Conditions Treated: Adult Idiopathic Scoliosis

Adult idiopathic scoliosis is, in essence, a continuation of adolescent idiopathic scoliosis. Sometimes a spine curvature of an idiopathic (cause not known) nature that began during teenage years may progress during adult life. Curves may increase in size 0.5° to 2° per year. Adolescent curves less than 30° are unlikely to progress significantly into adulthood, while those over 50° are likely to get bigger, which is why adult scoliosis specialists should monitor the curves over time.

Occurs in the thoracic (upper) and lumbar (lower) spine, with the same basic appearance as that in teenagers, such as shoulder asymmetry, a rib hump, or a prominence of the lower back on the side of the curvature. Curves can worsen in the older patient due to disc degeneration and/or sagittal imbalance. Additionally, arthritis commonly affects joints of the spine and leads to the formation of bone spurs.

Adults with idiopathic scoliosis have more symptoms than teens because of degeneration in discs and joints leading to narrowing of the openings for the spinal sac and nerves (spinal stenosis). Some patients may lean forward to try and open up space for their nerves. Others may lean forward because of loss of their natural curve (lordosis, sway back) in their lumbar spine (low back). The imbalance causes the patients to compensate by bending their hips and knees to try and maintain an upright posture. Adult patients may have a variety of symptoms, which can lead to gradual loss of function:

• Low back pain and stiffness are the 2 most common symptoms
• Numbness, cramping, and shooting pain in the legs due to pinched nerves
• Fatigue results from strain on the muscles of the lower back and legs

Scoliosis defined with radiographs that can include the following:

• Standing x-ray of the entire spine looking both from the back as well as from the side so your physician can measure the radiographs to determine curve magnitude, measured in degrees using the Cobb method.
• Magnetic resonance imaging (MRI) study of the spine is rarely used for patients experiencing minimal symptoms with adult idiopathic scoliosis. An MRI is usually ordered if you have leg pain, your physician finds some subtle neurologic abnormalities on physical examination, or if you have significant pain or an "atypical" curve pattern.

The majority of adults with idiopathic scoliosis do not have disabling symptoms and can be managed with simple measures including the following:

• Periodic observation
• Over-the-counter pain relievers
• Exercises aimed at strengthening the core muscles of the abdomen and back and improving flexibility
• Braces, in short-term use for pain relief (long-term use in adults is discouraged because braces can weaken the core muscles)
• Epidurals or nerve block injections for temporary relief if the patient has persistent leg pain and other symptoms due to arthritis and pinched nerves. Patients should track their response to the various injections to help define their pain generators.

Stronger pain medications can also be habit-forming and must be used with caution. If narcotics are needed to control the pain, see a scoliosis surgeon to learn more about the possible causes of pain.

Surgical treatment is reserved for patients who have:

• Failed all reasonable conservative (non-operative) measures.
• Disabling back and/or leg pain and spinal imbalance.
• Severely restricted functional activities and substantially reduced overall quality of life.

The goals of surgery are to restore spinal balance and reduce pain and discomfort by relieving nerve pressure (decompression) and maintaining corrected alignment by fusing and stabilizing the spinal segments. When patients are carefully chosen and mentally well-prepared for surgery, excellent functional outcomes can be achieved which can provide positive life-changing experience for a given individual patient. When larger surgeries—those greater than 8 hours—are necessary, surgery may be divided into 2 surgeries 5 to 7 days apart. Surgical procedures include:

• Microdecompression relieves pressure on the nerves; A small incision is made and magnification loupes or a microscopic assists the surgeon in guiding tools to the operation site. This type of procedure is typically used only at one vertebra level, and carries a risk of causing the curve to worsen, especially in larger curves >30 degrees.
• Surgical stabilization involves anchoring hooks, wires or screws to the spinal segments and using metal rods to link the anchors together. They stabilize the spine and allow the spine to fuse in the corrected position.
• Fusion uses the patient's own bone or using cadaver or synthetic bone substitutes to "fix" the spine into a straighter position
• Osteotomy is a procedure in which spinal segments are cut and realigned
• Vertebral column resection removes entire vertebral sections prior to realigning the spine and is used when an osteotomy and other operative measures cannot correct the scoliosis.