Scoliosis is defined as an abnormal sideways curvature of the spine. While often associated with adolescence, it is a significant concern for many older individuals. The goal of treatment in older adults often shifts away from full “correction,” which typically means restoring a straight spine, toward managing pain and improving functional ability. Understanding the underlying cause of the curvature is the initial step in determining a realistic treatment path.
Understanding Degenerative Adult Scoliosis
The most frequent type of spinal curvature in older adults is degenerative adult scoliosis, which develops due to age-related wear and tear. This condition is often referred to as de novo scoliosis, meaning it begins anew in adulthood, typically after age 40 or 50. The primary mechanism involves the asymmetric degeneration of the intervertebral discs and the facet joints. As discs lose height and water content, and facet joints develop arthritis, the vertebrae tilt and rotate, causing the spine to collapse sideways.
The curve most often develops in the lower back, or lumbar spine, which is subjected to the greatest amount of stress and movement over a lifetime. This structural change can lead to a forward-leaning posture and a shift in the body’s center of balance, known as spinal imbalance, which increases mechanical strain and pain.
The uneven collapse of the spinal structures frequently results in spinal stenosis, a narrowing of the spaces through which the nerves travel. This compression can cause chronic back pain, shooting leg pain known as sciatica, and symptoms like numbness or weakness in the legs and feet. The focus for managing this degenerative condition is on achieving stability and decompressing these compromised nerves, rather than attempting to fully reverse the structural changes of the curve itself.
Non-Surgical Approaches to Pain and Function
For the majority of older adults with degenerative scoliosis, non-surgical management focuses on alleviating symptoms and preserving functional capacity. This conservative path aims for a functional correction, meaning improving how the body moves and feels, even if the curve’s angle remains unchanged. Nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen are commonly used as first-line pharmacological treatments to manage chronic back pain. Muscle relaxants may also be prescribed for short periods to relieve painful muscle spasms.
Physical therapy is a foundational component of conservative management, focusing heavily on core strength, balance, and postural correction. Targeted exercises help strengthen the paraspinal muscles, which can provide better support to the unstable spine and potentially slow the progression of the curve. Low-impact aerobic activities, such as walking, swimming, or cycling, are also encouraged to maintain mobility and endurance without placing excessive strain on the lumbar spine.
For patients experiencing significant leg pain due to nerve compression, injection therapies can provide temporary relief. Epidural steroid injections deliver anti-inflammatory medication directly into the space around the spinal nerves to reduce swelling and pain. Similarly, facet joint blocks can be used to diagnose and treat pain originating from the arthritic facet joints. These injections can be a useful tool for managing acute flare-ups and allowing patients to participate more effectively in physical therapy.
Bracing is sometimes used in older adults, not to correct the curve as in adolescents, but primarily to provide external support and pain relief during periods of increased activity. The brace functions as a temporary external stabilizer to reduce mechanical forces on the spine, which can help manage pain and improve walking endurance. Lifestyle modifications, particularly weight management, also play a significant role, as excess body weight increases the mechanical load on the already compromised spine.
Evaluating Surgical Correction in Advanced Cases
Surgical correction is reserved for a small subset of older adults who have severe, progressive deformity, disabling pain that does not respond to conservative treatments, or significant neurological deficits. The decision to pursue surgery is complex because true straightening of the spine is often impractical or too risky; instead, the primary surgical goals are stabilization, decompression of nerves, and restoring a balanced posture. The concept of restoring balance, particularly the sagittal balance which dictates whether a person can stand upright without leaning forward, is a major focus of these procedures.
Advanced adult deformity surgery is a major undertaking that often requires a spinal fusion, where multiple vertebrae are permanently joined together. This involves the use of instrumentation, such as metal rods and screws, to hold the spine in a corrected position until the bone fuses. In cases of severe imbalance, surgeons may perform osteotomies, which are precise bony cuts, to realign the spine and improve the patient’s posture.
The risks associated with this type of extensive surgery are considerable, especially in an older population. These risks include significant blood loss, longer recovery times, and the fusion failing to heal, known as pseudarthrosis. Surgery is only considered when the benefits of pain relief and improved function clearly outweigh the substantial risks. Ultimately, while surgery can achieve a degree of correction for highly selected individuals, it is a treatment of last resort, not a routine solution for adult scoliosis.