Scoliosis in Older Patients

Scoliosis in Older Patients: Progression, Symptoms, and Treatment Options

 

Scoliosis is a spine curve that is not normal to the side. It is often tied to the teen years. But scoliosis in older folks can stay or show up later in adulthood. Once people pass 45 or 50, new doubts come up about whether the spine keeps bending. There are also doubts about pain and sore backs, and what care is best for older folks. This piece takes a full look at scoliosis in the elderly, noting its growth, rise of signs, and care plans made for this group.

Understanding Scoliosis in Older Patients

Scoliosis can be split into three main types seen in older folks:

• Idiopathic Scoliosis: Starts in youth or teen years (often called teen idiopathic scoliosis, or AIS). This type may last into grown years if not fixed or if it is bad.
• Wear-and-Tear (De Novo) Scoliosis: This type starts later in life from age-linked wear of the spine. It comes from stress on discs, joints, and bands. It is more common in people past 50.
• Post-Injury or Second Scoliosis: Can come from harm, surgery, or other spine problems that show up or get worse with age.

For older folks, the mix of past scoliosis and age-linked spine change, like joint wear, disc wear, and weak bones, makes the curve worse and the care more difficult.

Does the Spine Continue to Curve After Age 45 or 50?

The progression of spinal curvature in older adults depends on several factors.  These include the type of scoliosis, the degree of curvature at maturity, and individual health conditions.

Idiopathic Scoliosis in Older Patients

• In patients with idiopathic scoliosis from youth, the curvature often stabilizes after skeletal maturity. Studies suggest that curves less than 30 degrees at maturity are unlikely to progress significantly in adulthood. However, curves exceeding 50 degrees at skeletal maturity have a higher likelihood of worsening.  The average is approximately 0.5 to 1 degree per year due to gravitational forces and asymmetric loading on the spine.
• After age 45 or 50, progression is not guaranteed, but it can occur.  Particularly, if the spine undergoes degenerative changes that exacerbate instability or asymmetry.

Degenerative Scoliosis in Older Patients

• Unlike idiopathic scoliosis, degenerative scoliosis tends to emerge or worsen with age. This occurs because the spine deteriorates over time, with intervertebral discs losing height, facet joints developing arthritis, and ligaments weakening. These changes can lead to a new curvature or accelerate an existing one, typically at a rate of 1 to 3 degrees per year in symptomatic patients.
• Osteoporosis, common in older adults (especially postmenopausal women), can further contribute to curve progression.  This happens by weakening vertebral bones, leading to compression fractures that tilt the spine.

Key Factors Influencing Progression

• Curve Magnitude: Larger curves (e.g., >50 degrees) are more prone to progression.
• Spinal Degeneration: Conditions like disc herniation or spondylolisthesis can destabilize the spine.
• Bone Health: Reduced bone density accelerates structural changes.
• Posture and Muscle Strength: Weak core muscles and poor posture may worsen mechanical stress on the spine.

In summary, while idiopathic scoliosis may not always progress significantly after 45 or 50, degenerative scoliosis often does. Particularly, in the presence of age-related spinal wear. Regular monitoring via X-rays is essential to track changes in curvature over time.

Do Symptoms of Pain and Discomfort Worsen for Scoliosis in Older Patients?

Pain and discomfort in scoliosis patients tend to increase with age, though the relationship between curve severity and symptom intensity is not always linear. In older adults, symptoms arise from both the curvature itself and coexisting degenerative processes.

Why Symptoms Worsen

• Degenerative Changes: As discs degenerate and facet joints erode, older patients experience increased stiffness, inflammation, and nerve compression (e.g., spinal stenosis or radiculopathy). These amplify pain beyond what the curve alone might cause.
• Muscle Fatigue: The asymmetric spine places uneven demands on the back and core muscles, leading to fatigue, spasms, and chronic pain over time.
• Nerve Impingement: Progressive curvature or vertebral collapse can compress spinal nerves, causing sciatica, numbness, or weakness in the legs.
• Reduced Mobility: Stiffness and pain limit range of motion, impacting daily activities and quality of life.
• Pulmonary and Cardiac Strain: In severe cases (curves >70–100 degrees), the chest cavity may become restricted, reducing lung capacity or stressing the heart, though this is rare in milder cases.

Evidence of Symptom Progression

• Research indicates that adults with scoliosis report higher rates of back pain than the general population, with prevalence increasing after age 50. A study in Spine (2011) found that 61% of adults over 60 with degenerative scoliosis experienced moderate to severe pain, compared to 30–40% of younger adults with idiopathic scoliosis.
• Pain is often more debilitating in degenerative scoliosis due to its association with arthritis and nerve compression, whereas idiopathic scoliosis pain in older adults is typically milder unless the curve progresses significantly.

Variability in Experience

• Some older patients remain asymptomatic despite moderate curves (20–40 degrees), while others with smaller curves experience significant discomfort due to inflammation or comorbidities like obesity.

In conclusion, symptoms of pain and discomfort often exacerbate with age, driven by degenerative changes rather than curve progression alone. Elderly patients are more likely to experience chronic pain, reduced mobility, and neurological symptoms compared to their younger counterparts.

Treatment Options for Scoliosis in Older Patients

Managing scoliosis in older adults focuses on alleviating symptoms, improving function, and preventing further progression. Treatment is individualized based on curve severity, symptom intensity, and overall health. Options range from conservative approaches to surgical intervention.

Conservative Treatments

• Physical Therapy: Targeted exercises strengthen core and back muscles, improve posture, and enhance flexibility. Aquatic therapy is often recommended for elderly patients to reduce joint stress.
• Pain Management:
  • Medications: Over-the-counter analgesics (e.g., acetaminophen), nonsteroidal anti-inflammatory drugs (NSAIDs), or prescription muscle relaxants can relieve mild to moderate pain. For nerve-related pain, medications like gabapentin may be prescribed.
  • Injections: Epidural steroid injections or facet joint injections can reduce inflammation and provide temporary relief for severe pain or radiculopathy.
• Bracing: While less common in adults than adolescents, a custom brace may stabilize the spine and reduce pain in select cases, particularly for degenerative scoliosis or post-fracture support. However, compliance can be challenging due to discomfort or frailty.
• Lifestyle Modifications: Weight management, ergonomic adjustments, and low-impact activities (e.g., walking, tai chi) help minimize spinal stress.

Alternative Therapies

• Chiropractic Care: Gentle spinal manipulation may alleviate discomfort, though it’s not suitable for all elderly patients, especially those with osteoporosis.
• Acupuncture: Some patients report reduced pain and improved mobility, though evidence is anecdotal.

Surgical Options for Scoliosis in Older Patients

• Surgery is reserved for severe cases where conservative measures fail, or when neurological deficits, significant deformity, or intolerable pain emerge. Common procedures include
  • Spinal Fusion: Fusing vertebrae with rods and screws stabilizes the spine and halts curve progression. Bone grafts (often synthetic in older patients) promote fusion.
  • Decompression Surgery: For nerve compression (e.g., spinal stenosis), a laminectomy removes bone or tissue to relieve pressure.
  • Minimally Invasive Techniques: Advances like percutaneous instrumentation reduce recovery time and risk compared to traditional open surgery.
• Considerations for the Elderly:
  • Surgery carries higher risks in older adults due to comorbidities (e.g., heart disease, diabetes), reduced bone density, and slower healing.
  • A study in the Journal of Bone and Joint Surgery (2019) reported that patients over 65 undergoing scoliosis surgery had a 10–15% complication rate (e.g., infection, hardware failure), though outcomes improved pain and function in 70–80% of cases.
  • Surgeons often weigh the patient’s life expectancy, frailty, and goals (e.g., pain relief vs. cosmetic correction) before recommending intervention.
• Monitoring and Prevention
  • Regular checkups with X-rays or MRIs track curve progression and guide treatments.
  • Bone health management can mitigate fracture risk and slow degenerative changes.

Conclusion

For older folks with scoliosis, whether from birth or wear and tear, the spine may keep curving past age 45 or 50, most often in wear-and-tear cases or sharp, long-held curves. Signs like pain and ache often get worse with age from spine wear, weak muscles, and nerve pain, all of which cut into day-to-day life. Care choices for older folks range from safe steps like back work and pain care to back surgery in hard cases. The choice of care rests on the signs, curve growth, and overall health of the patient, with a stress on safe and strong care in this at-risk group.

By facing scoliosis early, older adults can keep moving and ease, while meeting the trials of an old spine with care made for them. A talk with a broad care team—bone docs, back guides, and pain care pros—is key to reaching the best end in this hard state.

Reasons to Choose The Southwest Scoliosis and Spine Institute:

At the Southwest Scoliosis and Spine Institute, we focus on Scoliosis Diagnosis, Treatment, & Care for our Patients. Our fellowship-trained, board-certified expert orthopedic scoliosis surgeons, Richard Hostin, MD, Devesh Ramnath, MD, Ishaq Syed, MD, Shyam Kishan, MD, and Kathryn Wiesman, MD, specialize in all types of spine conditions, deformities, and scoliosis pain. The group also has top tools and new care plans, with both non-surgical and surgical care made to fit each patient’s needs. The team at The Southwest Scoliosis and Spine Group works hard to provide the best in care.

In short, our docs, surgeons, and staff give kind help and the best care for each patient. If you have back pain, we urge you to call our office. Please set a time to meet at one of our three sites in Dallas, Plano, and Frisco, Texas.

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The medical content on this page has been carefully reviewed and approved for accuracy by the Southwest Scoliosis and Spine Institute’s qualified healthcare professionals, including our board-certified physicians and Physician Assistants. Our team ensures that all information reflects the latest evidence-based practices and meets rigorous standards of medical accuracy, with oversight from our expert spine doctors to guarantee reliability for our patients.