Adult scoliosis is an abnormal, sideways curvature of the spine, defined as a lateral curve measuring 10 degrees or more on an X-ray. When this condition occurs in adults who are skeletally mature, the question of whether it can be “fixed” becomes complex because the spine is no longer growing. Unlike in adolescents, where the primary focus is often on achieving maximum curve correction, treatment for adults shifts toward managing symptoms and preventing the curve from worsening. The overall approach must be highly individualized, aiming to improve a person’s function and quality of life rather than simply eliminating the curve.
Differentiating Adult Scoliosis Types
Adult scoliosis is generally categorized into two distinct types, and the origin of the curve significantly influences the necessary treatment plan. The first type is Adult Idiopathic Scoliosis (AdIS), which began during adolescence but progressed or became symptomatic later in life. These curves often present as larger, S-shaped deformities spanning the thoracic (mid-back) and lumbar (lower back) regions. The second type is Degenerative De Novo Scoliosis (ADS), which develops for the first time in adulthood, typically after age 40 or 50. This form is caused by the asymmetric wear and tear of spinal components, such as the discs and facet joints, often leading to spinal stenosis and resulting in back and leg pain.
Defining Realistic Treatment Goals
For an adult with scoliosis, the concept of a “fix” is redefined from complete curve reversal to achieving specific, measurable improvements in daily life. The foremost goal of intervention is substantial pain reduction, particularly the low back and leg pain that commonly accompanies the condition. Treatment also focuses on stabilizing the spine and preventing the curve from progressing further, especially those exceeding 30 degrees. Restoring the patient’s overall spinal balance, or sagittal alignment, is crucial because poor posture contributes significantly to chronic muscle fatigue and pain. Success is measured by an improved quality of life, quantified using patient-reported outcome measures that assess functional status and the ability to perform daily activities.
Non-Surgical Management Strategies
Most adults with scoliosis manage their condition successfully without surgery, relying on conservative, non-invasive methods aimed at symptom control. Physical therapy is a cornerstone of this approach, often involving specific scoliosis-focused exercise programs like the Schroth Method. Schroth exercises are customized for a patient’s unique curve pattern and work to de-rotate, elongate, and stabilize the spine, aiming to improve postural alignment and muscular symmetry. Pain management includes over-the-counter or prescription anti-inflammatory medications, and for compressed nerves or arthritis, epidural steroid injections or nerve blocks can provide temporary but effective relief. Lifestyle modifications, such as maintaining a healthy weight and engaging in low-impact aerobic conditioning, also support spinal health by reducing stress on the degenerative joints and discs.
Surgical Intervention for Deformity Correction
Surgery is reserved for a small percentage of adults when non-surgical treatments fail, typically indicated by intractable pain, progressive curve worsening, or evidence of neurological compromise. The decision to operate is a serious one, as adult scoliosis surgery is complex and carries a higher risk of complications compared to adolescent procedures. The primary goals of surgical intervention are nerve decompression, spinal stabilization, and limited correction of the deformity. The most common surgical technique is spinal fusion with instrumentation, which involves placing metal rods and screws to realign the curve and using bone grafts to fuse the affected vertebrae into a single, solid segment. Restoring the sagittal balance is often considered more important than the amount of sideways correction achieved, as success is ultimately measured by the patient’s functional improvement and reduction in pain.