ADULT SCOLIOSIS

Adult Scoliosis is a curve of the spine. In most patients, no surgery is needed; however, in patients who have an excessive curve and it compromises breathing or walking, surgery can help correct those complications. Adult Scoliosis can vary from a minor problem, where it just needs watching, to chronic pain and a severe deformity.

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Adult Scoliosis

Scoliosis is characterized by an abnormal curvature of the spine, which can resemble an S or C shape. While it frequently emerges during childhood and adolescence, many adults also develop or continue to experience scoliosis. Scoliosis can manifest in several ways, depending on the severity and type of curvature. Some individuals may experience visible spinal deformity, uneven shoulders, or hips, while others may suffer from chronic back pain, limited mobility, or respiratory issues in more severe cases. The condition can also lead to a noticeable shift in posture and muscle imbalances. In some patients, scoliosis remains asymptomatic and is only discovered during routine screenings, while others may experience fatigue and discomfort after prolonged physical activity. Over time, if left untreated, scoliosis can progressively worsen and affect the overall alignment of the body, potentially impacting vital organs.

Types of Adult Scoliosis

1. Idiopathic Scoliosis

Definition: This type of scoliosis arises without a known cause.
Characteristics: Typically, idiopathic scoliosis begins during adolescence. If it persists and worsens over the years, it becomes known as adult idiopathic scoliosis.
Affected Areas: This type often impacts either the thoracic (upper) or lumbar (lower) spine.

2. Degenerative Scoliosis

Definition: This occurs due to degeneration of spinal discs and joints, often linked with the aging process.
Symptoms: Degenerative scoliosis can lead to conditions like spinal stenosis and arthritis, which can further complicate mobility and comfort.

Questions and Answers

What is Adult Scoliosis, and what causes it?

Adult Scoliosis is a condition in which the spine curves to the side in an abnormal way. The most common cause of adult scoliosis is idiopathic scoliosis, which means that the cause is unknown. Other causes of adult scoliosis include degenerative disc disease, spinal stenosis, osteoporosis, and neuromuscular conditions.

What are the symptoms of Adult Scoliosis, and how is it diagnosed?

The symptoms of adult scoliosis can include back pain, stiffness, and fatigue. In some cases, the curvature of the spine can also lead to breathing difficulties and decreased mobility. Adult scoliosis is typically diagnosed through a combination of physical examination, imaging tests (such as X-rays or MRI scans), and a review of the patient’s medical history.

What are the treatment options for Adult Scoliosis?

The treatment options for adult scoliosis depend on the severity of the curvature and the symptoms the patient is experiencing. In some cases, conservative treatments such as physical therapy, pain management, and bracing may be sufficient. However, in more severe cases, surgery may be necessary to correct the curvature and stabilize the spine. The specific type of surgery used will depend on the individual patient’s needs and may involve spinal fusion or other techniques. It is important to work with a healthcare provider to determine the best treatment plan for each individual case.

Another Success Story

Randy had been diagnosed with Scoliosis when he was 15. As the years went by, his scoliosis back pain increased and he could no longer manage it with pain medicine, injections, or physical therapy. He was in his 50s when he decided to have scoliosis surgery. His back surgery included rods and screws from T5 to his pelvis. His surgeon was Richard Hostin, M.D., with the Southwest Scoliosis and Spine Institute. Randy feels wonderful post-surgery. He is back to doing what he wants to do and enjoying his life.

Scoliosis Care

Adult scoliosis can lead to various conditions and complications, Understanding the type of scoliosis and its potential impact is crucial for managing symptoms and seeking appropriate treatment options. Adult scoliosis, while challenging, can often be managed effectively through a combination of medical care, physical therapy, and lifestyle adjustments.

Sustaining progress involves several key strategies:

Follow-Up Appointments: Regular check-ups are essential. These appointments help track the progression of the condition through ongoing imaging and assessments. They also allow for necessary adjustments to be made to braces and other supports.
Embracing Physical Therapy: Physical therapy plays a significant role in maintaining spinal health. Tailored exercises can strengthen muscles, improve posture, and reduce pain.
Adopting Lifestyle Changes: Making changes such as improving posture, avoiding heavy lifting, and quitting smoking can have a positive impact on spinal health. Ensuring that you maintain a healthy weight and stay active is also beneficial.
Brace Maintenance and Usage: For those who require a brace, proper maintenance and consistent usage are crucial. This helps prevent further curvature and can reduce pain.
Regular Physical Activity: Incorporating regular exercise into your routine is vital. Activities like swimming, walking, and yoga can help maintain flexibility and strength.

By integrating these strategies into daily life, individuals with scoliosis can better manage their condition and maintain a higher quality of life.

What Are the Symptoms of Scoliosis in Adults?

Scoliosis in adults can manifest in various ways, often leading to a gradual decline in physical function. Here are some common symptoms:

Pain: Chronic back pain is a common issue, resulting from the misalignment of the spine.
Decreased Mobility: The curvature and degeneration can limit movement and flexibility.
Spinal Stenosis: Narrowing of the spinal canal, which can lead to nerve compression.
Bone Spurs: Arthritis in the spinal joints may result in bony growths, exacerbating pain and discomfort.
Lower Back Discomfort: Many adults experience persistent pain and stiffness in the lower back.
Nerve Pain: Pinched nerves can result in numbness, cramping, or sharp, shooting pain down the legs.
Fatigue: The extra strain on the back and leg muscles often leads to significant fatigue.
Asymmetry in the Shoulders or Hips: You might notice one shoulder or hip sitting higher than the other.
Uneven Arm Position: One arm may appear to hang lower than the other.
Rib Hump: A noticeable protrusion or hump may develop in the lower back area.

These symptoms can vary in intensity and may progressively worsen over time, making early detection and treatment essential.

Adult Scoliosis Diagnosis

To diagnose scoliosis, we conduct a physical exam with specialized X-rays. During the physical exam, Dr. Hostin looks for the degree of rotation in the curvature of the spine, as well as other changes in other parts of the body. These may include:

Uneven shoulders
Rib hump
Low back hump
Change in the shape of the waist
Uneven pelvic bones or hips

Frequently, these changes do not show in a person while standing but become noticeable when the person bends forward. X-rays are important to pinpoint the shape and location of the curves, as well as for measuring the degree of the curvature for proper diagnosis. Because of this, we use an advanced X-ray imaging system that allows us to quickly take full-body images of patients in standing or seated positions while delivering the lowest possible dose of radiation.

How to Recognize the Early Signs of Scoliosis in Children

Identifying scoliosis early can make a significant difference in managing the condition effectively. Here are key indicators to watch for in children:

Uneven Shoulders: One shoulder may appear higher than the other, which can be easily noticed when the child is standing straight.
Prominent Shoulder Blades: A noticeable protrusion of one shoulder blade could indicate an abnormal spinal curve.
Uneven Waist: Look for asymmetries in the waistline; one side might seem higher or more pronounced compared to the other.

Parents should regularly observe their child’s posture and overall spinal alignment. If any of these signs are noticeable, it’s crucial to seek a professional evaluation. Consulting with a healthcare provider, such as a pediatrician or an orthopedic specialist, can lead to early detection and prompt intervention. Organizations like the Scoliosis Research Society and the American Academy of Pediatrics provide valuable resources and guidance on managing and treating scoliosis.

Early diagnosis and specialized care can significantly improve outcomes, ensuring that children receive the appropriate treatment as soon as possible.

Adult Scoliosis Treatment

Dr. Hostin performs complex surgeries to treat adult scoliosis. As such, scoliosis treatment decisions are based on many factors: the degree of curvature, curvature location, risk of progression, spinal imbalance, other disease factors, and the patient’s pain. In recent years, the medical profession has made great strides in the diagnosis and treatment of scoliosis. To stay at the leading edge and forefront of this disease, our doctors and medical staff offer the most advanced treatment options available. To date, we have seen over 100,000 new patients and successfully performed more than 16,000 surgeries.

You deserve to get the care you need from only the best-trained doctors. At our practice, we understand our patients are dealing with more than the physical challenges of scoliosis. In addition, they also cope with emotional challenges as well. Therefore, having our patients talk with others who underwent scoliosis surgery provides a powerful method to alleviate the fear of an operation. “We measure our success by our patients’ expectations of success,” says Dr. Hostin. “We commonly receive letters and pictures from our patients telling us how we improved the quality of their lives.”

We’re here to help STOP THE PAIN
Call 214-556-0555 or Email Us to make an appointment with our expert scoliosis doctors.

What to Expect During Your Scoliosis Treatment Consultation

During the consultation, expect a thorough physical assessment and spinal examination. Additional imaging or diagnostic tests may be needed. Based on the findings, potential options will be discussed to address any concerns or fears you may have.

Comprehensive Evaluation Process

Our evaluation process includes several key components:

Imaging Techniques: We utilize X-rays or low-dose radiation EOS imaging from front, side, and bending positions to accurately measure the degree and flexibility of the curve. Scoliosis is diagnosed when the curve exceeds 10 degrees. However, adults usually seek treatment when the curve exceeds 30 degrees.
MRI Scans: If you’re experiencing leg pain or nerve-related symptoms, an MRI (magnetic resonance imaging) may be required. This scan provides detailed images of both bone and soft tissues, helping to rule out or identify herniated discs and other spinal issues.
Neurological Examination: Assessing nerve function is also essential. This might include tests for muscle strength, reflexes, and sensation to gauge the impact of the spinal curvature on the nervous system.
Assessment for Complications: Dr. Hostin will use the physical exam and imaging to check for signs of spinal stenosis, which is the narrowing or compression of the spinal canal. If there is evidence that scoliosis is affecting lung function, additional tests may be ordered. In rare cases, severe scoliosis can lead to pulmonary heart disease, necessitating evaluation and treatment by additional medical specialists.
Impact on Quality of Life: Understanding how scoliosis symptoms affect a patient’s daily activities and overall quality of life is another crucial part of our assessment. This information helps guide treatment choices to ensure they are tailored to the individual needs of each patient.

By incorporating these comprehensive evaluation techniques, we aim to provide a thorough and accurate diagnosis, ensuring the best possible treatment outcomes for our patients.

Modern Approaches to Scoliosis Treatment Non-Surgical Methods

Many patients experience significant relief of their pain from non-operative measures that may include:

Pain medication such as NSAIDs (nonsteroidal anti-inflammatory drugs)
Physical therapy to increase core muscle strength
Postural training
Weight maintenance
Activity modification

Patients who continue to experience nerve pain may benefit from steroid injections in the facet joints (where the vertebrae meet at each level of the spine). Steroids, which reduce inflammation, may also be administered by an epidural, in which the injection needle is inserted into the spinal canal to deliver the drugs directly to the affected nerve root.

In some patients experiencing muscle spasms, the doctor may prescribe a brace to be worn on a short-term basis. However, their usefulness is limited since the support they provide gradually weakens the muscles in the trunk and spine.

Alternative and Holistic Options

Modern approaches also emphasize non-surgical options such as DNA testing, physical therapy, and corrective exercises. Alternative treatments like chiropractic care and acupuncture are considered valuable for managing scoliosis. Specialized programs such as Scoliosis Boot Camp focus on enhancing posture, strength, and flexibility to promote optimal spinal alignment and overall physical well-being. These personalized programs empower individuals to manage their condition effectively without resorting to surgical interventions.

Medication

Because of the pain with scoliosis, we often prescribe mild pain medications to use as needed. Usually, we do not prescribe strong pain drugs, such as narcotics due to the risk of addiction.

Learn more about medications used to treat back pain.

Adult Scoliosis Brace

A spinal brace may provide some pain relief; however, in adults, it will not cause the spine to straighten. Once skeletal maturity is reached, bracing provides pain relief rather than prevention. If a significant difference in the length of your legs exists (or if scoliosis causes you to walk somewhat crooked), special shoe inserts, called orthotics, or a simple shoe lift may reduce your back pain.

Learn more about braces used to treat back problems.

Physical Therapy and Exercise

Also, adults with scoliosis may work with a physical therapist because a well-rounded rehab program assists in calming pain, improving mobility and strength, and helping patients conduct daily activities with greater ease and ability. Moreover, exercise does not help to reduce the curves of scoliosis; albeit, it does help with addressing pain, posture, and spinal stabilization. Our doctors advise some patients to schedule therapy sessions each week for four to six weeks.

The Goals of Physical Therapy are to Help

Learn ways to manage the symptoms of scoliosis
Improve spine posture
Maximize spinal stabilization

Learn more about spinal rehabilitation.

Surgical Options

When addressing severe curvatures, expert surgical options like spinal fusion and instrumentation can help correct and restore spinal alignment. These advanced techniques, available in specialized clinics, aim to treat severe cases for the long-term. When non-surgical treatments fail to provide relief, and you suffer from a spinal imbalance accompanied by severe back or leg pain, various surgical options can be considered for scoliosis. Here are some of the most common types:

Laminectomy: This procedure, also known as decompression surgery, involves the removal of part or all of the lamina—a portion of the vertebra. This helps alleviate pressure on the spinal cord.
Microdiscectomy: Also referred to as microdecompression, this minimally invasive surgery aims to relieve nerve pressure, often involving the removal of herniated or damaged disc material.
Spinal Fusion: In this process, two or more vertebrae are permanently joined together using bone grafts or synthetic materials. This stabilizes the spine and reduces pain.
Osteotomy: This surgery realigns the spinal segments to correct deformities. It often involves cutting and repositioning bones.
Vertebral Column Resection: When other surgeries like osteotomy fail to correct scoliosis, this procedure helps by removing sections of the spinal column to enable better alignment.

These surgical options offer varying approaches to relief and correction, tailored to specific needs and conditions.

We’re here to help STOP THE PAIN
Call 214-556-0555 or Email Us to make an appointment with our expert scoliosis doctors.

What Types of Scoliosis Surgery Are Available?

When non-surgical treatments fail to provide relief, and you suffer from a spinal imbalance accompanied by severe back or leg pain, various surgical options can be considered for scoliosis. Here are some of the most common types:

Laminectomy: This procedure, also known as decompression surgery, involves the removal of part or all of the lamina—a portion of the vertebra. This helps alleviate pressure on the spinal cord.
Microdiscectomy: Also referred to as microdecompression, this minimally invasive surgery aims to relieve nerve pressure, often involving the removal of herniated or damaged disc material.
Spinal Fusion: In this process, two or more vertebrae are permanently joined together using bone grafts or synthetic materials. This stabilizes the spine and reduces pain.
Osteotomy: This surgery realigns the spinal segments to correct deformities. It often involves cutting and repositioning bones.
Vertebral Column Resection: When other surgeries like osteotomy fail to correct scoliosis, this procedure helps by removing sections of the spinal column to enable better alignment.

These surgical options offer varying approaches to relief and correction, tailored to specific needs and conditions.

Surgery May Be Needed In The Following Situations:

Chronic pain is the most common reason for scoliosis surgery. Severe pain relief comprises about 85 percent of adult scoliosis surgeries. We will not recommend surgery if the pain is manageable through conservative treatments or facet joint injections.
Curve Surgery may be suggested if the curvature continues to worsen and the curve gets beyond 40 to 45 degrees to prevent problems that come with severe scoliosis. Surgery will usually be recommended for curves above 60 degrees, as the twisting of the torso can lead to serious lung and heart conditions.
We do not recommend Cosmetics Surgery merely for the sake of appearance. But sometimes scoliosis causes extreme physical deformity and may be the only option for correcting the condition. Most cases of cosmetic scoliosis surgeries occur in young adults who possess very noticeable curves.

For scoliosis patients whose curvature has increased and who are in pain, we may recommend surgery. To clarify, scoliosis deformity surgeries are serious and complex with multi-step procedures, and sometimes more than one surgery occurs — one performed from the front and one from the back. Typically, this takes place in one operation but in some cases two are necessary. In the event a patient needs surgery, our doctors sit down and explain the risks and benefits of the procedure and the expected outcomes. At the Southwest Scoliosis and Spine Institute, we are with you every step of the way.

The goals of most surgical procedures for adult scoliosis include:

When a patient requires surgery, your doctor can choose from a number of different procedures, usually, a spinal fusion procedure occurs. For instance, each case of scoliosis is somewhat different and may require a very specialized approach for optimal results. Normally, surgery will solve the problems brought on by scoliosis — not just straighten the spine.

Reducing the deformity (straightening the spine as much as needed)
Stopping the progression of the deformity
Removing any pressure from the nerves and spinal cord or spinal canal
Protecting the nerves and spinal cord from further damage

Criteria for Surgery

Surgery may be warranted in patients who have curves that exceed 50 degrees, are not responding to nonsurgical methods, or experience other complications. Our comprehensive approach ensures that we only recommend surgical intervention when absolutely necessary, aiming to provide the best outcomes for each patient.

Adult Scoliosis Surgery

Our doctors sit down and explain the risks and benefits of the procedure and the expected outcomes. They take into account several critical factors when reviewing the risks and benefits of scoliosis surgery, including:

Age: Younger patients may have different risks compared to older adults.
Medical History: A comprehensive review of the patient’s past medical conditions.

Presence of Other Conditions: These can pose additional surgical challenges, such as:

Arthritis
Kyphosis (a forward curvature of the spine)
Osteoporosis (a condition in which bone density decreases and the bones become more fragile and likely to break on impact)
Other, non-orthopedic medical conditions

This thorough assessment ensures that every aspect of the patient’s health is considered, providing a tailored approach to their surgical care.

Reducing the deformity (straightening the spine as much as needed)
Stopping the progression of the deformity
Removing any pressure from the nerves and spinal cord or spinal canal
Protecting the nerves and spinal cord from further damage

Surgical Outcomes

Curve Correction:

Typically, the curve correction falls in the range of 50% to 80%.

Quality of Life and Pain Relief:

We use standardized tools like the SRS 22 patient questionnaire and the Oswestry Disability Index (ODI) to measure the level of pain relief and improvement in the quality of life for each patient.

Potential Complications

Complications of scoliosis surgery in adults can include:

Pseudarthrosis: A nonunion of the spine fusion, which may lead to the loosening of the implanted instruments.
Infections
Neurological problems
Blood clots
Spinal imbalance: Problems with the correction, including the inability of unfused segments to spontaneously correct and balance the spine.

Recovery Process

Recovery times can vary based on the specific procedure and individual circumstances, but full recovery typically takes up to a year. During the initial 6-12 weeks post-surgery, it’s crucial to avoid lifting heavy objects and minimize bending to ensure proper healing.

If nonsurgical options haven’t provided the desired relief and you’re experiencing significant pain or spinal imbalance, consult with a specialist to determine if scoliosis surgery is the right path for you.

Hospital Stay:

Most patients remain in the hospital for three to seven days, or slightly longer for those who undergo combined anterior and posterior (front and back) surgeries.

Early Mobility:

Patients are usually back on their feet on the first day, walking with the physical therapists in the hospital.

Pain Management and Activity Limitation:

Pain medication is continued as needed. As recovery progresses, patients are advised to limit their activities to walking and to avoid bending and heavy lifting for the first four weeks.

Full Recovery Timeline:

By adhering to these guidelines and with the help of physical therapy, the patient should be able to resume normal activities at home in about four to six weeks. Subsequently, those with desk jobs may return to work. Adults may take a year or longer to achieve full functional recovery, and it is rare for adults to require pain medication for ongoing discomfort.

Follow-Up Care and Lifestyle Changes

Sustaining progress involves understanding the importance of regular follow-up appointments, embracing physical therapy, adopting lifestyle changes for spinal health, ensuring brace maintenance and usage, and incorporating regular physical activity for effective management.

Regular Check-Ups

Regular check-ups play a crucial role in managing the condition. These appointments help track the progression of the condition through ongoing imaging and assessment. Lifestyle changes may also impact the frequency of follow-up visits. Additionally, brace adjustments and emotional support are addressed during these check-ups.

Range of Motion

Patients should be aware that spinal fusion does result in some loss of range of motion; however, the degree varies depending on the size and length of the fusion:

Thoracic Spine: Normal mobility is often achieved after the healing process is completed.
Lumbar Spine: Sideways movement will be more restricted, though bending forward from the hips remains possible.
Cervical Spine: Fusion here places more restriction on movement.

Advanced Techniques

While surgical treatment of scoliosis in adults can present a complex set of challenges, a team approach and the use of refined surgical techniques and instruments both help ensure a positive outcome. In addition, orthopedic surgeons are increasingly using bone morphogenic proteins (BMPs) in spinal fusions. These substances enhance and accelerate healing for a good long-term result.

Physical Therapy and Regular Activity

Physical therapy is essential for maintaining spinal health and improving functional outcomes. Embracing a routine that includes targeted exercises and stretches can significantly aid in recovery and long-term management. Regular physical activity, tailored to individual capabilities, helps in sustaining progress and preventing further complications.

Brace Maintenance and Usage

For those requiring a brace, proper maintenance and consistent usage are critical. Ensuring that the brace fits correctly and is worn as recommended by healthcare providers can make a significant difference in managing scoliosis effectively.

By integrating these follow-up care steps and lifestyle changes, patients can optimize their recovery and maintain spinal health in the long term.

Surgery Methods

To achieve these goals, your doctor may suggest an operation. Straightening the spine is the first goal and then fusing the vertebrae together into one solid bone provides a positive solution and outcome. To accomplish this, two different types of surgical methods can be used. One is called lumbar fusion with pedicle screws and rods. The second method inserts special cylinders between the vertebrae to be fused, a procedure called lumbar fusion with intervertebral cages.

Accordingly, both procedures usually require some type of metal screws, plates, or rods, in order to help straighten the spine and hold the vertebrae in place while the fusion heals and becomes solid. The screws are placed into the vertebra. Also, the rods or plates then attach to the screws to connect everything together. Also, tightened together, they form an internal brace to hold the vertebrae in alignment while the fusion heals.

Learn more about lumbar fusion with pedicle screws and rods.

Learn more about lumbar fusion with intervertebral cages.

Possible Complications of Adult Scoliosis Surgery

Like all surgical procedures, operations on the back may have complications. Because the surgeon operates around the spinal cord, back operations are always considered extremely delicate and may be dangerous. Finally, take time to review the risks involved with spine surgery with your doctor. Also, make sure you agree with both the risks and the benefits of the planned procedure.

Flat-back Deformity

Over the years, many patients come to us with a flat-back deformity. This condition occurs from the surgical treatment of adult scoliosis. The lumbar (lower) spine naturally has a slight inward curve called lordosis. When the vertebrae in the lumbar spine become fused together, this lordosis curve may disappear, leaving the patient with a “flat-back” deformity. The loss of the curve may not appear right after surgery. If a young person is a patient, the loss of lordosis may not even appear until sometime between the ages of 30 and 50. Meanwhile, patients who experience a “flatback” syndrome after surgery experience pain and decreased mobility.

The Benefits of the Southwest Scoliosis and Spine Institute

The Southwest Scoliosis and Spine Institute is a private medical practice located in three locations in Dallas, Plano, and Frisco, Texas. The practice specializes in the diagnosis and treatment of spinal conditions, including scoliosis, kyphosis, and other spinal deformities. Furthermore, the Institute offers a variety of treatment options, including surgical and non-surgical approaches.

The Southwest Scoliosis and Spine Institute maintains a team of highly experienced and skilled spine surgeons. Furthermore, these doctors have received specialized training in the diagnosis and treatment of spinal conditions. Therefore, they use the latest techniques and technologies to ensure the best possible outcomes for their patients.

The Institute’s approach to spine treatment centers on the patient, meaning that the doctors and staff approach each patient differently. Moreover, they work closely with their patients to understand their individual needs and goals and develop a customized treatment plan that takes into account the patient’s unique situation, lifestyle, and preferences. Finally, the Institute also offers comprehensive follow-up care and support to its patients. This includes physical therapy and rehabilitation, to help them recover quickly and fully from their surgery.

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Scoliosis Research Society: Adult Scoliosis

If you or your loved one suffers from back pain from a spinal condition, we can help. Call Southwest Scoliosis and Spine Institute at 214-556-0555 to make an appointment today.