Scoliosis
Scoliosis refers to an unusual bending of the backbone, resulting in a curved shape. Normally, the spine has a natural curvature in the forward and backward directions. However, scoliosis causes the spine to twist and form a sideways curve. The severity of these curves can range from as little as 10 degrees to more than 100 degrees.
Types
Adult scoliosis can be classified into different types based on its underlying causes and characteristics. The main types of adult scoliosis include:
- Adult Idiopathic Scoliosis: This refers to scoliosis that persists or develops in adulthood without a clear underlying cause. It may be a continuation of adolescent idiopathic scoliosis or can arise later in life.
- Degenerative Scoliosis: Also known as de novo scoliosis, this type occurs as a result of degenerative changes in the spine due to aging, such as disc degeneration, osteoporosis, or spinal stenosis. It typically affects older individuals.
- Postural Scoliosis: Postural scoliosis is a non-structural type of scoliosis that is caused by poor posture, muscle imbalances, or habitual asymmetrical positioning. It can be corrected by addressing postural habits and strengthening the supporting muscles.
- Secondary Scoliosis: Secondary scoliosis occurs as a result of an underlying condition or factor. It can be associated with factors such as trauma, previous spine surgery, neuromuscular disorders (e.g., cerebral palsy), connective tissue disorders (e.g., Ehlers-Danlos syndrome), or spinal tumors.
- Iatrogenic Scoliosis: Iatrogenic scoliosis is a type of scoliosis that develops as a result of medical interventions, such as spinal surgery, radiation therapy, or prolonged immobilization.
It’s important to note that adult scoliosis can also be a combination of different types or have overlapping characteristics. The specific type of adult scoliosis helps guide treatment decisions and management strategies based on the underlying cause and individual needs.
Causes
of Scoliosis
The causes of adult scoliosis differ depending on the specific type of scoliosis. Degenerative scoliosis, which occurs as the spine undergoes age-related changes, is the most common form of adult scoliosis. In some cases, adult scoliosis may be a previously undetected case of scoliosis that originated during childhood or adolescence. There are instances where adolescent scoliosis manifests symptoms later in life due to aging and necessitates treatment. Idiopathic scoliosis, which arises from an unknown cause, is typically identified during childhood or adolescence while the spine is still growing. When it emerges or is identified after reaching puberty, it is referred to as adult idiopathic scoliosis, as the curvature is detected after the completion of skeletal growth.
Symptoms
of Scoliosis
The majority of adults with scoliosis do not experience noticeable symptoms, although they may develop pain over time. Back pain can arise due to various factors such as arthritis, difficulty maintaining an upright posture, or weakened core muscles and decreased physical fitness. If there is pressure on the nerves in the lower back (lumbar spine), it may lead to leg pain, numbness, or weakness.
In certain instances, individuals with adult scoliosis may undergo changes in their body, including a reduction in height and an uneven alignment of the pelvis and hips.
Complications
of Scoliosis
If left untreated, the scoliosis can potentially lead to several complications, including:
Increased pain and discomfort: The spinal curvature in scoliosis can cause strain and pressure on the surrounding muscles, ligaments, and nerves. Over time, this can result in chronic pain and discomfort in the back and other affected areas.
Reduced mobility and flexibility: Scoliosis can lead to stiffness and reduced range of motion in the spine, making it difficult to perform daily activities or participate in physical exercise.
Spinal imbalance and deformity progression: Without intervention, scoliosis curves may continue to progress and worsen over time. This can result in a more pronounced spinal imbalance, leading to changes in posture and appearance.
Breathing difficulties: In severe cases of scoliosis where the curvature affects the chest cavity, it can restrict lung expansion and compromise respiratory function. This can lead to shortness of breath and respiratory complications.
Digestive and cardiovascular issues: Severe spinal curvature can also compress the abdominal organs, leading to digestive problems such as difficulty in eating and digestion. Additionally, cardiovascular function may be affected due to compromised space within the chest cavity.
Psychological impact: The visible deformity and chronic pain associated with untreated scoliosis can have a negative impact on a person’s self-esteem, body image, and overall psychological well-being.
Nerve compression and neurological symptoms: In some cases, the spinal curvature can lead to compression of nerves, resulting in symptoms such as radiating pain, numbness, tingling sensations, and muscle weakness in the arms or legs.
It is important to note that the progression and severity of complications can vary among individuals and depend on factors such as the degree of curvature, age, overall health, and individual circumstances. Early detection and appropriate treatment can help mitigate these potential complications and improve long-term outcomes
Diagnostics
of Scoliosis
In order to develop a treatment plan for suspected adult scoliosis, your doctor will first need to gather relevant information by conducting a comprehensive history assessment. This may involve asking questions regarding:
- Family history: Inquiring about any instances of scoliosis or spine-related conditions among your family members.
- Onset of symptoms: Determining the date when you initially noticed changes in your spine or related symptoms.
- Progression of the curve: Assessing the progression of the spinal curvature by reviewing any available previous X-rays.
- Pain assessment: Inquiring about the presence and location of any pain or discomfort you may be experiencing.
- Neurological symptoms: Checking for any signs of bowel, bladder, or motor dysfunction, as these can indicate potential nerve damage or pressure resulting from scoliosis.
During a physical examination, your doctor will thoroughly examine your back to assess the shape of your spine and observe your range of motion. Additionally, nerve function tests, such as reflex, sensation, and muscle-strength checks, may be conducted.
If deemed necessary, your doctor may order X-rays. These X-rays, taken from both the front and side angles, provide a comprehensive view of your spine, enabling your doctor to confirm the presence of scoliosis and determine the degree of curvature.
Treatment
of Scoliosis
Non-surgical Treatment:
The majority of adult scoliosis cases can be managed without surgery through conservative measures, which involve regular monitoring by a doctor, over-the-counter pain medications, and exercises that focus on strengthening the core muscles of the abdomen and back while improving flexibility. It is important to quit smoking, as it can accelerate the degenerative process. In most cases, physical therapy will be recommended to maintain strength and alleviate pain. This may involve working on improving posture, engaging in low-impact exercises like swimming, performing daily stretching exercises, and staying physically active. If oral medications and physical therapy do not provide sufficient pain relief, the doctor may suggest epidural or nerve block injections for more effective pain management.
Surgical Treatment:
Surgery is reserved for cases of adult scoliosis where non-surgical interventions have proven ineffective or the condition has significantly worsened. However, surgery is considered a last resort due to the potential risks and complications associated with spinal surgery. The decision for surgery may be based on the following factors:
- Pain: Surgery may be necessary if the back and leg pain caused by scoliosis becomes severe and persistent, and does not respond to conservative treatment.
- Spinal imbalance: The balance of the spine is crucial in assessing scoliosis progression and the need for surgery. When standing, the head should be aligned over the center of the pelvis when viewed from the front and over the hip joints when viewed from the side. If the curve progresses to the extent that this balance cannot be maintained, it can lead to increased pain and functional limitations over time.
- Quality of life improvement: While surgery is not typically recommended solely for cosmetic purposes, some individuals may find the symptoms of their spinal deformity unbearable, impacting their overall quality of life. Surgery may be the only option in such cases. In younger adults, cosmetic deformity may be a significant consideration for surgery, but it is usually less important in older adults.
Various surgical options are available, tailored to each specific case. Generally, surgical procedures aim to stabilize the spine, restore balance, and relieve pressure on the nerves. Spine stabilization surgery involves fusing the spinal bones using bone grafts and metal implants to hold the spine in place. Advancements in surgical techniques and computer-assisted navigation systems have made less invasive approaches possible, resulting in quicker recovery times.
