There are few structures in the human body as important as the spine. The 24 vertebrae that make up the spine are critical for supporting the head, neck and trunk. More importantly, this bony architecture is also the main nerve pathway from the brain to the peripheral nerves. Any issues that may affect the spine can have a serious impact on bodily form and function. That is why adult degenerative scoliosis is such a serious concern, especially for those over the age of 50. Adult degenerative scoliosis is a result of eroding spinal joints or bones and can result in stiffness, aches, tingling or sharp pain in the back or lower limbs.
It is estimated that as many as 60 percent of people aged 60 or older may suffer from mild adult degenerative scoliosis. In many cases, this mild health condition may not exhibit any pain symptoms. However, for a smaller population in which this condition is quite severe, there is visible spinal imbalance which may cause sciatica and difficulty walking.
There are several treatment options for adult degenerative scoliosis, depending on the severity of the condition and the presenting symptoms. While most cases require only require mild pain relief medications, in more serious cases in which there is nerve dysfunction or severe pain, patients may need to resort to surgical treatments.
The Mechanism of Adult Degenerative Scoliosis
To understand how adult degenerative scoliosis occurs, you need insight into how a normal spine operates. The 24 vertebrae that make up the neck, thoracic (upper back) and lumbar (lower back), are composed of bone. In a healthy person, these three regions should be aligned if viewed from the rear. If viewed from the side, however, the neck and lumbar is curved toward the front, while the thoracic region is curved toward the rear.
Between the spinal bones are cushiony discs that prevent abrasion and help maintain alignment. There are also facet joints between vertebrae that allow bending and twisting. In old age, these joints and connective tissue degenerates naturally.
However, for some people this natural deteriorative process is accelerated or unbalanced. In extreme cases of adult degenerative scoliosis, the joints degrade to the point that bones no longer align. This can cause one or more of the following conditions:
- Scoliosis—this condition is characterized by a ten degree or more inclination of the spine to one side or the other. From the rear, a patient with scoliosis may have a sideways curvature that produces shoulders or hips of differing height or positioning.
- Kyphosis—this spinal misalignment produced an abnormally curved upper back of 50 degrees or more. Many patients with kyphosis are incapable of standing up straight.
- Lordosis—also known as swayback, this condition involves a significant inward curvature of the lower back.
Symptoms and Causes of Adult Degenerative Scoliosis
Although how adult degenerative scoliosis occurs is a fairly well-understood process, there are several health conditions that may cause it.
- Childhood scoliosis—If for some reason, childhood scoliosis is not diagnosed before puberty, it may progress during adulthood until it is recognized. Unlike adult degenerative scoliosis which is a secondary condition, childhood scoliosis is often the result of congenital factors like cerebral palsy, differing leg lengths or genetic disorders.
- Spinal surgery—in some rare cases, adult degenerative scoliosis may occur following a spinal surgery. If the procedure results in an imbalance in the spine, it may result in a deformation of the spine.
- Paralytic curve—some patients who have experienced an injury to the spinal cord and resulting muscle paralysis may also develop adult degenerative scoliosis. Because the muscles around the spine do not support it sufficiently, the bones may lose their alignment.
- Myopathic deformity—patients with polio, muscular dystrophy or cerebral palsy lack the proper muscular architecture to support spinal alignment and often suffer from adult degenerative scoliosis. The presence of scoliosis is most likely among patients that are bedridden.
- Osteoporosis—among older people with osteoporosis, a disease that weakens bones, scoliosis is a serious risk. Between 15 and 20 million Americans suffer from osteoporosis and almost half a million will experience spinal fractures every year. These fractures may result in spinal curvature.
Treatments for Adult Degenerative Scoliosis
Mild adult degenerative scoliosis is usually not a medical condition that requires serious intervention. However, moderate to severe cases of adult degenerative scoliosis or ones that are progressing abnormally quickly may necessitate one or more of the following therapies.
- Pain relief medications—for many mild to moderate cases of adult degenerative scoliosis, pain relief is the primary consideration. If the scoliosis is only producing a minor amount of pain due to a pinched nerve, your physician will likely recommend over-the-counter medications like aspirin, Tylenol or Advil. In some cases where the pain is severe or ongoing, your physician may prescribe more powerful pain relief drugs like opioids, but typically, only for short periods of time.
- Physical therapy—physical therapy is a useful treatment option for halting the progress of adult degenerative scoliosis. This exercise regimen is customized to each patient and is intended to align, elongate and stabilize the spine by strengthening and balancing musculature.
- Brace—although most medical experts do not recommend the use of a rigid back brace because it can accelerate muscular atrophy, in some special circumstances, it may be used to limit pain or slow progression of the health condition.
- Injections—if you do not respond to pain relief medications, then your physician may ask you to consider a spinal injection. Guided by x-ray imagery, your doctor will inject an anti-inflammatory or analgesic compound into the area around the affected nerves.
- Surgery—in cases where more conventional therapies prove ineffective, surgery may be the only option. Surgery is generally only recommended if pain is severe or if spinal curvature exceeds 40 or 45 degrees. There are a variety of surgical procedures that improve your condition by fusing vertebrae in an aligned position, alter or remove tissue impinging upon a nerve, or inserting a cage or spacer along the spine to stabilize it.
Article written by: Dr. Robert Moghim – CEO/Founder Colorado Pain Care
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