Degenerative scoliosis is a spinal condition most often observed in older adults, characterized by an abnormal curvature of the spine. This condition develops due to the wear and tear associated with aging, affecting the discs and joints that support the spinal column. This article explores how degenerative scoliosis progresses, signs of worsening symptoms, and strategies to manage its course.
What is Degenerative Scoliosis?
Degenerative scoliosis originates from the gradual breakdown of spinal components that occurs with age. Unlike adolescent idiopathic scoliosis, which often appears during growth spurts, this adult-onset form develops as intervertebral discs lose hydration and height, and facet joints undergo arthritic changes. This process, often referred to as spondylosis or osteoarthritis of the spine, compromises the structural integrity and stability of the vertebral column. The uneven deterioration of these spinal elements can cause the spine to gradually curve sideways, typically in the lumbar (lower back) region.
The spine’s natural alignment is maintained by healthy discs, ligaments, and facet joints, which collectively absorb shock and facilitate movement. As these structures degenerate, they can no longer adequately support the spine, leading to a loss of normal curvature and the development of an abnormal sideways curve. This spinal deformity is a direct result of age-related changes, contrasting with congenital or neuromuscular causes of scoliosis. The resulting instability can lead to mechanical stress on other parts of the spine.
Why Degenerative Scoliosis Progresses
Degenerative scoliosis can progress due to a combination of ongoing biological and mechanical factors. Continued degeneration of the intervertebral discs is a key driver, as disc height loss creates instability and shifts weight unevenly onto the facet joints. This uneven loading can accelerate arthritic changes in the facet joints, leading to the formation of bone spurs and further loss of spinal alignment. These changes contribute to an increasing sideways curvature of the spine.
Ligamentous laxity, where spinal ligaments become stretched or weakened, further compromises spinal stability. This weakening reduces the spine’s ability to maintain alignment against gravitational forces and daily movements.
Osteoporosis, reduced bone density, also contributes to progression by making vertebrae susceptible to fractures and collapse. These fractures can exacerbate existing curves or initiate new deformities. Additionally, progressive weakness of the paraspinal muscles, which stabilize the spine, can diminish the body’s natural support system, allowing the curve to worsen.
Identifying Worsening Symptoms
Changes in symptoms can indicate that degenerative scoliosis is progressing. An increase in back pain, particularly localized to the lumbar spine, which may become more constant or severe, is a key sign. This pain often results from increased mechanical stress on the spinal structures and nerve compression caused by the curve’s progression. The pain may worsen with activity and improve with rest.
Neurological symptoms also indicate progression, often stemming from spinal stenosis, a narrowing of the spinal canal that compresses nerves. These symptoms can include sciatica, characterized by radiating pain, numbness, or tingling down one or both legs. Muscle weakness in the legs may also develop, leading to difficulty walking or maintaining balance.
Postural changes, such as leaning to one side or a noticeable loss of height, can become more pronounced as the spinal curvature increases. These physical changes can significantly impact daily activities, making routine tasks such as standing, walking, or sitting for extended periods increasingly challenging.
Strategies to Manage Progression
Managing the progression of degenerative scoliosis often involves a comprehensive approach focused on non-surgical interventions. Physical therapy strengthens core muscles and improves spinal flexibility, enhancing stability and reducing pain. Specific exercises help in maintaining posture and supporting the spinal column. Pain management techniques, including over-the-counter medications like NSAIDs or prescribed pain relievers, help control discomfort. Injections, such as epidural steroid injections, may be used to reduce inflammation and alleviate nerve pain.
Lifestyle modifications also play a role. Maintaining a healthy weight reduces stress on the spine, while practicing good posture and ergonomic adjustments in daily activities can prevent further strain. While bracing is typically not effective in correcting the curve in adults, it might be used temporarily to provide support and alleviate pain in some cases. When non-surgical methods no longer provide adequate relief or when neurological symptoms become severe and progressive, surgical intervention may be considered. The goals of surgery are to decompress compressed nerves, stabilize the spine, and correct the deformity to prevent further progression and improve function.