There are two main types of scoliosis in adults:
Adolescent Idiopathic Scoliosis in the Adult (ASA), this a pre-existing scoliosis which the person may or may not have been aware of. As typically Adolescent Idiopathic Scoliosis (AIS) does not result in pain or symptoms in adolescence, it is not uncommon for teenagers with less severe curves to pass into adult life without being aware of the condition. However, once adulthood is reached and posture starts to worsen and spinal degeneration increase pain and other symptoms start to develop.
ASA tends to present with larger more rounded curves, however with spinal degeneration and ligament weakening the curve can become more acute.
Degenerative Or De-Novo Scoliosis, is usually the development of scoliosis in adults due to spinal degeneration and loss of normal spinal stability as the ligaments weaken (not unlike a footballer’s knee’s). This type of scoliosis is very common and will affect 30% of people over the age of 60 and 40% of people over the age of 70.
This type of scoliosis tends to have smaller, more acute curves.
Symptoms and Presentation
Adult scoliosis patients will typically experience significant back pain and stiffness. As spinal degeneration increases, the inter-vertebral discs become narrowed and nerve compression develops resulting in constant sciatica, pin’s and needle’s, numbness or weakness in the legs. The spinal canal can also become narrowed and result in spinal stenosis where spinal cord is squeezed so the patient experiences heaviness in the legs, leg pain and difficulty walking.
Pain and disability in adult scoliosis is not typically associated with size of the curve. It is more importantly associated with:
- Curve location – lumbar and thoraco-lumbar curves typically tend to be more painful especially if they are singe curves.
- Postural Balance – Adults with good postural balance will have less symptom, thus often those who have double curves which are balanced will have less pain.
- Bent forward posture where an adults head and chest is in front of their pelvis is often the primary determinant of the severity of pain and symptoms.
- Adults whose head or chest is shifted to the left or right will also experience pain than those who are in better alignment.
Treatment For Adult Scoliosis
To achieve effective treatment for adult scoliosis, it is important to be able to to be able to differentiate between the symptoms that are caused by the degeneration of the spine alone compared to those that are caused by the deformity and its progression.
This means that unless treatment addresses the postural alteration or deformity the pain and symptoms won’t be improved. This applies to any back-rehabilitation regime, medication course or surgical procedure.
Recent advances in non-surgical treatment have shown significant improvement in pain and symptoms in those with adult scoliosis. This involves the patient learning how to self-correct their abnormal posture, not just strengthen their lower back or core. When combined with a customised Scoli-Brace which helps to support the posture in a more comfortable position, pain is reduced and quality of life is improved.
When non-surgical treatment is ineffective surgery is often the only option, especially when leg pain becomes incapacitating and walking is almost impossible. Unfortunately, surgery at this stage is always complex and with significant risk. This is why it is important to find not only a good spinal surgeon, but also one who specialises in scoliosis for the best possible outcome.