The Aging Spine

Scoliosis and Other Spine Deformities

Adult Idiopathic and Degenerative (De Novo) Scoliosis

Scoliosis (curvature of the spine) in the adult occurs for two reasons. The first is that it may be scoliosis that started when the patient was younger (adolescent idiopathic scoliosis). The degenerative or de novo type of scoliosis starts after age 40 and is thought to be the result of arthritis or degeneration of the spine, with changes in alignment due to degeneration of the discs and the facet joints. It is known that some of the curves that occur in a growing child will worsen as he or she progresses through adulthood. It has been suggested that curves of 50 degrees or more after skeletal maturity may worsen by an average of one degree per year. Curves of less than 30 degrees rarely worsen. This is otherwise known as the natural history, or what happens to the spine if no treatment is ever rendered. De novo curves may also progress a few degrees per year, particularly if there is osteoporosis and a sequential collapse of the vertebrae.

Symptoms and Diagnosis
Since both types of scoliosis can be associated with arthritis, many patients will have back pain and muscle fatigue, as well as possible leg pain. Larger curves (over 40 degrees) should be checked periodically for increase in curve magnitude. Worsening of the scoliosis and/or osteoporosis will cause loss of height along with the other symptoms previously mentioned. Evaluation involves the use of plain X-rays, MRI scans and possibly CT scan. These studies help identify abnormalities in the spine and around the nerve roots and spinal cord that may be associated with the spinal deformity.

Treatment
Treatment consists of non-steroidal anti-inflammatory medications for pain relief, physical therapy for improving overall function, and exercise to improve strength. If the medications and therapy do not work, steroid or local anesthetic injections in the muscle, joints, or spinal canal may be an option. Surgical treatment is frequently necessary if the curve increases or other symptoms worsen. The type of surgical procedure varies depending on the curve type and size. The most common surgery is a posterior spinal fusion with metal implants and bone graft (from the pelvis or the bone bank), with or without decompression of the nerve roots. Sometimes the surgery may need to be performed anteriorly (from the front of the spine) for better stability, correction, and healing. Occasionally, a combination of both anterior(front of the spine) and posterior(back of the spine) surgery is necessary to correct the problem. The hospital stay for such procedures depends on the type of procedure(s) done and the patient's overall condition. Many adults undergoing scoliosis surgery smoke or have medical conditions that may affect healing and recovery time. A brace is may be used after surgery. Details regarding return to normal physical and athletic activities, postoperative care, and other issues should be discussed with the patient's surgeon before surgery.

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