Adult Degenerative Scoliosis

What is Scoliosis?

Scoliosis is the lateral (sideways) curvature of the spine by 10 degrees or more. Adults can develop scoliosis because of tumors, multiple sclerosis, or other problems. Adult Degenerative Scoliosis (ADS) is a form of the disease in which vertebral rotation pulls the spine laterally, causing it to deviate from its normal position into an S-shaped or C-shaped curvature. This lateral curvature, which doctors call a deviation, deformity, or defect, can affect the entire spine or only a portion of it.
Degenerative scoliosis is often painful. If the curvature is severe enough, it can restrict lung expansion and compromise breathing. Other complications associated with spinal deformity can occur, too. For example, sometimes a vertebra in the affected segment slips sideways, a type of spondylolisthesis called lateral subluxation.

How Common is Adult Degenerative Scoliosis?

Researchers have tried to determine the percentage of adults with adult degenerative scoliosis in the United States. Their estimates vary widely, from 6% all the way up to 68%. As is often the case in estimating disease prevalence, a lot depends on how you define the disease.
One thing scientists can say for sure, though, is that the condition affects an equal number of men and women and is usually diagnosed around age 60 to 70.

Degenerative Scoliosis Causes

A vertebral bone typically has 4 facet surfaces on the back. These facets lie above and below the spiny part of the vertebra—the little knob you can see and feel beneath the skin. The two facets above are known as the superior facets, and the two below are the inferior facets, and the ligaments surrounding the joint work with the spinal musculature to keep the facets aligned so that their flat upper and lower surfaces meet up properly.

As we age, the facet joints and surrounding structures deteriorate, and cartilage wears away as we lose muscle and bone mass. Discs dry out and flatten, and ligaments calcify and lose their tautness. If structures on the right and left sides of the spine degenerate at different rates, the facet surfaces will be pulled off track, like gears that no longer mesh.

This degeneration of the spinal elements, along with the aging process, causes the spine to contort into an “S” or “C” shape instead of staying properly straight. This bend of the spine is left or right, not forward or back.

Degenerative Scoliosis Symptoms

Nearly all ADS patients have pain, particularly lower back pain and leg pain, especially when standing or walking (a symptom known as intermittent claudication). There can also be numbness and weakness in one or both legs. Unsteadiness or poor balance are also common. In some cases, the person who has degenerative scoliosis may feel an electric shock-like pain in one or both legs.

The pain of ADS tends to be diffuse — that is, generalized rather than located at a specific spot. You may feel that the pain radiates out in all directions from the center of the defect. Most patients also have pain caused by foraminal stenosis, or compression of the nerve roots, where they enter and exit the spine. The nerves must pass through small openings called foramen, which may be narrowed by the unusual configuration of the spine.

Symptoms of degenerative scoliosis can be more intense earlier in the day and subside throughout the day yet become worse as the person with degenerative scoliosis exerts too much energy or gets tired as the day goes on.

How is Degenerative Scoliosis Diagnosed?

The Scoliosis Research Society–Schwab spinal deformity classification system (2012) is widely used to categorize scoliosis according to its severity, location, direction, and cause.
To categorize your scoliosis accurately, your doctor will conduct a thorough physical examination, use imaging studies like an X-Ray or MRI, and create a comprehensive list of signs and symptoms based on the above items and a series of questions.

The Physical Examination

Your Inspired Spine doctor will review your medical history and perform a physical examination, where your doctor will ask questions like:

• Where is your pain located – in one leg, both legs, in your back, or elsewhere?
• What is the pain like – fast & fleeting, long-lasting, stabbing, dull, or constant?
• Are there any physical positions like standing, sitting, laying down that can subside the pain?

X-Rays & MRI

These images will give the orthopedist a direct view of the curve of your spine. They will be able to determine if you have degenerative scoliosis – and where you are in the progression of the abnormal curvature of the spine.

Based on the severity of the curvature and how it affects your daily life, the doctor will begin to create a recommended treatment path with a focus on being conservative. Many times, conservative degenerative scoliosis treatments can alleviate the pain you’re feeling without any surgery.

Conservative Degenerative Scoliosis Treatment Options

Once you’ve been diagnosed with ADS, IYR team at Inspired Spine will create a treatment plan based on your specific case. Depending on the severity of your pain, the ability to move, and the results from diagnostic tests, the following non-invasive treatments may be prescribed.

Physical Therapy

Physical therapy for ADS can restore lost muscle mass, which takes some of the burdens off lax ligaments, alleviates pain, and improves flexibility. Water aerobics or other aquatic therapy relaxes the back, improves body mechanics, and tones the back muscles. Modalities used to relieve the pain of ADS include massage, heat, ice, and a TENS unit to create controlled electrical nerve stimulation.

Medications

• Nonsteroidal anti-inflammatory drugs (NSAIDs): Nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen (Aleve) and ibuprofen (Advil), are useful in managing the pain of adult degenerative scoliosis. Muscle relaxants can be useful too.
• Antidepressants, anti-anxiety agents, and sleep aids can address the depression, stress, and sleeplessness often associated with ADS.
• Opioids: These prescription narcotic drugs relieve pain, and may be prescribed sparingly for degenerative scoliosis. If doctors and patients use them carefully and responsibly, opioids can be an effective supplement to your pain management plan, particularly in the postoperative period, and as you begin rehabilitation.

Degenerative Scoliosis Surgery

A degenerative disorder like ADS is, by definition, is progressive. In fact, the degree of curvature typically increases by about 3 degrees per year.4 If scoliosis begins to compromise your respiratory function, back surgery can halt the progression of the disease becomes even more urgent. Your age and the severity of your pain must be considered, too. Your doctor will help you decide when it’s time to schedule surgery.

Back Surgery & the Adult Spine

Correction of spinal curvature in an adult is more challenging than in a child, because the adult spine is more rigid, while a child’s spine is much more flexible and forgiving. In most cases, aside from its abnormal curvature, the spine of a young person with scoliosis has no other pathologic features—no disc degeneration, arthritis, calcification, bone spurs, or other unwelcome surprises.

However, in an adult spine, the surgeon must not only address the abnormal curvature, but also find workarounds for unrelated structural issues, such as bone spurs or fractures. Fortunately, most of these spinal conditions can be identified in advance with the aid of MRI or other imaging techniques. The surgeon can then account for them in his or her operative plan.

Co-Morbidities & Spinal Surgery

Your options for ADS surgery depend in part on the presence or absence of co-morbidities. The word “morbidity” simply refers to disease. A co-morbidity, then, is a coexisting, usually chronic disease that you have along with scoliosis. Patients who have diabetes, heart or kidney failure, and other severe comorbidities are at higher risk than those with no serious health problems.

Is Minimally Invasive Spinal Surgery an Option for Degenerative Scoliosis?

Minimally invasive spinal (MIS) surgical procedures reduce the surgical risk dramatically and spare you the lengthy, grueling recovery that used to do hand in hand with scoliosis correction. Fortunately, even patients with significant co-morbidities can usually undergo MIS back surgery at Inspired Spine. These revolutionary, minimally invasive spinal procedures reduce surgical risk dramatically and spare you the lengthy, grueling recovery that used to go hand in hand with scoliosis correction.

At Inspired Spine, the spinal surgeon reaches the vertebrae and surrounding structures through an incision no larger in diameter than a dime. A tube is then inserted through this opening, creating a tunnel through which surgical instruments can be passed. These instruments go straight to the spine through this canal, without cutting through the overlying musculature.

Once there, the spinal surgeon guides the instruments using magnified fluoroscopic images. This is a much faster, cleaner spinal surgery than traditional back surgery would allow. It also creates less blood loss during the procedure and shorter hospital stay. Most patients recover quickly and can then walk or bend or sit without pain, perhaps for the first time in years.

Call Inspired Spine today at (952) 225-5266 to speak with one of our Patient Care Coordinators.