Degenerative scoliosis (DS) is a spinal condition characterized by a sideways curve in the spine that develops in adulthood, typically affecting individuals over 40. DS is caused by age-related deterioration of the spinal discs and facet joints, primarily in the lumbar spine. This asymmetric degeneration causes vertebral segments to shift and rotate, leading to a spinal curve measuring 10 degrees or more. Treatment focuses not on reversing the curvature itself, but on managing associated pain and improving the individual’s ability to function in daily life. This condition often presents with both low back pain from arthritic joints and leg pain caused by nerve compression, which guides the tailored treatment approach.
Non-Surgical Management Approaches
For the majority of individuals diagnosed with degenerative scoliosis, the initial and most effective approach involves non-surgical, or conservative, management strategies. The primary purpose of these approaches is to control pain and inflammation, allowing the individual to remain active and maintain spinal stability. A multi-faceted plan is typically employed, combining pharmaceutical care, physical rehabilitation, and lifestyle adjustments.
Initial pain management often involves over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation in the arthritic facet joints. For severe muscle spasms, which are common as the body attempts to stabilize the curved spine, prescription muscle relaxants may be temporarily used. These medications provide sufficient pain relief so the patient can engage in physical activity and rehabilitation.
Physical Therapy and Bracing
Physical therapy (PT) represents a beneficial component of conservative care for degenerative scoliosis. A specialized PT program aims to dynamically stabilize the spine by focusing on strengthening the abdominal and core muscles. Strengthening the torso muscles helps to create a natural internal brace, which supports the spine and reduces mechanical stress on the degenerated segments. This training also incorporates exercises for flexibility and proper posture education.
Lifestyle modifications also play a significant role in managing symptoms. Maintaining a healthy body weight is particularly beneficial, as excess weight increases the compressive forces on the stressed lumbar discs and joints. Patients are advised to modify activities that repeatedly exacerbate their pain, such as avoiding heavy lifting or prolonged periods of standing or sitting in a single position.
While bracing is common for adolescent scoliosis, its role in adult degenerative scoliosis is limited. Braces do not correct the spinal curve in adults due as the spine is rigid from degeneration. Instead, a custom-fitted brace or corset may be used temporarily to provide external support, restricting motion to offer short-term relief during painful flare-ups.
Minimally Invasive Pain Procedures
When persistent pain remains despite consistent non-surgical management, targeted, minimally invasive procedures can be utilized to alleviate specific sources of discomfort. These interventions deliver potent anti-inflammatory medication directly to the pain generator, offering relief that often lasts longer than oral medications. Procedures are frequently performed under fluoroscopic guidance, which uses real-time X-ray imaging to ensure precise needle placement near the affected nerves or joints.
Epidural Steroid Injections
One common procedure is the epidural steroid injection (ESI), which targets pain caused by pinched nerves resulting from spinal stenosis. A corticosteroid and an anesthetic agent are injected into the epidural space surrounding the spinal cord and nerve roots. The steroid reduces inflammation around the compressed nerve, which can provide effective relief from radiating leg pain, also known as sciatica.
Other procedures focus on the facet joints, the small joints located at the back of the vertebrae that become arthritic in degenerative scoliosis. Facet joint injections deliver medication directly into these joints to reduce localized back pain. Alternatively, medial branch blocks are performed by injecting anesthetic onto the small nerves that transmit pain signals from the facet joints to the brain.
If a diagnostic medial branch block provides temporary pain relief, the individual may be a candidate for radiofrequency ablation (RFA). RFA uses heat generated by radio waves to create a lesion on the medial branch nerve, which interrupts the pain signal transmission for an extended period, often six months to a year or more. The temporary relief provided by these injections is often used as a window to allow the patient to participate more effectively in physical therapy.
Surgical Options and Goals
Surgery is typically reserved for individuals with degenerative scoliosis who experience severe, debilitating symptoms that have failed to improve after an extensive course of non-surgical and minimally invasive treatments. Surgical intervention is also considered if the spinal curve is rapidly progressing or if there is a progressive neurological deficit, such as foot drop or significant leg weakness. The overarching surgical strategy is built around two primary, interconnected goals: relieving pressure on the nerves and stabilizing the spine.
Decompression and Fusion
The first goal, decompression, is achieved through procedures like a laminectomy. This involves removing the bone, ligament, and other tissues that are crowding the spinal canal and compressing the nerve roots. Decompression effectively alleviates the radicular symptoms, such as leg pain and numbness, caused by spinal stenosis. However, performing decompression alone in a scoliotic spine can sometimes destabilize the structure, potentially causing the curve to worsen.
Decompression is often combined with the second goal: stabilization and fusion. Spinal fusion involves permanently joining two or more vertebrae using bone graft material, supplemented by internal hardware such as rods, screws, and cages. This instrumentation acts as an internal scaffolding to hold the spine in a corrected, stable position while the bone graft heals and creates a solid bridge between the segments. Fusion is essential for limiting the motion of the degenerated segments, reducing mechanical back pain and preventing curve progression.
Since many patients with degenerative scoliosis are older, recovery from this complex spinal surgery is often substantial. The procedure can be lengthy and carries higher risks than non-surgical options. Surgeons carefully weigh the potential for improved quality of life against the seriousness of the recovery and potential complications, often utilizing minimally invasive techniques where appropriate to reduce tissue trauma and blood loss.