FAQs on Degenerative Scoliosis

A common occurrence with age is degenerative changes to the spinal vertebrae (bones) and discs (cushions between the vertebrae). This degeneration is often associated with osteoarthritis and/or osteoporosis. Over time, the spine loses its integrity and starts to curve sideways in an S-shape curvature known as degenerative scoliosis.

What causes degenerative scoliosis?

There is no one exact cause of degenerative scoliosis; rather, a collection of factors contributes to the condition. With wear-and-tear and micro-trauma of the spinal bones and discs, the structures break down. The vertebrae are connected by facet joints that permit movement, and the discs sit between these bones to protect and cushion.

The spinal cord runs through the spinal canal, which is a passageway created by the vertebrae. Degenerative changes occur in the facet joints, the vertebrae, and the discs, and arthritis leads to thinning of the joint cartilage. The cumulative degenerative changes of these structures often results in spinal stenosis, where the spinal cord and nerves become constricted and compressed.

What are the symptoms of degenerative scoliosis?

Patients with degenerative scoliosis first seek medical care due to pain and the associated symptoms of leg pain, numbness, and tingling. The back pain is often related to muscle spasms, which radiate into the hips, buttocks, and hips. Patients who develop stenosis often experience fatigue with walking or report a heaviness of the legs.

How is degenerative scoliosis diagnosed?

In addition to taking a detailed medical history and conducting a physical examination, the doctor will use diagnostic imaging tests to confirm a diagnosis of degenerative scoliosis. Full spine x-rays are used to gage the degree of spine curvature, and a CT scan is used to assess details of the facet joints and to detect small fractures. For some patients, a MRI scan is done to obtain information about the nerves, soft tissues, and discs.

What are the treatment options for degenerative scoliosis?

The purpose of degenerative scoliosis treatment is to alleviate pain and associated symptoms. Therapies include:

  • Medications – For patients who have mild pain, the doctor will prescribe nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen. For nerve symptoms, a short course of steroids may be used to decrease inflammation, or the doctor may prescribe a neuroleptic drug (gabapentin or pregabalin) to reduce overactivity of nerves.
  • Facet joint injection (FJI) – These injections are usually given in a series of three. Facet joints are located between each vertebra that provide the spine with flexibility and stability. The doctor inserts a small needle directly into the facet joint using x-ray guidance for correct placement. Once placement is verified, a long-acting anesthetic and a steroid are injected into the joint space. Recently, researchers reported moderate evidence supporting lumbar FCIs for the relief of short- and long-term pain.
  • Facet rhizotomy – If the patient continues to have symptoms after facet injections, the doctor may perform a facet rhizotomy. A special thermal probe is inserted near the nerve outside of the facet joint. Once in position using x-ray guidance, the probe is heated to destroy a portion of the nerve, turning off the pain signals to the brain.
  • Epidural steroid injection (ESI) – The epidural is the layer outside the spinal cord. The space between the epidural and cord is called the epidural space. The doctor injects a long-acting steroid into this area under x-ray guidance. In a recent clinical study, ESI success rate was reported as 85%.

Resources

Abdi, S, Datta, S, Trescot, AM et al. (2007). Epidural steroids in the management of chronic spinal pain: a systematic review. Pain Physician, 10(1), 185-212.

Boswell MV, Colson JD, Sehgal N, Dunbar EE, & Epter R (2007). A systematic review of therapeutic facet joint interventions in chronic spinal pain. Pain Physician, 10(1):229-53.

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.