Chances are you're one of the millions of adults in America who has experienced back pain. Sprains, strains, or spasms are commonly responsible for the misery, but one cause of back pain in adults that's often overlooked is scoliosis, or lateral (side-to-side) curvature of the spine.
Scoliosis is usually thought of as a childhood disorder, but an estimated 6 percent of Americans over age 50 have some degree of scoliosis, as do about 15 percent of those older than age 60 who have low back pain. The numbers are likely even higher, as the condition frequently goes undetected in adults.
For example, in a 2010 study of almost 1,300 adults with back pain who had a magnetic resonance imaging (MRI) scan, Johns Hopkins researchers found that 13 percent of people age 46 to 60 and 39% of those over age 60 had lumbar (lower back) scoliosis. But the condition was not detected in nearly 67 percent of cases, especially when the spinal curvature was mild (11 degrees to 20 degrees). Even in people with moderate to severe curvature (more than 20 degrees), scoliosis was undetected more than 10 percent of the time.
As with scoliosis in childhood, adult scoliosis is more common in women than in men. In the Johns Hopkins study, which was published in the American Journal of Neuroradiology, females were 1.5 times as likely as males to have scoliosis.
What Causes Scoliosis In Adults?
Scoliosis in people over age 40 usually results from age-related degenerative changes to the spine such as osteoporosis, vertebral compression fractures, degenerative disk disease, and spinal stenosis. These conditions can cause the spine to lose its structural stability, increasing the risk of spinal curvature.
In other cases, scoliosis is idiopathic, meaning there is no apparent reason for its development. Most people with this type of scoliosis have had the condition since childhood, but in adulthood it has progressed enough to cause symptoms.
What Does Scoliosis Look And Feel Like?
Scoliosis in adults manifests itself in a variety of ways, depending on the degree of curvature and the location of the curve on the spine. Some people look as though they are leaning to one side. In others, one side of the rib cage and/or shoulders protrudes more than the other.
Scoliosis in adults typically remains stable over time, but in some cases it progressively worsens. In severe cases, adult scoliosis causes considerable pain and difficulty in standing, sitting, or walking. There may also be some nerve damage or lung problems caused by restriction and pressure by the spine.
How Is Scoliosis Diagnosed In Adults?
To diagnose scoliosis, your doctor will perform a physical examination to check for spinal irregularities and asymmetries in the height of your shoulders and hips and the length of your legs. Your range of motion also will be assessed.
In addition, spinal x-rays will be ordered to help pinpoint the exact location of the curve, determine the degree of curvature, and detect degenerative changes in the spine that could be contributing to the scoliosis. Lung function also may be tested in severe cases.
What Are the Nonsurgical Treatment Options for Adult Scoliosis?
The treatment for scoliosis varies, depending on the degree of curvature and the amount of pain (if any). In many cases, adult scoliosis needs no treatment at all, other than regular monitoring for progression of the curve. In cases of mild pain, over-the-counter or prescription nonsteroidal anti-inflammatory drugs (NSAIDs) or other painkillers may be enough. Sometimes, however, nerve blocks or epidural steroid injections may be necessary.
In addition, physical therapy, including abdominal and core strengthening exercises, is often recommended to ease pain and improve mobility.
In rare instances, an adult with scoliosis may need to wear a back brace to support the spine. Because back braces can lead to muscle atrophy in older people, they are used to alleviate pain and other symptoms only in older people with severe scoliosis who cannot undergo surgery, for example, those with severe osteoporosis.
When Does Surgery Make Sense for Scoliosis?
Most adults with scoliosis don’t require surgery, although it may be considered if:
- the amount of spinal curvature is greater than 50 degrees
- the curvature progresses 5 degrees or more within one year and the curve is greater than 40 to 45 degrees
- pain is persistent and severe
- lung function is impaired because of the spinal curvature.
Because surgery for adult scoliosis is complex and carries a high risk of complications, it is usually considered only after all other options, such as medication and physical therapy, have been exhausted.
Spinal fusion is the main surgical procedure used to treat scoliosis in adults. This procedure involves using screws and rods in conjunction with a bone graft to fuse together two or more adjacent vertebrae. The bone graft may be made from tissue from your own body (autograft), cadaver bone (allograft), or from a biologically manufactured human bone protein that stimulates bone growth. Instrumentation, such as rods, screws, and other hardware, are attached to the spine to partially correct the curvature and to support the spine in order to allow the bones to fuse, providing long-term stability.
Following surgery for scoliosis, most individuals spend several days in the hospital, and they can expect to be mobile within about four weeks. However, because it can take three to six months for vertebrae to fuse completely, it’s best to avoid strenuous activity and heavy lifting until your doctor gives approval for these types of activities.
Low-impact exercise may be recommended, and some doctors advise their patients to consume foods high in calcium, such as dairy products, and to avoid smoking to promote bone formation at the fusion site.
Is Surgery in Adults Effective?
Because of the variety of back problems that can contribute to adult scoliosis and the wide range of surgical options, it’s difficult to make comparisons and determine surgical success rates. Nevertheless, recent studies suggest some benefit from surgery in adults.
A 2009 retrospective study of 83 scoliosis patients over age 65, reported in the journal Spine, found that individuals who were treated surgically had less pain, better quality of life, and were more satisfied with their treatment than patients who were not treated surgically. A review of 49 studies of scoliosis surgery in adults ranging in age from 25 to 75, published in the Journal of Neurosurgery, found that surgery for adult scoliosis reduced curvature of the spine and significantly improved disability.
Additionally, newer, minimally invasive surgical procedures show promise. A 2010 study in the Journal of Neurosurgery reported on minimally invasive correction and fusion in 25 adults (average age 63). The results at one year were similar to those seen with traditional open surgery.
Is Surgery for Adult Scoliosis Safe?
High rates of complications have been reported, especially when surgery involves fusion of two vertebrae or there are two curves instead of one. Complications are particularly common among older people and can include pneumonia, persistent pain, infection, and pseudarthrosis (movement at the fused site). In the Journal of Neurosurgery review, investigators found that complications occurred in 40% of the cases, including pseudarthrosis in 13 percent.
If you’re considering surgery for adult scoliosis, make sure you have a clear understanding of its risks and the benefits.