between the ages of 30 and 50.