Adult Scoliosis – and how to treat it

Scoliosis is a lateral curve in the spine in one or more places.

There are two different diagnoses:

1. Idiopathic curves that develop in the spine during adolescence and present in adults.

2. Degenerative scoliosis results from asymmetrical degeneration of intervertebral discs, with ageing leading to the spine collapsing on one side resulting in a sideways curvature.

Irrespective of the cause most people can live and function very well with scoliosis.

Scoliotic backs are maintained like any other back, with regular exercise, keeping to a healthy weight, and simple analgesics as needed.

Reasons to consider surgery

When the curvature becomes significant (in broad terms beyond 50 degrees) it might warrant surgery. This will depend on one of three conditions. 

1. Pain

This is particularly common in the older (50+ years) degenerative group. It comes into consideration when non-operative treatments are no longer effective. Patients can develop:

• Arthritis in the spinal facet joints.
• Impingement on the lumbar nerves leading to sciatic pain.
• Severe curvature that causes impaction pain as the ribs start resting on the pelvis.

2. Imbalance

Patients struggling to stand up straight exhibit a lean either forward or to one side. This leads to difficulties walking, decreased mobility and a lower quality of life

3. Cosmetic

This third symptom is more applicable to younger adults. Patients can end up with a disfiguring prominence in their back and experience significant social and psychological distress.

Surgery

The treatment for scoliosis is fusion surgery.

Rods are placed along the spine and fixed by screws into the vertebrae; typically, over many vertebral levels.

It is effective but will lead to a loss in mobility because the fused part of the spine becomes rigid.

For example if the lumbar spine is totally fused, the patient is likely not be able to reach their feet again and will need help putting on socks and shoes. 

For many this is a price they are happy to pay as the benefits of surgical correction are life-changing. Though it is a deterrent to some in the younger idiopathic cohort.

For a small group of older patients, they fracture above the site of the surgery sometime later. If fractures occur then they will need further surgery.

Older patients will need pre-operative medical work to ensure they are fit for a large surgical procedure.

Post-Operative Recovery

After surgery patients will remain in hospital for a few days to recuperate, though they will be back on their feet undergoing rehabilitation exercises.

Thereafter the recovery process is typically two to three months. After which patients should be able to resume normal activities.

You can watch the recording of my webinar on Adult Scoliosis  here.

And as always if you have any questions about a patient, please feel free to call me on 02 9650 4893. I will return your call and discuss how we can help.

You can also reach me via ralphstanford@powspine.com.au.

Further resources for referrers include:

• Webinar: Diagnosing Back Pain
• Webinar: Sinister Causes of Back Pain
• Webinar: Cauda Equina Syndrome
• Webinar: Foot Drop
• Webinar: Neurogenic Claudication
• Webinar: Tingling, Numb Hands

Dr Ralph Stanford is a spinal surgeon with over 20 years’ experience. He is adept in all surgical approaches to successfully treat his patients.

As a teacher Dr Ralph Stanford is Conjoint Senior Lecturer at the UNSW; Supervisor of Training for Orthopaedic Trainees, Prince of Wales Hospital; and Education Secretary for the Spine Society of Australia.

As a researcher and scientist, he is a well-published author and Honorary Senior Scientist at Neuroscience Research Australia (NeuRA). He is also a current member of Spinal PFET. 

Posted 2 March 2023