Adult scoliosis is defined as a spinal curve of 10 degrees or more in a person who has finished growing. Unlike adolescent idiopathic scoliosis (AIS), adult scoliosis frequently involves degenerative changes from aging, arthritis, or disc wear. These changes can cause pain and nerve compression. Navigating the diagnosis and treatment requires a multidisciplinary team of medical professionals specializing in spinal health and function.
Initial Referral and Diagnostic Confirmation
The diagnosis often begins with a Primary Care Physician (PCP) or General Practitioner (GP) due to chronic back pain or a noticeable postural change. These initial doctors typically refer patients to a spine specialist who confirms the diagnosis and assesses the curve’s severity. This first specialist may be a general orthopedic doctor or a physiatrist.
Specialists confirm the diagnosis using specific imaging, most commonly a standing, full-length X-ray to measure the Cobb angle, which quantifies the spinal curvature. MRI or CT scans may also be ordered to evaluate soft tissues, such as discs and nerves, especially if the patient reports leg pain, numbness, or weakness. The specialist ensures the curve is the source of the symptoms and rules out other spinal conditions before coordinating treatment.
Physicians Managing Non-Surgical Treatment
For most adults with scoliosis, treatment focuses on managing symptoms and improving function rather than physically straightening the curve. Non-surgical specialists are the primary care providers. The physiatrist, a doctor of Physical Medicine and Rehabilitation (PM&R), often coordinates this conservative management. Physiatrists specialize in restoring functional ability and quality of life. They prescribe and oversee rehabilitation programs, including targeted physical therapy to strengthen core muscles, improve flexibility, and correct posture, aiming to reduce pain.
Physiatrists also assess neurological involvement and functional limitations, sometimes using diagnostic tools like electromyography (EMG). They are skilled in non-operative pain management techniques. When pain is a significant factor, a Physiatrist or a dedicated Pain Management Specialist may administer localized therapies. These include epidural steroid injections or nerve blocks, which deliver anti-inflammatory medication directly to irritated spinal nerves. These injections are helpful for patients experiencing radicular pain that radiates down the legs due to nerve compression.
Specialists for Surgical Correction
Surgical correction may be considered when conservative treatments fail to control pain or if the spinal curve is severe and rapidly progressing. The two primary types of surgeons who perform these procedures are orthopedic spine surgeons and neurosurgeons specializing in the spine. Orthopedic spine surgeons are experts in the musculoskeletal system, correcting complex spinal deformities, fusions, and structural bone problems. Their expertise centers on restoring proper alignment and stability to the bony structure.
Neurosurgeons focus on disorders of the nervous system, including the spinal cord and peripheral nerves. Their unique expertise is managing procedures involving delicate neural structures, making them suited for cases with severe nerve compression or spinal cord issues. For adult scoliosis, the two specialties often overlap, as many corrective procedures involve both complex bone work and decompression of pinched nerves. The choice of surgeon often depends on their fellowship training, experience with adult deformity, and the need for neurological manipulation.