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Degenerative Scoliosis

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 X-rays.

Our fellowship-trained surgeons, Richard Hostin, MD, Ioannis Avramis, MD and Shyam Kishan, MD will take the time to properly diagnose and discuss the most effective options with you.

Adult 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.

What causes scoliosis?

The causes of scoliosis are not entirely understood. In fact, according to the Scoliosis Research Society, a specific cause is not found in 8 of 10 cases. While many cases of scoliosis are thought to be genetic, there is no single cause that is widely agreed upon. “We have a number of observations and findings, but there’s no unified theory,” says Dr. Kishan. “We’re hindered in that we can’t take all of the observations and put them into a road map that explains why one child with a curve goes on to need complex surgical care while another with a curve that’s seemingly the same reaches adulthood and doesn’t need surgery.” Several observations do exist:

  • Heredity – Scoliosis tends to run in families and presents with different effects in each generation, perhaps even skipping generations.
  • Degeneration – Adult scoliosis can be caused by disk degeneration, osteoporosis or osteomalacia, a softening of the bones.
  • Spinal cord injury – Scoliosis can appear following spinal surgery or a spinal cord injury or trauma. Additionally, patients who had polio in the 1930s, ’40s and ’50s may now experience scoliosis as a result of paralysis.
  • Congenital – Scoliosis can result from improper formation of spinal bones during fetal development.
  • Neuromuscular – Abnormal nerve or muscle function can result in scoliosis.

Research is being conducted to identify specific genes associated with scoliosis in the hope that we will be better able to predict which curves are at highest risk for progression. “Scoliosis is thought to be genetic and a result of expression of multiple genes; however, it has variable penetrance, meaning that in each generation there is a variability in how strongly the genes are expressed, which determines how severe the curve is,” explains Dr. Kishan. “Scoliosis tends to run in families, but it tends to have variable effects in each generation. That is, a mother may have a mild curve who has a daughter with a severe curve, or a mother with a severe curve may have grandchildren who then have scoliosis, but the intervening generation didn’t exhibit any significant problems.”

What are the symptoms of scoliosis?

Scoliosis can be a hidden disorder with no obvious signs of curvature, or it can cause great discomfort, pain and disability. Some patients have undetected scoliosis for years until the curve starts to increase, causing pain and difficulty. “We think of scoliosis as being a childhood disease and are generally taught that it is such. In fact, most commonly, scoliosis is diagnosed in the juvenile and adolescent stages of 8, 9, 10, 11 and 12 years of age,” observes Dr. Kishan. “However, adult onset or degenerative scoliosis, which we think develops as a result of disk degeneration, is probably an entirely separate entity from what we commonly think of as adolescent idiopathic scoliosis.” Some symptoms include:

  • One shoulder that appears to be higher than the other
  • A pelvis that appears to be tilted
  • Any imbalance in the rib cage or other deformities along the back

In more advanced cases, scoliosis patients have reported pain, limited movement, difficulty breathing and headaches.

Is scoliosis worse in girls and women?

The natural history of the disease in women is different than in men. Overall, about the same number of men and women are diagnosed with scoliosis, but young women diagnosed as adolescents or young adults face a progression rate of seven to eight times higher than boys. Dr. Avramis explains what some of his patients face: “There are women who come in and say, ‘You know, I had a small curve, and it has continued to progress throughout adulthood. It didn’t seem to be related to pregnancy, but now that I’m [50, 52, 55], and I really am starting to have problems. My dresses are different. I don’t have a waistline anymore. My ribs are actually resting on my hip bones, and there’s really been a dramatic change in what I look like. But I’m here not because I’m worried about my cosmetics. It’s because I hurt. Because I have pain. It’s limiting my ability to live effectively.’” For degenerative scoliosis, the Southwest Scoliosis Institute has helped hundreds of women overcome the debilitating effects of the disease.

For more information or to make an appointment, call 214-556-0565.