Scoliosis is a condition characterized by a sideways curvature of the spine, often forming a C or S shape. While commonly associated with childhood and adolescence, whether scoliosis worsens with age depends on several interacting factors. Significant progression frequently occurs during periods of rapid growth in younger individuals, but spinal curves can also advance in adulthood, often due to different underlying mechanisms.
Scoliosis Progression Across the Lifespan
The trajectory of scoliosis progression varies depending on a person’s age and skeletal maturity. Adolescent Idiopathic Scoliosis (AIS), the most common type, manifests between ages 10 and 18. For individuals with AIS, the most significant curve progression takes place during periods of rapid growth, particularly during puberty. Once skeletal maturity is reached, the progression of the curve slows or stops, especially if the curve magnitude is less than 30 degrees. However, thoracic curves greater than 50 degrees and lumbar curves greater than 40 degrees at skeletal maturity may still progress by 1-2 degrees per year in adulthood.
Adult scoliosis can present as a continuation of AIS, or it can develop anew, known as adult degenerative scoliosis. This “de novo” deformity develops after age 50 and is primarily driven by degenerative changes in the spine, such as disc degeneration and facet joint arthritis. Progression in adults is slower, advancing at a rate of 3-4 degrees per year, and is linked to the wear and tear of spinal structures rather than growth. While some adult curves remain stable, others can worsen over time due to this ongoing degeneration, potentially leading to increased pain and functional limitations.
Key Factors Influencing Curve Worsening
Several factors influence whether a scoliosis curve will worsen over time. The initial curve magnitude plays a substantial role, as larger curves, such as those over 25 degrees in adolescents, have a higher likelihood of progressing. In adults, curves exceeding 30 degrees are more prone to progression. The specific type of scoliosis also influences its natural history; neuromuscular scoliosis, which arises from conditions affecting muscles or nerves like cerebral palsy or muscular dystrophy, is more progressive than idiopathic types.
Skeletal maturity is a significant factor for adolescents; the less mature the skeleton, the greater the risk of curve progression. Growth spurts, especially during puberty, are times of increased risk for curve acceleration. For adults, age-related spinal degeneration is a primary driver of progression. This includes the breakdown of intervertebral discs and the development of arthritis in the facet joints, which can destabilize the spine and contribute to curve worsening or new curve development. Osteoporosis, a condition causing weakened bones, can further contribute to spinal collapse and increased curvature in older adults.
Recognizing Signs of Progressive Scoliosis
Recognizing the signs of progressive scoliosis involves observing both visual changes and changes in symptoms. Visual indicators include increased asymmetry of the shoulders, where one shoulder appears higher than the other. Uneven hips or a waistline that appears more curved on one side are noticeable. A more prominent rib hump, especially when bending forward, is another common sign, as is a general leaning to one side of the body.
Beyond visual cues, individuals may experience new or worsening symptoms. Back pain is a common complaint in adults with progressive scoliosis, often due to the compressive forces on the spine and nerves. Stiffness in the back, increased fatigue, or new difficulties with movement and daily activities can suggest progression. In more severe cases, particularly if the curve is large and affects the thoracic region, shortness of breath or other breathing problems may arise due to the spine pressing against the lungs.
Approaches to Managing Worsening Curves
When scoliosis curves are found to be progressing, healthcare providers employ various strategies to manage the condition. Regular monitoring is a foundational approach, involving periodic clinical examinations and X-rays to track changes in curve magnitude and spinal alignment over time. This allows for timely intervention if progression reaches a certain threshold.
Physical therapy plays a role in managing symptoms and may influence progression. Specific exercises are designed to improve spinal strength, flexibility, and posture, which can help alleviate pain and discomfort. For adolescents, bracing is a common non-surgical treatment aimed at preventing curve progression during periods of rapid growth. Braces are less effective for significant curve correction or progression in skeletally mature adults.
Surgical consideration may arise for severe, progressive curves that cause substantial pain, significant functional impairment, or compromise organ function, such as breathing. Spinal fusion, a common surgical procedure, involves joining vertebrae to stabilize the spine and prevent further curvature.