Idiopathic Scoliosis – Adult
When a spinal deformity is discovered in an adult, it is often quite different from a deformity in an infant or juvenile. The goals for treatment are often different as is the location of the scoliosis. The deformity in an adult may have been present since childhood or may be the result of the aging process. In adults, it is more common for all areas of the spine to be effected including the bones in the neck. While scoliosis in children is often discovered during a screening, scoliosis in adults is typically discovered when pain or discomfort requires a physician visit. Besides pain in the back, patients may have pain radiating down their legs. Treatment of spine deformity in adults focuses on restoring function and alleviating pain in combination with correcting the curvature of the spine.
Adult spinal deformity refers to abnormal curvatures of the spine in patients who have completed their growth. Thus, they are typically seen in males and females over the age of eighteen. The age range of patients seeking treatment for adult scoliosis and other deformities varies widely, however. It is not unusual for patients who are well into their sixties, seventies or even eighties present with symptoms of pain and functional limitations. With increasing life expectancy along with more active lifestyles, the number of older adults requiring treatment has also gone up. Unlike the younger or adolescent patient with a spinal deformity, the older adult presents with a completely different set of problems and challenges to the treating physician.
There are many different causes of spinal deformity in the adult. The most common varieties include idiopathic scoliosis that was present during adolescence (teenage years) and then became worse during adulthood, and deformity that began in adulthood due to degenerative (wear and tear) changes in the spine and deformity that developed later in life. Other less frequent causes include curvatures due to osteoporosis (brittle bones), previous fractures of the spine due to an accident, spondylolisthesis (slipped vertebrae) and rarely, infections and tumors of the spine.
The following symptoms of scoliosis may be used to determine treatment options: persistent pain that cannot be alleviated, deformity progression, and reduced cardiopulmonary (heart and lung) function (rare). Conservative non-surgical treatment may include: moist heat, medication for pain and inflammation, and exercise. Bracing is rarely used to help control pain. It will not correct or cure scoliosis. Most patients with adult scoliosis do not require surgery.
Most patients with adult scoliosis do not require surgery. Surgery may be considered if any of the following exist:
- Thoracic (mid-back) curve greater than 50 degrees with persistent pain
- Progressive thoracolumbar (mid and low back) curve
- Lumbar (low back) curve with persistent pain
- Decreased cardiopulmonary (heart and lung) function due to thoracic curve
- Appearance, deformity
Pain control is the usual reason for surgery for scoliosis in adults. The spinal surgeon decides the procedure(s) that will provide the most benefit to the patient. Surgical intervention may include the removal of an intervertebral disc (e.g. discectomy) combined with spinal instrumentation and fusion. Spinal instrumentation utilizes rods, bars, wires, screws, and other types of medically designed hardware. Combined with fusion, instrumentation stabilizes spinal segments, enhances fusion, and provides a more permanent solution. These procedures may enable the patient to sit upright thereby reducing the risk for cardiopulmonary complication and may increase mobility. This type of surgery can be performed safely on adults with spinal deformity, usually with excellent results.