Scoliosis describes a sideways curvature of the spine, often recognized as an “S” or “C” shape. While frequently associated with adolescence, scoliosis can also progress in adulthood. This article addresses the progression of scoliosis in adults, exploring its nature, contributing factors, identifiable signs, and available management approaches.
Does Adult Scoliosis Progress?
Adult scoliosis can progress, contrary to the common belief that spinal curves stabilize once growth ceases. While typically slower than in adolescents, progression remains a concern for adults. Approximately 40% of adult scoliosis patients experience some degree of progression. Adult scoliosis generally falls into two main categories. Adult idiopathic scoliosis refers to a curve that originated during adolescence. De novo adult scoliosis develops in adulthood, often after age 40, in a previously straight spine. Larger curves, typically those exceeding 30-40 degrees, are more prone to progression.
Factors Contributing to Progression
Progression is primarily driven by age-related changes and conditions affecting spinal integrity. Spinal degeneration, involving the breakdown of intervertebral discs and facet joints, is a significant underlying mechanism. As discs lose height and elasticity unevenly, and facet joints experience wear and tear, the spine can become increasingly asymmetrical, leading to worsening curvature.
Osteoporosis, characterized by weakened bones, also contributes to curve progression. Weakened vertebrae can lead to instability or compression fractures, further deforming the spine. Spinal instability, resulting from degenerative changes in discs and joints, promotes further curvature. A high initial Cobb angle, typically above 30-40 degrees, is a recognized factor for continued progression. Previous spinal surgery can also influence progression by leading to adjacent segment disease, where degeneration occurs above or below a fused area due to altered biomechanics.
Recognizing Signs of Worsening Scoliosis
An adult’s scoliosis may be worsening if certain observable and symptomatic indicators become apparent. Increased back pain is often the most common symptom, which can be localized or radiate to other areas. This pain often stems from muscle strain, nerve compression, or increased joint wear caused by the changing spinal alignment.
Visible changes in body posture can also signal progression. These may include a noticeable increase in the spinal curve, one shoulder or hip appearing higher than the other, or the trunk leaning to one side. Neurological symptoms can emerge due to nerve compression, presenting as numbness, tingling, or weakness in the legs. In more severe cases, balance issues may arise as the spinal shift affects overall posture and stability. Although less common, severe curves in the thoracic spine can compress the lungs, leading to symptoms like shortness of breath during activity.
Approaches to Managing Adult Scoliosis
Managing adult scoliosis involves a range of strategies, with the specific approach tailored to the individual’s symptoms, curve magnitude, and rate of progression. Initial steps often include observation and regular monitoring, involving periodic check-ups with X-rays to track any changes in the spinal curvature. This allows healthcare providers to assess the curve’s stability or progression over time.
Non-surgical management options aim to alleviate symptoms and improve function. Pain management often includes medications, such as non-steroidal anti-inflammatory drugs (NSAIDs), or targeted injections to address nerve irritation. Physical therapy plays a role by focusing on strengthening core muscles, improving posture, and increasing flexibility to reduce discomfort. While less common than in adolescents, bracing may be used in specific adult cases for pain relief or to help slow progression, though it typically does not correct the curve itself.
Surgical intervention is generally considered when conservative treatments fail to provide sufficient relief, or when the curve is severe and progressing significantly, particularly if it leads to neurological deficits or severe deformity. The goals of surgery typically include pain relief, halting further curve progression, and stabilizing the spine, sometimes involving spinal fusion to join vertebrae.