“At Southwest Scoliosis Institute, we see adult patients who are in pain or are embarrassed by the curves. This is where our expertise and experience with complex adult scoliosis make the difference in improving these lives.”
Richard Hostin, MD
A particularly debilitating form of the disease in adults is degenerative scoliosis, which produces incapacitating pain and progressive curvature of the spine. Untreated cases may manifest as a disfiguring S- or C-shaped curve and often a large hump in the back. As they age, patients with this form of scoliosis have increasing difficulty exercising, and their lifestyle may be impacted by pain. As the disease progresses, some may experience difficulty breathing and walking.
Southwest Scoliosis Institute offers a comprehensive diagnosis of each patient’s specific curvature through a physical examination of the back and extensive testing including specialized low dose X-rays.
Degenerative Scoliosis is Classified as:
- Pure degenerative – Scoliosis patients who had straight spines earlier in life but developed curvatures from wear and tear of the aging spine.
- Old idiopathic curves with degenerations – Scoliosis patients who had curves in childhood that increased in curvature later in life.
- Secondary – Scoliosis patients who experienced curves caused by other conditions, such as tumors and fractures.
Degenerative scoliosis can have a range of symptoms depending on what is causing the condition. Some patients with degenerative scoliosis experience no symptoms, or they may be severely disabled. Degenerative scoliosis symptoms may include:
- Back pain that gets worse while standing (and may get better while laying down)
- Pain in one or both legs
- Numbness and/or weakness in one or both legs
Diagnosing Degenerative Scoliosis
Scoliosis is usually diagnosed by a combination of physical examination and specialized X-rays. During the physical examination, Dr. Hostin will look at the degree of rotation in the curvature of the spine, as well as secondary changes in other parts of the body, such as:
- Uneven shoulders
- Rib hump or asymmetry
- Low back hump or asymmetry
- Change in the shape of the waist
- Uneven pelvic bones or hips
Often, these changes are not noticeable while standing and only become visible when the person bends forward. X-rays are an important tool for pinpointing the shape and location of the curves, as well as for measuring the degree of the curvature so it can be classified. Southwest Scoliosis Institute uses the revolutionary EOS X-ray imaging system, which allows us to quickly take full-body images of patients in multiple positions while delivering the lowest possible dose of radiation.
When Does Degenerative Scoliosis Become Serious?
If degenerative scoliosis causes the spinal cord or a nerve root to become impinged, either through stenosis (narrowing of the spinal canal) or severe bending of the spine, nerve function could be jeopardized. Initially, this is often felt as a sharp or shock-like pain in the back that radiates down the buttock and/or into the leg, or as tingling or numbness that can radiates down into the leg. This is commonly referred to as sciatica or sciatic pain, and the medical term for this type of radiating pain is radiculopathy. While uncommon, it is possible for degenerative scoliosis to cause permanent weakness in the legs and/or problems with bladder and bowel control.
The treatment for degenerative scoliosis is usually conservative. Treatment commonly includes medication, exercise, and bracing to support the spine.
If osteoporosis is present, then treatment of the osteoporosis may also slow the progression of scoliosis. The current recommendations include increasing your calcium and vitamin D intake, and weight-bearing exercises.
Mild pain medications may be prescribed to use as needed. Usually, strong pain medications, such as narcotics, are not recommended due to the risk of addiction.
In many cases, the symptoms of degenerative scoliosis can be addressed through a combination of physical therapy and pain management. However, in cases where the patient’s curve has progressed to the point that they are in pain or having difficulty breathing, surgery may be the best option.
Physical Therapy and Exercise
A physical therapist or another qualified medical professional can help develop an exercise and stretching routine to meet the patient’s specific needs. Physical therapy can help keep the soft tissues and joints limber as well as strengthen the targeted muscles. The physician will most likely prescribe non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or medications that treat inflammation from arthritis to help reduce pain and allow the patient to continue his or her physical therapy.
The goals of physical therapy are to help
- learn ways to manage the symptoms of scoliosis
- improve spine posture
- maximize spine stabilization
Exercise has not proven helpful for changing the curves of scoliosis. However, it can be helpful by addressing pain, posture, and spine stabilization. Therapy sessions may be scheduled each week for four to six weeks.
The use of a spinal brace may provide some pain relief, but in adults, the brace will not cause the spine to straighten. Once you have reached skeletal maturity, bracing is used for pain relief rather than prevention. If there is a difference in the length of your legs (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.
Epidural steroid injections can reduce inflammation, and facet-block injections can prevent pain signals from reaching the brain. These types of injections deliver the anti-inflammatory medication directly to the affected area in the spine.
Degenerative Scoliosis Surgery
If the curve is severe and the patient is in a great deal of pain, the physician may recommend surgery. The most common type of surgery to address degenerative scoliosis is called spinal fusion, which involves inserting rods and screws (known as instrumentation) into the vertebrae to prevent the spinal curvature from progressing any further.
Surgeries to fix degenerative scoliosis are complex, multi-step procedures, but Richard Hostin, MD, Shyam Kishan, MD, and Kathryn Wiesman, MD, specially trained and have years of experience performing these types of complex spine surgeries.
“After a routine scoliosis surgery, patients are admitted to the intensive care unit where there is focused nursing care,” says Dr. Hostin. “It really is very comforting for both the patient and their family to know that there’s one nurse who is completely attentive to their needs.”