FAQs on Adult Scoliosis and Treatment
Adult scoliosis occurs from aging and deterioration of the spine. Also called degenerative scoliosis, adult scoliosis results in a curved spine and typically begins after the age of 40 years.
Most often in older women, adult scoliosis is the result of osteoporosis, which weakens the vertebrae bones of the spine. With these spine changes, the spinal column loses its ability to stay straight and begins to sag, forming a scoliotic curve.
According to statistics, adult scoliosis occurs in approximately 3-8% of the general population. Around 30% of elderly people with no history of spinal problems have adult scoliosis of some degree.
What causes adult scoliosis?
Scoliosis discovered after puberty is called adult scoliosis, which is caused from aging, degeneration, osteoporosis, and/or osteomalacia (bone softening). The causes of adult scoliosis are very different from those of childhood scoliosis.
In the adult form of the disease, the intervertebral discs lose height and tilt, causing pressure on one side of the spinal column. The S-shape curve occurs as the spine bends. In addition, spinal surgery can result in an imbalance in the spine, which leads to scoliosis.
What are the signs and symptoms of adult scoliosis?
Adult scoliosis usually first leads to low back pain. At first, the curvature is slight, and this is not noticed at first by the patient in many cases. When the curvature reaches 20 degrees or greater, pain is more severe. The pain is not caused from the curving, but rather, it is the result of the degeneration process.
The abnormal curvature causes pressure on nerves and the spinal cord, which results in numbness, weakness, and pain of the low back and extremities. Severe cases of adult scoliosis lead to loss of coordination in the leg muscles, which results in difficulty walking. Several physical characteristics of adult scoliosis include trunk imbalance, spinal deformity, lack of body symmetry (one hip or shoulder lower than the other), and walking difficulties (one leg longer than the other).
How is adult scoliosis diagnosed?
The doctor will conduct a physical examination and take a medical history if he/she suspects adult scoliosis. In addition, for proper scoliosis diagnosis, the doctor will take full-length spine x-rays. For patients with symptoms of nerve impingement (leg pain and weakness), the doctor may order a magnetic resonance imaging (MRI) scan to assess for spinal stenosis, where bony vertebrae press on the spinal cord.
How is adult scoliosis treated?
The treatment of adult scoliosis depends on the individual patient’s symptoms and the severity of his/her spine condition. Treatment options include:
- 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. In a recent study, there was moderate evidence supporting the use of lumbar FCIs for short- and long-term pain relief.
- Radiofrequency facet denervation (RFD) – This procedure is best for patients with severe low back pain related to adult scoliosis. The doctor tests the nerves by using x-ray guidance to place the needle and injecting a numbing agent. If pain improves after the injection, the doctor destroys the function of the nerve with radiofrequency energy. In a recent observational study, 76% of participants had 50% or more pain reduction at 7-21 days after the procedure. In addition, 32% had pain relief at 6 months post-procedure.
- Lumbar sympathetic block – With this procedure, the doctor positions injection needles and administers a long-acting anesthetic medication to first diagnose the pain. A neurolytic substance (absolute alcohol or phenol) is instilled to destroy the lumbar sympathetic nerves. In research studies, more than 66% of patients reported pain relief with this block.