Scoliosis is a persistent, sideways curvature of the spine measuring ten degrees or more on an X-ray. While often associated with adolescence, this spinal deformity can manifest or progress significantly in adulthood, presenting unique challenges for management. The adult spine lacks the flexibility of a growing teenager, meaning true, non-surgical correction of the curve is highly improbable. Therefore, treatment goals shift from structural curve reversal to functional improvement and pain management.
Understanding Adult Scoliosis
Scoliosis in adults is categorized into two types based on its origin. The first is Progressive Adult Idiopathic Scoliosis, a continuation of a curve that originated during adolescence. The curve may worsen over time due to gravity and age-related wear on the already deformed spinal structure.
The second, and more common type, is De Novo or Degenerative Scoliosis. This develops anew in a previously straight spine after skeletal maturity. It arises primarily from the aging process, specifically the degeneration of intervertebral discs and facet joints. When one side of a disc space collapses more rapidly than the other, the spinal segment tilts, causing a lateral curve to form in the lumbar spine.
Assessing Curve Severity and Progression
The degree of spinal curvature is measured using the Cobb angle, determined from an X-ray image. This technique involves identifying the most tilted vertebrae at the top and bottom of the curve and calculating the angle formed by lines drawn along their endplates. A curve measuring ten degrees or more is the technical threshold for a scoliosis diagnosis.
In adults, the severity of the curve, combined with symptoms, dictates the need for intervention. Curves over 25 degrees are moderate, while those exceeding 50 degrees are classified as severe and carry a higher risk of progression. Treatment decisions are driven by associated symptoms, such as chronic back pain, spinal imbalance, and neurological issues like radiculopathy (pain radiating into the legs due to compressed nerves).
Goals of Non-Surgical Management
For the majority of adults with scoliosis, initial management focuses on non-surgical strategies aimed at mitigating symptoms and slowing potential curve progression. Non-surgical methods, such as specialized physical therapy and exercise programs, are designed to strengthen the core musculature and improve spinal flexibility and posture. These interventions help manage the mechanical stress on the spine, reducing pain and improving overall mobility.
Pain control is a central component, often involving anti-inflammatory medications or targeted treatments like epidural steroid injections for nerve-related discomfort. These conservative options are not intended to structurally straighten the curve itself. Instead, they enhance function and quality of life, reserving invasive procedures for cases unresponsive to these measures.
The Reality of Surgical Correction
Surgical intervention is reserved for adults with severe curves, generally over 50 degrees, that are worsening or causing debilitating pain unresponsive to conservative treatment. Since the adult spine lacks the plasticity of the adolescent spine, the concept of “correction” is redefined.
Primary surgical goals focus on addressing symptoms through nerve decompression, spinal stabilization, and restoration of sagittal balance (the proper alignment of the spine when viewed from the side). Achieving a significant reduction in the coronal (sideways) curve is a secondary objective, often necessary to restore overall balance and alleviate pain.
Adult scoliosis surgery is a complex procedure, frequently requiring multi-level spinal fusion, where several vertebrae are permanently joined together using bone grafts, rods, and screws. Rigid deformities may also necessitate osteotomies, which involve cutting and reshaping the vertebral bone to achieve better alignment. This extensive surgery carries a higher risk profile and a longer recovery period compared to procedures performed on adolescents due to the degenerative state of the adult spine.