Adult scoliosis

You may remember going to a healthcare provider in your school to be examined for scoliosis. Most people believe that only small children and adolescents can develop scoliosis, which isn’t true. Adults can also get diagnosed with this condition - this isn’t anything new, but it still needs proper recognition. 

Are treatments for scoliosis in adults and adolescents the same? No, they aren’t treated the same way. This blog is written to educate people regarding adult scoliosis. Read on and gain knowledge on the same. 

Adult scoliosis

What Is Adult Scoliosis?

Scoliosis is generally known as an adult deformity. It is characterized as an unusual curvature of the spine. The spine is inherently curved, but people with scoliosis have curves that cause it to twist from side-to-side in an abnormal “S” or “C” shape. Any curve over 20 - 25 degrees is believed to be abnormal. 

In children and adolescent patients, the deformity is usually painless. It causes more of a cosmetic problem, but adult patients with scoliosis may seek medical assistance because of pain and neurologic dysfunction.

What Causes Adult Scoliosis? 

In some cases, scoliosis can be hereditary or the consequence of past trauma. The prime cause of the adult deformity is natural wear-and-tear or aging, as well as degenerative arthritis within the joints of the spine.

As a result of natural degeneration and arthritis, mild scoliosis is quite common in older age. However, for a few patients, the deformity can advance and develop into spinal stenosis where nerves start to get pinched.

The main symptom of scoliosis is a pain in the legs caused due to these pinched nerves, along with low-back pain. Some people may not experience any symptoms. To confirm the diagnosis of scoliosis, doctors use MRI and X-ray imaging.

What Section Of The Spine Curves In People With Scoliosis?

The spine of scoliosis patients can curve in any of the following three sections:

  • cervical spine (neck)
  • thoracic spine (chest and upper back region)
  • lumbar spine (lower back)

What Are The Symptoms Of Adult Scoliosis?

The most common symptom of adult scoliosis is pain and, sometimes, an evident bulge on the back at the location of this pain. Less frequently, people may experience a loss of height, fatigue, or a sense of fullness when, in fact, the stomach is actually empty. 

Common symptoms

Pain: Adults with scoliosis usually experience pain, which causes them to seek medical assistance. Pain could be related to the curve itself or as a result of compression of the spinal nerves. 

There is also muscular fatigue allied pain because of muscles on the convex side, functioning harder to sustain postural balance. In contrast, the concave muscles are mechanically injured to work normally. This causes fatigue and failure, particularly after activities on the convex side. When there is nerve compression, this is known as spinal stenosis. Stenosis can cause inflammation in nerves, which, in turn, leads to leg pain and weakness or numbness when walking or standing for an extended duration.

Deformity or bulge in the back: Patients can generally spot the location of their back pain, and a bulge may be noticeable because of rib cage rotation or muscle rotation. Asymmetry in the trunk as it associates with the pelvis can be marked. There can also be an incapability to stand upright.

Other Symptoms

  • Loss of height (stature)
  • Rapid fatigue or shortness of breath - This impacts patients with huge and progressive curves (more than 70 degrees) that contract the lungs.
  • Feeling fuller too soon (Hunger satiety) - It affects people with advanced, thoracolumbar curves (curves that range to the thoracic and lumbar sections of the spine). Corresponding pressure on the abdomen can make an individual feel full while eating, although the stomach itself may not be actually complete.

How Is Adult Scoliosis Diagnosed?

If adult scoliosis is suspected, the doctor will need to know about your medical history. He may ask questions about:

  • Date when you first observed changes in your spine
  • Curve progression (evaluated from earlier X-rays, if available)
  • Presence and site of pain, if any.
  • Any bladder, bowel, or motor dysfunction, which may be a warning sign of more serious nerve damage or pressure resulted due to scoliosis
  • Family history

In a physical exam, the doctor will examine your back to review your spine's shape and see how you walk around. He may also test your nerves through sensation, reflex, and muscle-strength checks.

If required, your doctor can recommend X-rays. X-rays taken from the front and side will display a comprehensive image of your spine. Your doctor can then ascertain whether you have scoliosis and, if so, to what extent.

Also Read: Chiropractic - The Art of Controlling your Spine

How Can Adult Scoliosis Be Treated?

Conservative Treatment

Most adult scoliosis cases could be managed nonoperatively through frequent screening by a healthcare specialist, over-the-counter pain medicines, and core-strengthening exercises to reinforce your back and abdomen and enhance flexibility. If you are an active smoker, it’s essential that you quit this habit of yours soon. Smoking has been shown to accelerate the degenerative process.

In most cases, your doctor will suggest some kind of physical therapy to preserve strength and ease pain. These may include the following:

  • Staying active
  • Working to improve posture
  • Daily stretching
  • Performing low-impact exercises, such as swimming

If pain is not managed with oral medicines or physical therapy, your healthcare specialist may suggest epidural or nerve block injections for better relief.

Surgery

Types of surgery

One of the most common types of spinal surgery used in treating adult scoliosis is spinal fusion. During this procedure, the spine is consolidated to bone grafts or substitutes to keep the spine in a straighter position. Fusion is generally included in other surgical procedures, including:

  • Decompression fusion: Pressure is managed by removing tissues or nerves pushing on the spine, succeeded by fusion. This procedure is usually performed when the deformity is not that serious, and the priority is to ease symptoms from spinal stenosis (or leg pain).
  • Surgical stabilization: If scoliosis tends to be more severe, rods and screws can be joined to the spine, which is then interconnected by means of metal rods, succeeded by fusion.
  • Osteotomy: Osteotomy is the surgical incision of a bone. The surgeon cuts vertebrae to allow the spine to be bent into the required position and then consolidated into place. This procedure is done when the deformity needs to be corrected beyond what screws and rods can accomplish.
  • Vertebral column resection: In this, complete sections of vertebrae are removed, followed by a restructuring of the spine by osteotomy and then fusion. This procedure is done only in case of very severe deformity and can have a higher complication rate.  

Surgery is required in a few cases of adult scoliosis. This treatment is usually the last alternative because of the increased risk of complications from spinal surgery. The doctor can recommend surgery due to the following reasons:

  • Pain: Surgery may be required when back and leg pain resulting from scoliosis becomes severe and progressive, and doesn’t get handled with any kind of conservative treatment.
  • Spinal imbalance: Whether the spine remains balanced is significant in monitoring scoliosis progression and the requirement for surgery. When we stand, the head should be balanced with the pelvis's center when observing from the front and above the hip joints when looking from the side. If the curve advances to the point that doing this is no more possible for you, patients will eventually progress and have excessive pain and disability.

Surgery is required to enhance the quality of life. Although surgery is not suggested only to improve appearance, certain people find their spinal deformity symptoms intolerable. Their spinal imbalance also impacts primary function and the entire quality of life. Surgery is the only way out in such cases.

In younger adults, cosmetic deformity could be a primary factor in opting for the surgery, but this is not generally the case in older adults. There is a wide range of spinal surgical options based on each case. Usually, surgical procedures are developed to support the spine, regain balance, and ease the nerves' strain. Spine stabilization surgery joins the spine's bones together, utilizing bone grafts and then metallic implants to maintain the spine in place.

How Can You Prevent Adult Scoliosis?

Unfortunately, there's no way to prevent adult scoliosis cannot be prevented. In individuals with idiopathic scoliosis, the cause of the condition is uncertain. Degenerative scoliosis occurs over the years as the body ages. It is significant to keep up with a routine low impact aerobic and core strengthening exercise program.




Sources:

https://www.hss.edu/

https://my.clevelandclinic.org/

https://www.srs.org/

https://brighamhealthhub.org/

https://www.spine-health.com/