Scoliosis in Older Patients

Scoliosis in Older Patients: Progression, Symptoms and Treatment Options

Scoliosis, a condition characterized by an abnormal lateral curvature of the spine, is often associated with adolescence. However, scoliosis in older patients can persist or develop in adulthood. As individuals age beyond 45 or 50, questions arise about whether the spine continues to curve.  In addition, questions about pain and discomfort evolve, and what treatment options are available for elderly patients. This article comprehensively explores scoliosis in older adults, addressing its progression, symptom exacerbation, and management strategies tailored to this demographic.

Understanding Scoliosis in Older Patients

Scoliosis can be broadly categorized into three types relevant to older patients:

• Idiopathic Scoliosis: Originating in childhood or adolescence (typically adolescent idiopathic scoliosis, or AIS), this form may persist into adulthood if untreated or severe.
• Degenerative (De Novo) Scoliosis: This type develops later in life due to age-related degeneration of the spine, including wear on discs, joints, and ligaments. It is more common in individuals over 50.
• Post-Traumatic or Secondary Scoliosis can result from injury, surgery, or other spinal conditions that emerge or worsen with age.

For older patients, the interplay between pre-existing scoliosis and age-related spinal changes—such as osteoarthritis, disc degeneration, and osteoporosis—complicates the condition’s progression and management.

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 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 treatment adjustments.
  • Bone health management (e.g., calcium, vitamin D, bisphosphonates for osteoporosis) can mitigate fracture risk and slow degenerative changes.

Conclusion

For older patients with scoliosis—whether idiopathic or degenerative—the spine may continue to curve after age 45 or 50, particularly in degenerative cases or severe pre-existing curves. Symptoms like pain and discomfort often worsen with age due to spinal degeneration, muscle fatigue, and nerve issues, significantly impacting quality of life. Treatment options for elderly patients range from conservative strategies like physical therapy and pain management to surgical interventions in severe cases. The choice of treatment depends on the patient’s symptoms, curve progression, and overall health, with a focus on balancing efficacy and safety in this vulnerable population.

By addressing scoliosis proactively, older adults can maintain mobility and comfort, adapting to the challenges of an aging spine with tailored care. Consultation with a multidisciplinary team—orthopedic specialists, physical therapists, and pain management experts—is key to optimizing outcomes in this complex condition.

Reasons to Choose The Southwest Scoliosis and Spine Institute:

Older patients seeking treatment for Scoliosis should consider The Southwest Scoliosis and Spine Institute for several reasons. Led by renowned spine surgeons Doctors Richard A. Hostin, Devish Ramnath, and Ishaq Syed, the institute offers comprehensive spine care. Similarly, the institute provides access to state-of-the-art facilities and advanced treatment options, including both nonsurgical and surgical interventions tailored to individual patient needs. Therefore, the team at The Southwest Scoliosis and Spine Institute is dedicated to delivering high-quality care.  To summarize, our doctors, surgeons and staff provides compassionate support and optimal outcomes,

If you are suffering from Back Pain we invite you to call our office.  Please schedule an appointment at one of our three locations in Dallas, Plano, and Frisco, Texas.