Scoliosis is a sideways curvature of the spine that can occur at any age. While often associated with adolescence, scoliosis can indeed develop or progress in adulthood. Adult scoliosis often differs from childhood forms in its causes and impact. Unlike the idiopathic (unknown cause) scoliosis common in younger populations, adult scoliosis often involves age-related spinal changes or the progression of a pre-existing curve.
Types of Adult Scoliosis
Adult scoliosis manifests in distinct ways, reflecting different origins. One common form is degenerative scoliosis, also known as de novo (new onset) scoliosis. This type develops in adulthood due to the natural wear and tear on the spinal discs and facet joints that occurs with aging. It typically affects the lumbar, or lower, spine and is characterized by a curve forming as the vertebral structures degenerate and lose their ability to maintain proper alignment.
Adult idiopathic scoliosis refers to a curve that began in adolescence and has progressed into adulthood. This progression is often influenced by the ongoing degenerative changes within the aging spine, which can destabilize an already curved segment.
Less common types fall under secondary scoliosis, where the spinal curvature is a direct result of other conditions or events. This can include scoliosis resulting from trauma, such as a spinal fracture, or as a consequence of previous spinal surgeries that alter spinal mechanics. Certain neuromuscular conditions, like cerebral palsy or muscular dystrophy, can also lead to the development of scoliosis in adults due to muscle imbalances or weakness affecting spinal support.
Causes and Risk Factors
The main cause of adult scoliosis development or progression is age-related degeneration of spinal structures. As people age, the intervertebral discs, which act as cushions between vertebrae, can dehydrate and lose height, contributing to spinal instability. Similarly, the facet joints, which connect vertebrae, can develop arthritis, leading to bone spurs and further compromising spinal alignment. Osteoporosis, characterized by reduced bone density, also plays a role by weakening the vertebral bodies, making them more susceptible to collapse or wedging, which can initiate or worsen a spinal curve.
Previous spinal conditions can also predispose an individual to adult scoliosis or its progression. Conditions such as spinal stenosis, where the spinal canal narrows and puts pressure on nerves, or disc herniation, where a disc bulges or ruptures, can alter spinal mechanics and contribute to instability. Spondylolisthesis, a condition where one vertebra slips forward over another, can similarly disrupt spinal alignment and increase the risk of developing a scoliotic curve.
While not a direct cause of de novo adult-onset scoliosis, a genetic predisposition can influence the likelihood of adolescent idiopathic scoliosis progressing in adulthood. Lifestyle factors, such as prolonged poor posture or occupations involving repetitive heavy lifting, are generally considered contributing factors rather than sole causes. These elements can place additional stress on the spine, potentially accelerating degenerative changes that might lead to or worsen a scoliotic curve.
Recognizing Symptoms and Diagnosis
Adult scoliosis often presents with a range of symptoms, with pain being a common complaint, distinguishing it from childhood scoliosis where pain is less frequent. Individuals may experience persistent back pain, particularly in the lower back, along with stiffness and muscle fatigue, especially after prolonged standing or activity. Nerve compression, often a result of the spinal curvature and associated degenerative changes, can lead to leg pain, numbness, or weakness radiating into the lower extremities. Noticeable changes in posture, such as leaning to one side, uneven hips or shoulders, or a perceived decrease in height, can also indicate the presence of adult scoliosis.
If persistent back pain, posture changes, or neurological leg symptoms develop, seek medical attention. A healthcare professional can evaluate the spinal condition. Diagnosis typically begins with a thorough physical examination. During this examination, the doctor assesses posture, spinal range of motion, and checks for visible spinal asymmetry or unevenness in the shoulders, hips, or waist.
Following physical assessment, imaging tests confirm diagnosis and assess curve severity. X-rays are fundamental, providing bone images and allowing Cobb angle measurement to quantify spinal curvature. MRI may evaluate soft tissues like discs and nerves, identifying nerve compression or other issues. CT scans may provide detailed images of bony structures, helping identify bone spurs or other degenerative changes.
Managing Adult Scoliosis
The management of adult scoliosis focuses on several goals: alleviating pain, improving functional ability, and preventing further progression of the spinal curve. The approach to management is typically individualized, taking into account the type and severity of scoliosis, as well as the patient’s symptoms and overall health. For many individuals, non-surgical approaches are the first line of treatment and can provide relief.
Conservative treatments often include physical therapy, which aims to strengthen core muscles, improve spinal flexibility, and enhance overall posture. Specific exercises can help to stabilize the spine and reduce muscle imbalances that contribute to pain. Pain management strategies may involve oral medications, such as anti-inflammatory drugs, or targeted injections to reduce localized pain and inflammation. Lifestyle modifications, including maintaining a healthy weight and engaging in regular, appropriate exercise, can also play a supportive role in managing symptoms and promoting spinal health.
Surgical intervention for adult scoliosis is generally reserved for severe cases where conservative treatments have not provided adequate relief, when there is nerve compression leading to neurological deficits, or if the spinal deformity is worsening and affecting quality of life. The decision for surgery is complex and involves a careful assessment of the risks and potential benefits, with the aim of stabilizing the spine, correcting the curve, and decompressing any affected nerves.