Scoliosis is defined as a sideways curvature of the spine measuring ten degrees or more. While often associated with childhood and adolescence, this condition is common in the adult population, particularly older adults. Adult scoliosis refers to any sideways spinal curve found in a skeletally mature individual. This condition can lead to back pain, leg symptoms, and changes in posture.
Understanding Adult-Onset Scoliosis
Adult scoliosis arises from two distinct origins: the progression of a curve that began in youth or the development of a new curve in later life. The progression of an existing curve, often a mild case of Adolescent Idiopathic Scoliosis (AIS), becomes symptomatic in adulthood due to degenerative changes. These cases represent curves that were present before skeletal maturity but worsen over time due to age-related wear and tear.
The second type is de novo adult degenerative scoliosis, meaning the curve develops entirely in adulthood without any prior history of the condition. This form is typically seen in adults over the age of 50 and is caused by the deterioration of the spinal components. As the intervertebral discs lose height and the facet joints develop arthritis, the spine becomes unbalanced and begins to curve sideways, most commonly in the lumbar (lower) spine.
The asymmetrical breakdown of discs and joints creates an instability that forces the vertebrae to slip and rotate out of their normal alignment. This structural collapse is the mechanism that generates a new sideways curve. Factors like osteoporosis, which weakens bone density, also contribute to the degenerative process that can lead to this de novo curve formation.
Recognizing Key Symptoms
Unlike adolescent scoliosis, which is often detected as a visible deformity before pain begins, the primary complaint for adults is usually chronic pain. This discomfort commonly localizes in the lower back, resulting from the strain placed on muscles and ligaments trying to stabilize the curved and unbalanced spine. The pain is often described as a deep ache that worsens with activity or prolonged standing.
A more concerning manifestation is the presence of nerve-related symptoms in the legs, which signals spinal stenosis. The degenerative changes that cause the curve can narrow the spinal canal, compressing the nerves exiting the spine. This compression leads to radiculopathy, experienced as shooting pain, numbness, tingling, or weakness that radiates down the legs, commonly known as sciatica.
Adult scoliosis can also impact a person’s overall posture and balance, a condition known as impaired sagittal balance. Patients may notice difficulty standing fully upright or visibly leaning to one side. Other visible changes include uneven hips or shoulders, a noticeable rib hump when bending forward, and fatigue due to the continuous muscular effort required to maintain posture against the spinal imbalance.
Diagnosis and Treatment Options
Diagnosis begins with a thorough physical examination to assess posture, range of motion, and any neurological deficits like leg weakness or altered sensation. Standing X-rays are the standard method to visualize the spine and quantify the curve. The severity of the curve is measured using the Cobb angle, determined from the X-ray images.
Advanced imaging, such as Magnetic Resonance Imaging (MRI) or Computed Tomography (CT) scans, is frequently ordered to evaluate the soft tissues and neural structures. These scans help confirm the presence of spinal stenosis and determine the extent of nerve root compression, which is crucial for guiding treatment decisions.
The initial approach to managing adult scoliosis is non-surgical, focusing on pain relief and functional improvement. Physical therapy is often recommended to strengthen core muscles and improve flexibility, which helps support the spine and reduce muscle fatigue. Pain management involves over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) or prescription medications to control discomfort.
Epidural steroid injections may be used to deliver anti-inflammatory medication directly to the area of compressed nerves, providing temporary relief from radicular leg pain. Surgery is reserved for cases where non-surgical treatments have failed to control severe back or leg pain, or when the curve is progressing rapidly, typically exceeding 45 to 50 degrees. Surgical goals include decompressing pinched nerves and stabilizing the spine through fusion to prevent further progression and restore balance.