Adult scoliosis is an abnormal spinal curvature that occurs in someone over 18 years of age. This condition is often referred to as degenerative scoliosis or adult degenerative scoliosis. The spine has 24 irregular shaped bones (vertebrae) that stack one on top of each other. These bones are separated by fluid-filled cushions, which are known as intervertebral discs.
Scoliosis affects around 5-7 million Americans. Adult degenerative scoliosis affects around 2.5-10% of the general population. The prevalence rate among people 60 years and older is approximately 68%.
Many symptoms are associated with degenerative scoliosis. It can lead to pain, humpback, spinal instability, trunk imbalance, rib prominence, trouble standing or sitting, spinal rigidity and stiffness, and breathing problems. The pain is associated with nerves that become stretched and/or pinched from the arthritic process. In addition, the spinal nerve roots are pinched from bone spurs that surround them and block their exit route.
As the vertebral column starts to age, degenerative scoliosis occurs. This condition is caused by spinal stenosis, osteoporosis, degenerative disc disease, and vertebral compression fractures. Spinal instability occurs when the spinal structures can no longer maintain proper alignment.
To diagnose adult degenerative scoliosis, the doctor will take a detailed medical history and conduct a thorough physical examination. The exam involves assessing for balance problems, muscle weakness, pain, sensation, and movement. Diagnostic tests, such as x-rays, are used to assess spinal alignment and the degree of curvature.
Orthotics and spine braces – For spinal support, the doctor may order a spine brace. In adults, these do not correct the scoliosis, as the curvature is not flexible. But they can provide pain relief. Use of a brace can weaken the spine, so daily exercises are recommended along with this approach.
Physical therapy – For improved function, endurance, flexibility, and decreased pain, one option of treatment is physical therapy. This involves visits 2-3 times each week for a period of 4-8 weeks.
Medications – The pain management specialist can prescribe certain pain medicines to alleviate discomfort, such as non-steroidal anti-inflammatory drugs (NSAIDs) and narcotics.
Facet joint injection (FJI) – This involves injecting a corticosteroid, with or without an anesthetic, into the facet joint space along the spinal column. To assure correct needle placement, the doctor uses x-ray guidance.
Radiofrequency facet neurotomy – This procedure involves destruction of a portion of the nerve root with radiofrequency energy. According to a recent study, the efficacy rate of radiofrequency medial branch neurotomy is 85%, with pain relief lasting 10 months or longer.
Epidural steroid injection (ESI) – For this procedure, the doctor will inject a steroid agent into the epidural space, which is near spinal nerves of the back. Clinical studies report that ESI has a 90% success rate, with researchers reporting that the procedure was very effective for pain relief.