Scoliosis describes an abnormal, sideways curvature of the spine, measured by a Cobb angle of ten degrees or greater in a skeletally mature individual. The question of whether this condition can be “fixed” in adulthood is complex, as the spine has finished growing and is subject to age-related changes. Complete reversal of a structural curve is generally not possible. Instead, the focus of adult treatment shifts entirely to management, curve stabilization, and symptom reduction. Treatment pathways are designed to alleviate pain, improve function, and often prevent the curve from worsening over time.
Understanding Adult Scoliosis
Adult scoliosis has two forms, each with a distinct origin and mechanism of progression. Adult Idiopathic Scoliosis represents the progression of a curve that originated in adolescence but was not fully treated or stabilized before skeletal maturity. These curves continue to progress slowly due to gravity and aging, often worsening by less than one degree per year, though curves greater than 50 degrees may progress more rapidly.
De Novo or Degenerative Scoliosis develops entirely in adulthood, typically after age 40. This new curvature is the direct result of asymmetric degeneration within the spine. As one side of a disc collapses faster than the other, it creates an uneven load, causing the vertebra above it to tilt and rotate, leading to the development of a lateral curve. This asymmetric degeneration creates instability and is often compounded by reduced bone density, which accelerates the deformity.
The mechanism of progression in both forms centers on this increasing asymmetric load. This process is exacerbated by the body’s natural tendency to compensate for the curve, leading to muscle fatigue and pain. Unlike in adolescents, where the treatment goal is often curve correction, the adult spine’s rigidity means that interventions are aimed at addressing the symptoms caused by this imbalance and the degenerative changes.
Non-Surgical Treatment Pathways
The majority of adults with scoliosis manage their condition without surgery, focusing on managing pain and improving functional capacity. Targeted physical therapy focuses on enhancing the strength of the paraspinal and abdominal core muscles. Strengthening the core acts as an internal brace, improving spinal stability and reducing the strain placed on degenerating discs and joints. Specific exercises, such as Pelvic Tilts, Bird-Dog, Pilates, or aquatic therapy, are often recommended to improve flexibility and postural control without undue stress.
Pain management techniques address discomfort caused by muscle strain or nerve compression. Nonsteroidal anti-inflammatory drugs (NSAIDs) are typically the first line of pharmacological treatment to reduce inflammation and pain. For more localized or severe pain radiating into the legs, interventional procedures like epidural steroid injections or selective nerve blocks may be used. These injections deliver an anti-inflammatory agent directly to the irritated nerve root or joint, though the pain relief they provide is often temporary, lasting only a few weeks to months.
While bracing is a primary treatment for growing adolescents, its role in adults is limited to pain relief and support, not curve correction. A custom-fit orthosis may be prescribed to be worn part-time, providing external stability to reduce mechanical back pain and improve posture during activities. Complementary lifestyle modifications are also recommended to reduce mechanical strain on the spine. Maintaining a healthy body weight decreases the compressive load on the lumbar spine, and ergonomic adjustments help maintain more balanced posture throughout the day.
Surgical Considerations and Goals
Surgical intervention for adult scoliosis is reserved for a small subset of patients whose curves are severe, generally exceeding 45 to 50 degrees, or who experience intractable pain, functional decline, or a progressive neurological deficit. The primary goals of adult deformity surgery are not cosmetic correction but rather pain relief, stabilization of the curve, and restoration of proper spinal alignment. Achieving optimal spinal balance, particularly in the sagittal (side-view) plane, is important for functional outcome.
Surgeons aim to place the head directly over the pelvis, maintaining the body’s center of gravity within a low-energy expenditure zone known as the “cone of economy.” Correcting the Sagittal Vertical Axis (SVA), which measures the forward lean of the spine, is paramount because a positive SVA correlates strongly with increased disability and pain. The procedure most commonly performed is a spinal fusion, where multiple vertebrae are joined together using bone graft material and internal instrumentation, such as titanium rods and screws.
In cases of a rigid or severe imbalance, more complex procedures known as osteotomies may be required to realign the spine. These involve removing a precisely measured wedge of bone from the spine to facilitate a greater degree of correction, with techniques ranging from the less invasive Smith-Petersen osteotomy to the more extensive Pedicle Subtraction Osteotomy (PSO) or Vertebral Column Resection (VCR). This major surgery requires a prolonged recovery period, with full fusion and return to unrestricted activity often taking six to twelve months. Although surgical correction can significantly improve alignment and quality of life, it is a complex undertaking with risks, including the potential for hardware failure, non-union of the fusion (pseudarthrosis), and reduced flexibility in the fused segment.