Degenerative scoliosis is a spinal curvature that develops in adults, characterized by a sideways curve of 10 degrees or more. Unlike scoliosis seen in childhood, this condition arises from age-related wear and tear on spinal components, stemming from the natural aging process rather than abnormal growth patterns.
How Degenerative Scoliosis Develops
Degenerative scoliosis is a progressive sideways curvature of the spine, most commonly affecting the lower back or thoracolumbar region. It originates in adulthood due to the deterioration of spinal structures, rather than growth abnormalities.
Its development involves the degeneration of intervertebral discs, which lose height and cushioning, and arthritis in the facet joints. These changes can lead to vertebral slippage (degenerative spondylolisthesis) and sometimes ligament laxity or thickening. Uneven degeneration of these spinal components can cause the spine to curve abnormally. Risk factors include advanced age, pre-existing spinal conditions, and osteoporosis.
Common Symptoms
Individuals with degenerative scoliosis often experience a range of symptoms, with lower back pain being a primary concern. This pain typically worsens with activity and may improve with rest, often becoming chronic.
Nerve compression is another common issue, leading to radiating pain, numbness, tingling, or weakness in the buttocks and legs, often referred to as sciatica or neurogenic claudication. This occurs because degenerative changes and the spinal curvature can narrow the spinal canal, compressing nerves. Observable postural changes may also develop, such as uneven hips or shoulders, a visible curve, or a leaning posture.
Pinpointing a Diagnosis
Healthcare professionals diagnose degenerative scoliosis with a thorough clinical evaluation. This involves taking a detailed medical history and conducting a physical examination to assess posture, spinal alignment, range of motion, and neurological function.
Imaging studies are essential for confirming the diagnosis and assessing its severity. Standing X-rays, taken from the front and side, are crucial for measuring the Cobb angle, which quantifies the degree of spinal curvature, and evaluating overall spinal balance. Dynamic X-rays, taken during bending, can assess curve flexibility.
Magnetic Resonance Imaging (MRI) provides detailed views of soft tissues, such as intervertebral discs, nerves, and the spinal cord, helping identify nerve compression or spinal stenosis. A Computed Tomography (CT) scan offers detailed images of bone structures, useful for detecting facet joint arthritis, bone spurs, and vertebral slippage.
Treatment Pathways
Managing degenerative scoliosis often begins with non-surgical approaches aimed at pain relief and improving function. Pain management may include medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) or muscle relaxants. Physical therapy is a cornerstone of conservative treatment, focusing on strengthening core muscles, improving flexibility, correcting posture, and reducing pain.
Targeted pain relief can be achieved through injections, such as epidural steroid injections or facet joint injections. While bracing is not typically used to correct the curve in adults, it may offer short-term support and pain relief.
Surgical interventions are considered when conservative treatments do not adequately relieve severe pain, if there are progressive neurological deficits, or in cases of significant functional impairment. The primary goals of surgery are to decompress nerves and to stabilize or correct spinal alignment, often through spinal fusion. Common procedures include decompression with fusion, where vertebrae are “welded” together to prevent further movement. Treatment plans are highly individualized, depending on the severity of symptoms, the extent of the curve, and the patient’s overall health.