Scoliosis, a sideways curvature of the spine, is often associated with childhood and adolescence. However, scoliosis can develop over time, even in adulthood. This is known as adult-onset or degenerative scoliosis, which typically progresses later in life due to various factors.
Understanding Adult-Onset Scoliosis
Adult-onset scoliosis describes a sideways spinal curve that develops after skeletal maturity, usually after age 40 or 50. This differs from adolescent idiopathic scoliosis, which has no clear cause and typically begins during puberty. The most common type of adult-onset scoliosis is primary degenerative or de novo scoliosis, which occurs in individuals who previously had a straight spine. This form results from asymmetric degeneration of the intervertebral discs and facet joints, the moving parts of the spine.
As spinal discs and ligaments wear down, the spine can become unstable and change shape, leading to a lateral curve. This often affects the lower back, or lumbar spine, forming a slight “C” shape. Scoliosis can also progress in adulthood from previously undetected or mild adolescent idiopathic scoliosis. In these cases, a curve present but not problematic in youth can worsen due to age-related degenerative changes.
Risk Factors and Progression
Several factors can increase the likelihood of developing adult-onset scoliosis or progressing an existing curve. Age is a primary factor, as natural wear and tear on the spine contributes to disc and joint degeneration. This age-related degeneration can lead to conditions like spinal spondylosis, which contributes to adult degenerative scoliosis.
Osteoporosis, a condition where bones become weak and brittle, is another significant risk factor, particularly in post-menopausal women. Weakened bones can make the spine more susceptible to curving or fracturing, potentially leading to spinal misalignment. Past spinal injuries or surgeries can also contribute to the development or worsening of a spinal curve. Certain neuromuscular conditions, such as cerebral palsy, muscular dystrophy, or spina bifida, can predispose individuals to scoliosis. While genetic predisposition is often associated with adolescent idiopathic scoliosis, some genetic factors may also play a role in age-related spinal degeneration.
Recognizing the Signs
The signs of scoliosis developing or worsening in adults can vary, often appearing gradually. A common indicator is back pain, ranging from a dull ache to severe pain, particularly in the lower back. This pain often worsens with activity or prolonged standing and walking, but may improve with rest or sitting.
Postural changes are also observed, including uneven shoulders or hips, where one side may appear higher than the other. A visible curve in the spine might become noticeable, especially when bending forward. Some individuals may experience leg pain, tingling, numbness, or weakness, often referred to as sciatica, if nerve roots are compressed. In severe cases, posture changes can lead to a pronounced lean to one side or a hunched forward appearance.
Managing Scoliosis That Develops Over Time
Once adult-onset scoliosis is identified, management typically begins with non-surgical approaches. Physical therapy is a common recommendation, focusing on pain relief, improving spinal mobility, and strengthening muscles that support the spine. Exercises can help increase flexibility and teach posture correction to minimize stress on the spine.
Pain management strategies may include over-the-counter pain relievers, anti-inflammatories, or spinal injections like epidural steroid injections to reduce inflammation and discomfort. While bracing is often used in adolescents, it is generally less effective in correcting curves in skeletally mature adults, though it can provide support. Surgical intervention may be considered when non-surgical methods fail to alleviate symptoms, particularly in cases of severe pain, neurological deficits, or progressive deformity. The goal of surgery is to reduce pain and improve quality of life, often involving spinal fusion to stabilize the curved bones.