Scoliosis is an abnormal side-to-side curvature of the spine. It is defined as a spinal curvature in the “coronal” (frontal) plane and can be seen when viewing the spine from the front or back.
The spine’s normal curves occur at the cervical, thoracic as well as in lumbar regions in the so-called “sagittal” plane. These curves can be seen when viewing the spine from the side. These natural curves position the head over the pelvis and work as shock absorbers to distribute mechanical stress during movement.
Scoliosis is generally associated with children, but adults can have it, too. Most adults with scoliosis can be divided into the following categories:
- Adult scoliosis patients who were surgically treated as adolescents
- Adults who did not receive treatment when they were younger
- Adults with a type of scoliosis called degenerative scoliosis
Scoliosis may cause the patient’s shoulders, rib cage and pelvis to lack symmetry. An asymmetric pelvis can lead to trunk imbalance and may make the patient appear to be listing to one side. Scoliosis can cause rib prominence on one side and leg length discrepancy, which often results in gait dysfunction.
Pain, difficulty sitting or standing, stiffness and spinal rigidity are often associated with scoliosis. Back pain is the primary complaint. Pain is more common and severe in the lumbar spine. When the pain is thoracic, rest often alleviates it. In severe cases the patient may have cardiopulmonary and/or neurological symptoms as well.
PA (posterior-anterior, back-front), lateral (side) and bending x-rays are almost always required.
Most adult patients require an MRI so the surgeon can visualize the lumbar (low back) discs. Patients with congenital scoliosis, under age 10, unusual curve patterns, rapidly worsening curvature, severe back pain or neurological symptoms, neurofibromatosis (nerve tumors) or other tumors are sent for MRI.
Myelogram and CAT Scan
These tests tell the surgeon much about the patient’s nerves, spinal cord and bones using dye to outline the nerve structures.
Conservative non-surgical treatment may include exercise, moist heat and medication for pain and inflammation. Occasionally, spine injections can help alleviate or reduce pain in the adult scoliosis patient. Bracing is rarely used to help control pain. It will not correct or cure scoliosis.
Most patients with adult scoliosis do not require surgery. Surgery may be considered if any of the following exist:
- Thoracic (mid-back) curve greater than 50 degrees with persistent pain
- Progressive thoracolumbar (mid- and low-back) curve
- Lumbar (low-back) curve with persistent pain
- Decreased cardiopulmonary (heart and lung) function due to thoracic curve
- Appearance, deformity
Pain control is the usual reason for surgery for scoliosis in adults. The spinal surgeon decides the procedure(s) that will provide the most benefit to the patient.
Surgical intervention may include the removal of an intervertebral disc combined with spinal instrumentation and fusion. Spinal instrumentation utilizes rods, bars, wires, screws, and other types of medically designed hardware. Combined with fusion, instrumentation stabilizes spinal segments, enhances fusion and provides a more permanent solution. These procedures may enable the patient to sit upright thereby reducing the risk for cardiopulmonary complication and possibly increasing mobility. This type of surgery can be performed safely on adults with spinal deformity, usually with good results.