Adult scoliosis comes in two basic types:
- “De novo” scoliosis - curves that begin after skeletal maturity. This is usually due to arthritis.
- Progression of an adolescent curve.
Although many patients hope their curves will stop growing when they are fully grown, this is usually not the case. The rate of curve progression certainly decreases. However, curves can increase 0.5-2 degrees per year. This may seem like a small amount, but it can add up over a 20 year period!
The main reason patients come in for evaluation is pain - either in the spine or the legs. Low back pain can be common in all adults. However, pain over a scoliotic hump is usually due to the scoliosis itself. Pain down the legs can occur if arthritis pinches a nerve causing sciatica.
Treatments are tailored to the symptoms patients are experiencing. If thoracic or lumbar back pain is the primary problem, a combination of physical therapy, acupuncture, and chiropractic modalities can be helpful. Biomechanical studies demonstrate that the spine itself can only support a small amount of weight - it depends on the surrounding muscles for support.
If leg pain is the primary complaint, we typically begin with the plan listed above, and add epidural steroid injections if we can isolate the pain generators on imaging studies.
Surgery is only necessary if everything else fails. Dr. Rinella tells patients that he never has to convince them when it is time for surgery - the patients always know. In more severe curves that require surgery, exercise programs will only keep the pain away for so long.
For more information about adult scoliosis, please read Dr. Rinella’s chapter on Adult Scoliosis and Kyphosis.
Scoliosis can be detected on physical exam, especially when patients bend forward. The key component of scoliosis is rotation, so the spine shows rotational differences when comparing one side to the other. The shoulders may become angulated, and the body may shift to the side, depending on the size and location of the curve. When there is pain in the front or back of the legs, an MRI of the lumbar spine can be helpful to detect where the nerves are being pinched.
