What Is Adult Scoliosis?
Adult scoliosis is an abnormal curvature of the spine in a patient who is skeletally mature (finished with growing). Scoliosis is a “three-dimensional” disease, meaning the spine twists in addition to curving side-to-side either to the right or to the left.
In some cases, adult scoliosis is the result of an untreated curve during childhood that grew bigger over time (see Adolescent Idiopathic Scoliosis). In other cases, scoliosis spontaneously develops in an adult patient who has no history of spinal deformity as a child, and this is called adult degenerative scoliosis. Certain medical conditions such as osteoporosis, disc degeneration, compression fracture, or a combination of these problems may contribute to the development of adult scoliosis.
Signs and Symptoms
Although scoliosis is known to cause deformity such as formation of a humpback, patients with adult scoliosis most commonly complain of back pain when they decide to seek medical help. Scoliosis can cause uneven shoulders, rib cage, and pelvis. An uneven pelvis, in turn, can lead to trunk imbalance and give the impression that the patient is leaning toward one side.
Along with pain, patients may experience stiffness as adult scoliosis is much less flexible than that of a child, and this can cause difficulty sitting, standing, and/or walking. In severe but rare cases, heart and lung function can be diminished. Some patients may even complain of their bottom ribs touching the top of the pelvic bone when upright.
Dr. Cho performs a complete medical and orthopaedic evaluation for each patient during his or her initial visit. Patients are usually sent for x-rays to confirm the diagnosis. MRI and CT scans are often used to assess the three-dimensional nature of the deformity. In addition, special tests like pulmonary function test and bone mineral density test, along with several blood tests, may be required to comprehensively treat adult scoliosis.
Most patients with adult scoliosis can be successfully treated without surgery. Non-operative treatment may include an exercise program to condition the back and abdominal muscles, a formal physical and/or occupational therapy, bracing, and anti-inflammatory medications. Epidural steroid injections and nerve root blocks can be helpful when there is back or leg pain due to a pinched nerve (see Sciatica). Many patients also suffer from osteoporosis, or loss of bone mass, and need nutritional and/or medical treatments (calcium, vitamin D, bisphosphonate, or parathyroid hormone therapy).
Dr. Cho recommends spine surgery for adult scoliosis patients only when non-surgical treatments do not relieve the pain, the curve noticeably worsens, or the curve is bigger than 45 degrees – and especially when the curve is large enough to reduce lung function and hasten the development of arthritis in the spine.
Dr. Cho typically performs the surgery all from the back of the spine using the latest, scientifically proven techniques and appropriate implants such as pedicle screws and rods to correct the spinal deformity and immobilize the spinal segments as they fuse and heal in the newly corrected position. Anterior surgery, meaning approaching the spine from the front, is rarely used in select cases. Dr. Cho prefers to use local bone graft from the spine, along with bone bank bone and biologic proteins – an advanced technique that improves the fusion success rate and avoids pain caused by taking bone graft from the hip bone for adult scoliosis patients.
For more details regarding surgery, please see Posterior Spinal Instrumented Fusion for Adult Scoliosis.