ADULT SCOLIOSIS: TYPES, LATEST ADVANCEMENTS, LIVING WITH, AND MORE

Medically Reviewed by Dr. Sony Sherpa (MBBS) and Updated on July 01, 2024

Adult scoliosis is an abnormal lateral curvature of the spine that is either a continuation of adolescent scoliosis into adulthood or a condition that develops after skeletal maturity. The curvature is often S-shaped or C-shaped, and while it can occur in any part of the spine, thoracic scoliosis and lumbar scoliosis are most common. A leftward curve is termed levoscoliosis, whereas a rightward curve is called dextroscoliosis.

The primary difference between adult scoliosis and childhood or adolescent scoliosis lies in the cause and progression of the condition. In children, scoliosis often occurs due to unknown reasons, termed idiopathic, and is closely monitored for progression during growth spurts.

In adults, scoliosis can stem from the worsening of an idiopathic condition that began in childhood. It can also develop without a history of scoliosis, due to age-related spinal degeneration, known as de novo scoliosis.

Prevalence and Age of Onset

Adult scoliosis affects a significant portion of the adult population, with estimates suggesting that up to 60% of people over the age of 60 may have some degree of scoliosis. The condition can occur at any age in adulthood, but de novo scoliosis typically begins to manifest in people 50 years of age and older.

Scoliosis Types and Causes

Scoliosis can broadly be categorized based on its cause: idiopathic, degenerative, and iatrogenic or post-surgical scoliosis. Each type has distinct characteristics, causes, and potential treatments.

Idiopathic Scoliosis

Idiopathic is the term used when the exact cause of scoliosis is unknown. This type often originates in childhood or adolescence but may not become apparent or symptomatic until adulthood.

This condition can remain undetected till adulthood, when the symptoms may prompt a medical evaluation leading to the diagnosis. The prognosis for idiopathic scoliosis in adults depends on multiple factors, including the degree of curvature at the time of diagnosis, whether the curve is progressing, and symptoms such as pain or mobility issues.

Adult Degenerative Scoliosis

Adult degenerative scoliosis, or adult-onset scoliosis, is a type of Adult Spine Deformity (ASD) that occurs due to age-related spinal wear and tear. This is primarily seen in people over 50 and is associated with declining bone density, osteoporosis, spondylosis (spinal osteoarthritis), and spinal stenosis (narrowing of the spinal canal).

These conditions weaken the spine's structures, including the vertebrae and the discs between them, contributing to the development of spinal curvature. The degree of curvature in degenerative scoliosis can vary significantly among people and can influence the choice of treatment.
Degenerative scoliosis can be classified as:

• Primary Degenerative Scoliosis: This form develops as a primary condition in adulthood without a prior history of scoliosis, largely due to age-related spinal degeneration.
• Secondary Degenerative Scoliosis: Occurs as a progression of pre-existing adolescent idiopathic scoliosis into adulthood, further complicated by degenerative changes in the spine.

Iatrogenic Scoliosis / Post-surgical Scoliosis

Iatrogenic scoliosis refers to a curvature of the spine that arises after spinal surgery or other medical interventions. This can occur when surgical procedures alter the anatomy or biomechanics of the spine in a way that leads to an imbalance, causing the spine to curve. It can also occur after significant spinal injuries that damage the vertebral structures or disrupt the spine's alignment.

Risk factors

Age

Age is a significant risk factor for scoliosis, especially for the development of degenerative scoliosis. As people age, the likelihood of experiencing degenerative changes in the spine increases, making older adults particularly susceptible to developing scoliosis.

Family History

Genetics is a crucial factor in the development of scoliosis. Those with a family history of scoliosis are at a higher risk of developing the condition themselves. This genetic predisposition is particularly relevant for idiopathic scoliosis. The specific genetic factors and mechanisms involved are still under investigation, but the familial trend is well-documented.

Gender

Females have an elevated risk of developing the condition and experiencing progression of the curve. Women are also more prone to degenerative scoliosis, partly due to the higher incidence of osteoporosis, which can contribute to the degenerative changes that lead to scoliosis.

Lifestyle factors

A sedentary lifestyle, poor nutrition, and smoking can also contribute to bone health deterioration and increase the risk of scoliosis.

Scoliosis Symptoms in Adults

Adult scoliosis can present a range of symptoms, varying greatly in severity based on the degree of curvature, location, and individual health factors. The most common symptoms include:

• Back pain
• Radicular symptoms such as pain, numbness, and weakness caused by nerve compression
• Uneven shoulders or hips
• Visible curvature of the spine
• Visible rib cage prominence or rib humping
• Difficulty standing straight
• Shortness of breath
• Premature feeling of fullness in the stomach (early satiety)
• The body leans to one side

What Happens if Scoliosis Is Left Untreated in Adults?

If adult scoliosis is left untreated, the condition can deteriorate into worsening symptoms and complications, including:

• Progression of Curvature: Without treatment, the spinal curvature may worsen, leading to more pronounced physical deformity and increased pain.
• Chronic Pain: Ongoing discomfort and pain can become a significant issue, affecting mobility, posture, and quality of life.
• Difficulty Breathing: In severe cases, the curvature can compress the chest cavity and affect lung function.
• Neurological Problems: Though rare, severe nerve compression can lead to issues such as numbness, weakness, and in extreme cases, paralysis.
• Compromised Organ Function: Severe curvature can impact the positioning and function of internal organs, including the lungs and heart, leading to additional health issues.

Early detection and treatment can considerably improve the prognosis by managing symptoms and preventing further curvature progression.

Diagnosis

Diagnosing adult scoliosis involves a comprehensive approach that considers aspects such as the degree of curvature, the presence of spinal stenosis, the potential impact on lung function, and the patient's overall health and mobility.

• History and Physical Examination
• Scoliosis Screening Tests: Adam’s Forward Bend Test, where the patient bends forward at the waist, allowing the healthcare provider to observe the spine from behind for any abnormal curvature or rib hump.
• X-rays
• Low-Dose Radiation EOS
• MRI Scans

Adult Scoliosis Treatment

Non-Surgical Treatments for Adult Scoliosis

For many adults with scoliosis, non-surgical treatment options can effectively manage symptoms and improve quality of life. Treatment choices depend on factors such as the severity of the curvature, symptoms, and overall health.

• Observation
• Physical Therapy
• Bracing
• Over-the-counter or prescription medications
• Spinal Injections
• Adult Scoliosis Exercises
• Smoking Cessation

Surgical Treatment for Adult Scoliosis

Surgery may be considered for adults with scoliosis when:

• The spinal curvature is severe or worsening, causing significant pain or functional limitations
• There is evidence of nerve compression leading to numbness, weakness, or coordination problems
• Non-surgical treatments have not provided sufficient relief

Differences in Surgical Approach for Adult Scoliosis

The surgical approach for adults differs from that in pediatric cases mainly due to factors such as spinal degeneration, the presence of other health conditions, and less flexibility in the spine, making the surgery more complex.

Types of Scoliosis Surgery

Core Surgical Procedures

A comprehensive suite of surgical options is offered to restore spinal integrity and functionality:

• Osteotomies: These are performed to correct spinal alignment through the targeted removal or cutting of bone.
• Decompression Procedure: Designed to relieve pressure on spinal nerves, reducing pain and improving mobility.
• Spinal Fusion: A key procedure that fuses two or more vertebrae to stabilize the spine and prevent further curvature, utilizing autografts (patient’s own bone), allografts (donor bone), implant cages, and lumbar interbody fusions.
• Disc Arthroplasty: This involves replacing diseased or degenerated discs with artificial ones to maintain spine mobility.
• Percutaneous Vertebroplasty: This procedure stabilizes fractured vertebrae through the injection of bone cement.

• Minimally Invasive Spinal Corrections: This category encompasses spondylodesis for early joint release, percutaneous myofasciotomy, and muscle replacement surgeries. Procedures are also available for correcting bony changes in legs and feet, axis corrections, and performing both bony and soft tissue hip surgery.

• Focused Spinal Corrections: Selective thoracic fusion is utilized for short-range spinal corrections alongside a 3D derotation system for accurate spinal adjustments.

Latest Advancements in Adult Scoliosis Treatment

The landscape of adult scoliosis treatment is rapidly evolving, with new technologies and surgical techniques offering more options for patients seeking relief from their symptoms. These advancements aim to reduce recovery times, minimize surgical risks, and improve overall outcomes. Below is an overview of some of the latest advancements in the treatment of adult scoliosis:

Minimally Invasive Surgical Techniques

• APiFix: A less invasive alternative for correcting scoliosis, the APiFix system involves a shorter surgical procedure and significantly reduced recovery time. It is particularly suitable for patients with less severe curvatures who are looking for a quicker return to daily activities.
• Minimally Invasive Lumbar Decompression (MILD): This technique is designed to treat spinal stenosis (a common issue in adults with scoliosis) by removing small amounts of bone and soft tissue to relieve pressure on the spinal nerves, often through small incisions with minimal disruption to surrounding structures.
• Video-Assisted Thoracoscopic Surgery (VATS): VATS allows surgeons to perform procedures on the thoracic spine with minimal disruption to the chest and back muscles. This approach is beneficial for correcting certain types of spinal deformities with less pain and a shorter recovery period.

Vertebral Body Tethering (VBT)

While traditionally used in pediatric patients, VBT is gaining attention for its potential in select adult cases. This technique involves placing a flexible cord along the side of the spine to gradually correct curvature while preserving spine mobility, potentially offering an alternative to traditional fusion surgery for some adults.

Motion-Preserving Implants

Interspinous Process Distraction (IPD) Devices are designed to alleviate pressure on spinal nerves caused by spinal stenosis, a condition that can exacerbate scoliosis symptoms. By maintaining space between the vertebrae, these devices can help ease pain and improve function without the need for more invasive procedures.

3D Printing

The use of 3D printing in spinal surgery enables the creation of custom implants and surgical tools tailored to the patient's anatomy. This precision can improve the fit and effectiveness of implants, potentially leading to better surgical outcomes and reduced risk of complications.

Neuromodulation Therapy

Neuromodulation therapy, including spinal cord stimulation, can be effective in treating chronic pain associated with scoliosis. By delivering electrical impulses to particular areas of the spinal cord, this therapy can help manage pain in patients unresponsive to other treatments.

Newer Pain Management Options

Advancements in pharmacological treatments and pain management techniques offer new hope for managing chronic pain associated with adult scoliosis. These include novel medications, targeted nerve blocks, and comprehensive pain management programs.

Living with Adult Scoliosis

Living with adult scoliosis involves navigating daily activities while managing symptoms and maintaining a healthy lifestyle to prevent the condition from worsening. Here is a guide on how to live with adult scoliosis, including recommended activities, pain management strategies, and addressing common questions.

Exercises for Scoliosis in Adults

Regular exercise is crucial for people with adult scoliosis, as it helps strengthen the muscles supporting the spine, maintains flexibility, and can improve posture. However, it is essential for those with scoliosis to consult a doctor before incorporating any exercises.

Focus on low-impact activities such as:

• Swimming and water aerobics, which reduce stress on the spine
• Walking, which promotes spinal health without excessive impact
• Pilates and yoga, which can increase core strength, flexibility, and awareness of spinal alignment. However, some positions may need to be modified or avoided
• Cycling, either stationary or on gentle terrain, to maintain cardiovascular health with minimal spinal stress.

Activities to Avoid

Certain activities can exacerbate scoliosis symptoms or contribute to the progression of the curvature. It is generally recommended to avoid:

• Heavy weight lifting
• High-impact sports
• Activities that involve twisting the spine or asymmetric loading

Pain Management Strategies

Managing pain is a critical aspect of living with adult scoliosis. Some effective strategies include:

• Regularly scheduled physical therapy sessions to address specific muscle imbalances and alignment issues
• Use of heat and cold therapy to soothe muscle pain and reduce inflammation
• Over-the-counter or prescription medications, as advised by a healthcare provider

FAQs

How Should a Person with Scoliosis Sleep?

The best sleeping position for someone with scoliosis is typically on the back with a pillow under the knees or on the side with a pillow between the knees. This can help maintain natural spinal alignment and reduce strain. A supportive mattress that conforms to the spine's natural curvature is also recommended.

What Positions Should a Person with Scoliosis Avoid?

People with scoliosis should generally avoid sleeping on the stomach, as this position can place additional stress on the spine. Avoiding extreme spinal flexion, extension, or rotation in daily activities and intense exercises can also be beneficial in preventing discomfort and worsening symptoms.

How Fast Can Scoliosis Get Worse in Adults?

The rate at which scoliosis worsens in adults can vary. In many cases, the progression is slow and may take years to become noticeably worse. However, factors such as severe degeneration, osteoporosis, and significant initial curvature can accelerate progression.

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