Adult Degenerative Scoliosis

Dr. Akbarnia is respected internationally as one of the most experienced spinal deformity surgeons. After more than 30 years of treating scoliosis patients, he still remains at the forefront of the specialty. The following article provides an overview of adult degenerative scoliosis, and describes the treatment options that Dr. Akbarnia and his team employ.

Basics
Scoliosis, or curvature of the spine, is a condition many people associate only with adolescents. But adults can have scoliosis as well. Adult scoliosis is defined as abnormal curvature of the spine in a patient over the age of 18. Sometimes this is the result of a childhood curvature that was left untreated and has since progressed. If scoliosis occurs in an adult with no history of a childhood curvature, it is classified as adult degenerative (de novo) scoliosis.

Causes
As we age, many changes occur to our bodies. This is especially true in the spine. When parts of the vertebral column begin to deteriorate, many people begin to experience significant back or neck pain. Common degenerative or aging spinal conditions include:

• Spinal stenosis
• Degenerative disc disease
• Osteoporosis
• Vertebral compression fractures

Symptoms
Any of the conditions outlined above can cause the spine to curve to the left or the right. This curvature is not only cosmetically troubling to many patients, it can also cause other problems such as:

• Trunk imbalance, making the patient appear as though listing to one side
• Spinal instability
• Rib prominence on either side
• Humpback
• Irregular gait caused by a discrepancy in leg length
• Pain
• Difficulty sitting or standing
• Spinal rigidity and stiffness
• Nerve damage
• Cardiopulmonary (heart and lung) problems

Diagnosis
The first, and highly important step, in treating adult degenerative scoliosis, is obviously to make an accurate diagnosis and assessment. At our practice we use a combination of tools and advanced diagnostic technologies:

• Medical history. We will talk to you about your symptoms, their severity, and the treatments you have already tried. We will be especially interested to know about any history of scoliosis in your family.
• Physical examination. You will be carefully examined by one of our spine specialists for limitation of movement, problems with balance, pain, loss of reflexes in the extremities, muscle weakness, loss of sensation or other signs of neurological damage. You will also be asked to perform a series of range of motion exercises, including bending sideways, backwards and forwards at the waist. The doctor may also measure your legs to see if there is any difference in length.
• Diagnostic tests. Generally, we start with standing x-rays, taken from the front and the side. Side bending and traction x-rays are sometimes used to evaluate spinal flexibility. We may also use a CT scan, a CT Myelogram, MRI and/or a discogram. These tests provide further imaging of the spine along with information about the way the nerves are being affected by the deformity, and possible sources of pain.

Treatment of Adult Degenerative Scoliosis
Non-Operative Treatment
Most cases of adult scoliosis are treated using non-surgical methods. These may include:

• Soft tissue therapies
• Pain and anti-inflammatory medications
• Physical therapy and active back exercises for posture and strength
• In some cases, bracing may be used (but only to control pain, not to correct the deformity)

Surgical Treatment
Surgical correction of adult degenerative scoliosis is not common. However, it may be necessary under the following conditions:

• When non-operative treatment methods have failed and pain persists
• The curvature is progressive or excessive
• There is evidence of cardiopulmonary (heart and lung) problems caused by the curvature

If surgery is necessary it will likely include some of the following elements:

• The approach may be from the front (anterior), back (posterior) of the spine, or may involve two procedures with one from the front and one from behind.
• The procedure will be likely to include a decompression, i.e. the removal of bony and/or soft tissue that is causing pressure on the spinal cord or other nerve structures.
• The procedure will be likely to include a fusion of two or more spinal vertebrae combined with spinal instrumentation (the use of rods or screws or other implants to stabilize the spine).

We will carefully determine which type of surgery is best for your condition. Be assured that if surgery is necessary, all aspects of the procedure, including risks and benefits, will be fully explained to you ahead of time.

Conclusion
Keep in mind, many cases of adult scoliosis need no treatment at all. A "wait and watch" approach may be used to see if the curve progresses over time. In the meantime, it will be important for you to maintain your general and spinal health by exercising regularly to maintain flexibility and strength, eating right, not smoking, and learning correct body mechanics (posture, the correct way to carry heavy loads, etc.) These are the best ways to prevent further back problems.