Scoliosis describes a condition where the spine curves sideways, typically forming an “S” or “C” shape. While often diagnosed in childhood, scoliosis can also affect adults. For adults, the question of whether scoliosis can be “fixed” is complex, as treatment usually focuses on managing symptoms, preventing curve progression, and enhancing overall quality of life rather than achieving a perfectly straight spine. The spine in adults has completed its growth, which influences the types of interventions available and their goals.
Understanding Adult Scoliosis
Adult scoliosis is defined as a spinal curve of 10 degrees or greater in a skeletally mature individual. This condition can manifest in two primary ways: as a progression of adolescent idiopathic scoliosis (AIS) or as “de novo” or degenerative scoliosis, which develops in adulthood due to spinal degeneration. AIS that progresses into adulthood often involves curves that were present in youth and continued to worsen over time, especially if they exceeded 30-50 degrees at skeletal maturity. Degenerative scoliosis, on the other hand, typically arises from age-related wear and tear on the spinal discs and facet joints, leading to an asymmetrical collapse and curvature, most commonly in the lumbar spine.
Common symptoms experienced by adults with scoliosis include back pain, which can be a dull ache or stiffness, and leg pain, numbness, or weakness resulting from nerve compression. Some individuals may also notice changes in their posture, such as uneven shoulders or hips, a visible hump, or difficulty standing upright. Unlike childhood scoliosis where cosmetic deformity is often a primary concern, adult scoliosis symptoms frequently relate to pain and functional limitations. While adult scoliosis rarely causes severe neurological problems like paralysis, significant curves, particularly those over 80 degrees in the thoracic spine, can affect lung function.
Conservative Approaches for Adults
Many adults with scoliosis can manage their symptoms and improve their quality of life through non-surgical treatments. Physical therapy is a primary conservative approach, involving tailored exercise programs designed to strengthen core muscles, improve posture, and increase flexibility. These exercises can help alleviate pain and, in some instances, improve spinal alignment. Aquatic therapy is one form of physical therapy that can be particularly beneficial.
Pain management techniques also play a significant role in conservative care. Over-the-counter medications like nonsteroidal anti-inflammatory drugs (NSAIDs) are often the first recommendation. For more severe or persistent pain, doctors may suggest prescription medications or injections, such as epidural steroid injections or nerve blocks, which can help reduce inflammation and discomfort around compressed nerves. Bracing generally has a limited role in correcting curves in adults compared to adolescents, but it can sometimes provide temporary support and pain relief. Lifestyle modifications, including maintaining a healthy weight and adjusting activities to minimize strain on the spine, also contribute to managing symptoms.
Surgical Options for Adults
Surgical intervention for adult scoliosis is generally considered when conservative treatments have not provided sufficient relief, or when there is significant curve progression, severe pain, or neurological deficits. Goals of surgery include alleviating pain, halting curve progression, decompressing pinched nerves, and improving spinal balance and alignment. While surgery aims to reduce deformity, it does not usually result in a perfectly straight spine.
The most common surgical procedure for adult scoliosis is spinal fusion, which involves joining vertebrae to stabilize the spine. During this procedure, instrumentation (screws, rods) is implanted to hold the spine in a corrected position while bone graft facilitates fusion. Decompression surgery, often performed alongside fusion, removes pressure from spinal nerves. In cases of severe deformity, osteotomy, where spinal segments are cut and realigned, may be necessary. Surgical approaches can vary, involving both anterior (front) and posterior (back) incisions, depending on curve complexity and patient condition.
Adult scoliosis surgery is complex, with considerations including longer recovery times compared to younger patients and a higher risk of complications. Factors such as advanced age, smoking, obesity, and other health conditions can increase surgical risks. Despite these considerations, surgery can lead to substantial improvements in pain, mobility, and overall quality of life for carefully selected patients.
Living with Adult Scoliosis
Living with adult scoliosis often involves ongoing management, whether individuals undergo surgery or pursue conservative care. Regular monitoring of the spinal curve and symptoms is important, as adult idiopathic curves can progress, particularly those exceeding 40 degrees. Adherence to rehabilitation programs, including continued physical therapy and specific exercises, helps maintain the gains achieved from treatment and promotes long-term spinal health. These programs focus on strengthening muscles and improving posture to support the spine.
A multidisciplinary approach to care is beneficial for adults with scoliosis, involving various specialists such as orthopedic surgeons, neurologists, pain management specialists, and physical therapists. This collaborative effort addresses the diverse aspects of the condition, from physical symptoms to psychological well-being. With a comprehensive and personalized management plan, individuals can lead active lives while effectively addressing the challenges associated with adult scoliosis.