Adult Scoliosis

What is Adult Scoliosis?

Scoliosis that is first diagnosed in adulthood may actually represent a progression of juvenile or adolescent scoliosis that went untreated or unrecognized during childhood. But scoliosis can also first develop during adulthood. The causes of adult- onset scoliosis, unlike those of most juvenile or adolescent scoliosis, can often be identified. Degenerative adult scoliosis occurs when a combination of age and deterioration of the spine leads to the development of a scoliotic curve. Degenerative scoliosis usually appears after the age of 40. In older patients, particularly women, it is often related to osteoporosis, which weakens the bone, leading to deterioration. As the deteriorating spine "sags," a scoliotic curve can slowly develop.

Conservative treatment for adults begins with the treatment of osteoporosis, if any is present. Treatment of osteoporosis may also slow the progression of scoliosis. Current recommendations include an increase in calcium and vitamin D intake, hormone replacement therapy, and weight-bearing exercises. Exercise may help to relieve pain but will not affect the natural history of the curve.

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Surgical treatment

After the completion of skeletal maturity, smaller curves tend not to progress, seldom cause significant back pain, and therefore do not require surgery. With medium and large curves, however, adult progression and the presence of secondary symptoms become more likely, making surgery a treatment option to consider. Those who would benefit most from surgery include patients with severe pain, difficulty breathing, or progressive deformity.

Surgery for scoliosis almost always involves spinal fusion with instrumentation. Nearly all scoliosis surgery employs some type of rods to help straighten the spine. The physician may use a posterior approach, which involves entering the spine through the back, an anterior approach, which is performed from the front or side, or a combined approach. The decision to have surgery is a joint decision arrived at by the patient, patient’s family and the physician. Surgery for scoliosis is never an emergency and sufficient time is always available to make everyone comfortable with the decision.

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