Tag: scoliosis adults

Scoliosis Awareness Month – Raising Awareness of Adult Scoliosis

Posted on June 1, 2022 by - Blog

Scoliosis is a condition which affects people of all ages – patients right from birth to old age present at scoliosis clinics around the world, seeking help for many forms of the condition every year. Despite this, there is somewhat of a bias toward thinking of scoliosis as a “young persons” condition – while there are some legitimate reasons for this perception, it’s not an accurate one. As many as one in three over 60’s actually suffer from Scoliosis, struggling with issues such as pain and discomfort which, in many cases, could be treated. This Scoliosis awareness month the UK Scoliosis clinic is focusing on raising awareness about scoliosis in adults – a lesser discussed, but equally important condition.

 

What is adult Scoliosis?

Scoliosis, for those who don’t know – is a condition in which the spine “curves” from side to side. A normal spine can and should have a natural curvature – however, this should be “Front to back”, so that when viewed from the side the spine looks something like an “S”. This natural curvature is not only normal but is actually critical to allowing us to move and remain balanced properly! Scoliotic curves, in which the spine looks like an “S” when viewed from behind are the opposite – they destabilise the spine causing pain, discomfort, aesthetic problems and, in serious cases, can even interfere with breathing. Scoliosis is a condition which tends to progress over time, meaning it usually gets worse without treatment.  Very often, scoliosis is diagnosed in younger teenagers – with girls between the ages of roughly 10 and 15 being the “classic” risk group. This group also attracts the attention of much of the scientific literature, and almost all of the “social” content relating to the condition – but in fact, far more adults, especially older adults, suffer with scoliosis than do younger people.

Adult Scoliosis then, is technically any scoliosis case that exists either in those over 18, or those having reached skeletal maturity, either definition is valid but most scoliosis specialists would prefer the latter since we are focused more on the condition itself than an arbitrary point of “adulthood.”

There are two main types of adult scoliosis. Pre-existing adult scoliosis is essentially a case of scoliosis which is continuing from an earlier age (usually adolescent scoliosis). In adulthood, a continuing case of scoliosis typically becomes known as Adolescent Scoliosis in Adults or ASA. ASA can be discovered in adults of any age, but many ASA cases are already known from treatment earlier in life.

The second type is Degenerative De-Novo Scoliosis (sometimes noted as DDS) – this is the development of a new scoliosis case, usually as a result of spinal degeneration.

 

What causes Scoliosis in Adults?

ASA – that was scoliosis carried into adulthood from adolescence, isn’t caused in adulthood – it may or may not worsen depending on a number of factors, but the condition originated at an earlier point in life. Degenerative scoliosis is somewhat unusual in the scoliosis world since we understand its cause well – it’s due to wear and tear on the spine, but it is also strongly associated with a variety of conditions. Osteoporosis, degenerative disc disease, compression fractures and spinal canal stenosis have all been implicated in the development of degenerative scoliosis.

Since De-Novo scoliosis is a consequence of spinal degeneration with age, it rarely presents before 40 years of age – although, in patients with no known history of scoliosis, differentiation from degenerative idiopathic scoliosis may be difficult. It is thought that as many as 40% of over 60’s suffer from de-novo scoliosis[1], although a percentage of these cases will be undiscovered scoliosis from earlier in life. In fact, a good number of adult scoliosis cases are discovered through an investigation for another condition (such as back pain).

 

What is the prognosis and treatment for Adult Scoliosis?

ASA can be considered both stable (progression is very slow or non-existent) or unstable, progression is continuing. Whether an ASA case will progress quickly, slowly, or not at all may well depend on the size of the curve itself when adulthood is reached. Research has suggested that simply put, large curves tend to get worse – smaller curves may well be stable. Weinstein et al. and Ascani et al. have reported results showing that children with curves < 30° at skeletal maturity did not demonstrate curve progression into adulthood, while the majority of curves > 50° progress at approximately 1° per year.[2] The degree of progression will be the best guide for treating ASA cases – bracing, exercise or even just periodic monitoring could all be the right approach, depending on the case.

De-Novo scoliosis is a condition related to ageing – and since we can’t stop ageing itself, De-Novo Scoliosis always continues – however, the impact upon a person’s life can be greatly minimised with the correct treatment. Patients with de-novo or degenerative scoliosis will often experience constant back and leg pain which makes it difficult for them to walk or stand for any period of time. They may become aware that they cannot stand up straight and lean towards one side, this becomes more noticeable the longer they are upright. Frequently they don’t find relief with medication, or through more standard conservative treatment (such as chiropractic or physiotherapy) and they are not suitable for surgery due to osteoporosis i.e. bone weakening.

The good news is that recent advances in non-surgical treatment have shown significant improvement in terms of reduction of pain and symptoms in those with adult scoliosis.  One approach involves the patient learning how to self-correct their abnormal posture, not just strengthen their lower back or core –  indeed, studies show that simple, exercise based approaches can reduce pain in adult scoliosis cases.[3]

The most effective approach would be the use of a customised brace, such as a ScoliBrace which helps to support the posture in a more comfortable position, pain is reduced (even with part-time bracing)[4] and quality of life is improved. Indeed, De-Novo Scoliosis patients often respond well to a gentle supportive brace, which helps to keep them upright and less tilted thus they can walk or stand more comfortably for longer periods of time.

 

Treatment for adult scoliosis

The main takeaway from this blog, and from our Scoliosis awareness efforts this month, should be that treatment options for adults with scoliosis do exist and, if you’re within travelling distance, they’re available at the UK Scoliosis Clinic!

 

 

 

[1] ‘Scoliosis in adults aged forty years and older: prevalence and relationship to age, race, and gender‘
Kebaish KM, Neubauer PR, Voros GD, Khoshnevisan MA, Skolasky R, Spine 2011 Apr 20;36(9):731-6.

[2] Weinstein SL, Ponseti IV: Curve progression in idiopathic scoliosis. J Bone Joint Surg (Am) 1983, 65:447-455.

Weinstein SL, Zavala DC, Ponseti IV: Idiopathic scoliosis: longterm follow-up and prognosis in untreated patients. J Bone Joint Surg (Am) 1981, 63:702-712.

Ascani E, Bartolozzi P, Logroscino CA, Marchetti PG, Ponte A, Savini R, Travaglini F, Binazzi R, Di Silvestre M: Natural history of untreated idiopathic scoliosis after skeletal maturity. Spine 1986, 11:784-789.

[3] ‘Scoliosis-Specific exercises can reduce the progression of severe curves in adult idiopathic scoliosis: a long-term cohort study’
Negrini A, Donzelli S, Negrini M, Negrini S, Romano M, and Zaina F 2015,, Scoliosis Jul 11 10:20

[4] Scoliosis bracing and exercise for pain management in adults—a case report Weiss et al, J Phys Ther Sci. 2016 Aug; 28(8): 2404–2407

‘Effects of Bracing in Adult With Scoliosis: A Retrospective Study‘
Palazzo C, Montigny JP, Barbot F, Bussel B, Vaugier I, Fort D, Courtois I, Marty-Poumarat C, Arch Phys Med Rehabil. 2016 Jun 22. pii: S0003-9993(16)30256-8. doi: 10.1016/j.apmr.2016.05.019

 

Do I need to treat my Scoliosis?

Posted on February 21, 2022 by - Blog

Scoliosis, in most cases, is a progressive condition – this means it gets worse with time. For this reason, we recommend most people (and all young people who have not reached skeletal maturity) treat, and try to correct Scoliosis as soon as possible. There are, however, some circumstances where treatment of Scoliosis may not be required – let’s take a look.

 

Scoliosis in children – does it need to be treated?

We started out by saying that for young people, scoliosis should always be treated – the reason is simple – Scoliosis tends to progress over time, and in a very young person there is a lot of time for scoliosis to continue to progress. It’s true that once a person reaches adulthood the development of scoliosis slows considerably – and below a certain cobb angle the curve may stop completely, but sadly most young people will reach a surgical threshold before this.

Research has demonstrated that cases of Juvenile scoliosis greater than 30 degrees tend to progress quickly – studies suggest that as much as 100% of these patients will progress to the surgical threshold. Juveniles with curves from 21 to 30 degrees are more difficult to predict in terms of progression but can frequently end up requiring surgery, or at least are left living with a significant disability.[1]

There is always a chance that scoliosis may not progress as much as predicted, and an individual who experiences scoliosis at a young age may make it to adulthood without requiring surgery. There are, however, still many common symptoms that scoliosis sufferers will experience throughout their life without treatment. Some of the most common include pain, physical deformity, limited mobility and difficulty breathing during exercise.[2] Some recent research has also suggested that even a small cobb angle can have a significant negative impact upon a person’s ability to be active and keep fit and healthy.[3] Since we understand how important staying fit and active is to long term health, it is also fair to say that left untreated scoliosis could be a predictor for longer-term health problems.

Since, with modern, active, bracing there is an excellent chance of not only preventing scoliosis development but actually reversing it. So there are almost no circumstances where active treatment of scoliosis isn’t worth at least investigating.

The only significant exception here would be in the case of an individual who is certainly going to require surgery regardless of attempts to slow or reduce scoliosis through a non-surgical method such as bracing. Bracing can sometimes be used in severe cases as a way to try to delay surgery, but this is not always a net benefit in the long term.

 

How about in adults?

There are two types of scoliosis in adults – these are adolescent scoliosis in adults (ASA) (Essentially, scoliosis carried over from childhood) and de-novo scoliosis. De-novo scoliosis will be discussed in a moment, so let’s consider ASA first.

The rate of progression of scoliosis in adults varies – but is certainly slower than in children. As a rough figure, about 1 degree per year can be expected. There is, however, quite some variation in the actual worsening experienced by an individual – with research suggesting that this may be correlated to the degree of scoliosis on reaching adulthood – those with larger curves tend to progress more in adulthood, those with smaller curves progress less and many not progress at all.

This is the first case in which there are a large group of people who probably do not need to treat scoliosis – although they should have regular check-ups to ensure that the condition has not started to worsen. An adult with a relatively small curve, which does not cause pain or discomfort and is not progressing, does not stand to gain significantly from Scoliosis treatment. Although it is not impossible to slightly reduce a scoliotic curve in an adult, any correction will be much smaller than in a child hence, if there are no other symptoms, monitoring scoliosis is probably the best approach.

Adults with a curve which does seem to be progressing, or who are experiencing pain or other symptoms from scoliosis may want to consider either an exercise-based approach or bracing as a method to manage Scoliosis. Both approaches are suitable for adults since there is less concern about adherence to an exercise regime (a common problem with children). The appeal of bracing for adults is likely to be ease of use, and, although bracing is expensive, it’s worth keeping in mind that an adult brace will likely last a lifetime if well cared for.

While we often associate scoliosis with younger people – especially girls (certainly, these are the group we most often think about treating today) this stereotype is somewhat unhelpful. In fact, the group most often impacted by Scoliosis are the over 60’s – here, as much as 30% of the cohort suffer from degenerative or “de-novo” scoliosis, a condition caused by spinal degeneration induced by ageing which can cause pain and discomfort. [4]

In older adults, the decision to treat scoliosis is more nuanced – although de-novo scoliosis does progress, cases tend to do so more slowly, hence the main issue to be addressed is often pain. Approaches such as bracing can be an excellent option here, but they do come with a cost – for some older adults with only mild discomfort from their scoliosis the cost of bracing base treatment may therefore be too high to justify, although an exercised based approach can be an excellent compromise between cost and results.

 

 

[1] Progression risk of idiopathic juvenile scoliosis during pubertal growth, Charles YP, Daures JP, de Rosa V, Diméglio A. Spine 2006 Aug 1;31(17):1933-42.

[2] Sperandio EF, Alexandre AS, Yi LC, et al. Functional aerobic exercise capacity limitation in adolescent idio- pathic scoliosis. Spine J. 2014;14(10):2366–72. PubMed doi:10.1016/j.spinee.2014.01.041

[3] SARAIVA, BA; et al. “Impact of Scoliosis Severity on Functional Capacity in Patients With Adolescent Idiopathic Scoliosis”. Pediatric Exercise Science. 30, 2, 243-250, May 2018

[4] ‘Scoliosis in adults aged forty years and older: prevalence and relationship to age, race, and gender‘
Kebaish KM, Neubauer PR, Voros GD, Khoshnevisan MA, Skolasky R, Spine 2011 Apr 20;36(9):731-6.

‘The prevalence and radiological findings in 1347 elderly patients with scoliosis‘
Hong JY, Suh SW, Modi HN, Hur CY, Song HR, Park JH.,  Journal of bone and joint surgery 2010 Jul;92(7):980-3

 

How to treat degenerative scoliosis?

Posted on January 14, 2021 by - Blog

Degenerative (sometimes called De-Novo) scoliosis is one of two main types of adult scoliosis. De-Novo roughly means “new” so degenerative scoliosis is a type of scoliosis which develops over time as a result of degeneration in the spine. The other kind of adult scoliosis is known as Adolescent Scoliosis in Adult (ASA) – and refers to scoliosis which started at a younger age, but was not treated (or was not treated successfully).

 

What is De-Novo scoliosis?

Degenerative scoliosis is fundamentally due to wear and tear on the spine, but it is also strongly associated with a variety of conditions. Osteoporosis, degenerative disc disease, compression fractures and spinal canal stenosis have all been implicated in the development of degenerative scoliosis.

Since De-Novo scoliosis is a consequence of spinal degeneration with age, it rarely presents before 40 years of age – although, in patients with no known history of scoliosis, differentiation from degenerative idiopathic scoliosis may be difficult. It is thought that as many as 40% of over 60’s suffer from de-novo scoliosis.[1]

 

How is De-Novo scoliosis diagnosed?

While most forms of scoliosis are not usually associated with severe pain, De-novo scoliosis is often discovered as the result of a back-pain investigation. Patients with degenerative De-Novo scoliosis typically present with complaints ranging from debilitating back or lower extremity pain to spinal imbalances, as well as as a response to incidental findings on lumbar radiographs. As usual scoliosis will be diagnosed by a combination of physical examination and X-ray or imaging techniques. In the case of De-Novo scoliosis, a thorough examination of the patient’s medical history will help to determine any underlying condition which is implicated in the development of scoliosis.

Counter-intuitively, the pain caused as a result of adult scoliosis is not related to the size of the curve. Several good studies show there is little to no relationship between the size of the curve and the intensity of pain – therefore a 20 degree and a 55-degree curve have the same chance of causing pain in an adult. This means that visual observation is not always sufficient to rule out scoliosis in adults, and professional consultation is the best approach.

Adult scoliosis patients will typically experience significant back pain and stiffness. As spinal degeneration increases, the intervertebral 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 the spinal cord is squeezed so the patient experiences heaviness in the legs, leg pain and difficulty walking

 

How is De-Novo scoliosis treated?

To achieve effective treatment for adult scoliosis, it is important to be able to differentiate between the symptoms that are caused by the degeneration of the spine as 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. Without treatment, we can estimate the increase in curvature to be approximately 0.82° per year, leading to a significant deformity over a period of, say, 10 years.[2]

The good news is that Recent advances in non-surgical treatment have shown significant improvement in terms of reduction of pain and symptoms in those with adult scoliosis.  One approach involves the patient learning how to self-correct their abnormal posture, not just strengthen their lower back or core. The most effective approach would be the use of customised brace, such as a ScoliBrace which helps to support the posture in a more comfortable position, pain is reduced (even with part time bracing)[3] 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.

 

 

[1] ‘Scoliosis in adults aged forty years and older: prevalence and relationship to age, race, and gender‘
Kebaish KM, Neubauer PR, Voros GD, Khoshnevisan MA, Skolasky R, Spine 2011 Apr 20;36(9):731-6.

‘The prevalence and radiological findings in 1347 elderly patients with scoliosis‘
Hong JY, Suh SW, Modi HN, Hur CY, Song HR, Park JH.,  Journal of bone and joint surgery 2010 Jul;92(7):980-3

[2] Progression risk of idiopathic juvenile scoliosis during pubertal growth, Charles YP, Daures JP, de Rosa V, Diméglio A. Spine 2006 Aug 1;31(17):1933-42.

[3] Scoliosis bracing and exercise for pain management in adults—a case report
Weiss et al, J Phys Ther Sci. 2016 Aug; 28(8): 2404–2407