Tag: scoliosis in adults

Does Degenerative Scoliosis cause pain?

Degenerative, or “De-novo” scoliosis is the name given to a scoliosis case which develops later in life and which has a known cause. Whereas the vast majority of scoliosis cases in younger people are classified as “idiopathic” scoliosis (that is to say, a condition without a clearly defined cause) de-novo scoliosis is understood to be the direct result of spinal degeneration – the term “de-novo” simply means “new”. Usually, de novo scoliosis develops as discs and facet joints (the hinge joints at the back of the spine) start to age – often in the lumbar spine (the lower part of the spine). When discs and facet joints age the vertebrae can slip out of place, which makes the spine curve – weakening of muscles and ligaments can also help to exacerbate the condition. Research suggests that de-novo scoliosis may affect as many as 30% of the over 60’s.[1]

 

Adult, or De-novo scoliosis?

Sometimes naming conventions are less than well thought through and scoliosis in adults is just such an example. There are, in fact, two main types of scoliosis in adults – these are de novo scoliosis and adult scoliosis. Adult scoliosis is the term which refers to a scoliosis case from adolescence, which has been carried into adulthood – and is also sometimes called adolescent scoliosis in adults (ASA). The difference matters since in adult scoliosis cases, curves that are 50 degrees or more in size after a person is fully grown are likely to increase by an average of 1 degree per year, whereas curves of less than 30 degrees rarely get significantly larger. De-novo scoliosis cases tend to increase in magnitude, but the progression is less predictable. Knowing as much as possible about a patients history is therefore critical to making the right diagnosis.

 

Is de-novo scoliosis painful?

There has been a long-running debate in the field of scoliosis treatment and research – does scoliosis cause pain? Since at least the 70’s there have been opposing views on both sides of the argument all of which have presented evidence to support their claims. In many instances, there have been limitations to the studies in both camps (with sample size being the most frequent issue) but it is also the case that adolescent scoliosis often receives more attention in research. In this regard, however, it does seem to be increasingly demonstrated that pain is correlated with scoliosis – and it’s not unreasonable to suggest the same is true in de-novo cases.

In the last 5 years or so, numerous studies have suggested that…

  • Spinal pain is, in fact, a frequent condition in AIS patients, further supporting the need for early detection and screening to minimise potential pain and suffering[2]
  • In patients under 21 treated for back pain, scoliosis was the most common underlying condition (1439/1953 patients)[3]
  • In one study of 2400 patients with AIS, 23% reported back pain at their initial contact[4]
  • Scoliosis patients have between a 3 and 5 fold increased risk of back pain in the upper and middle right part of the back[5]
  • Chronic nonspecific back pain (CNSBP) is frequently associated with AIS, with a greater reported prevalence (59%) than seen in adolescents without scoliosis (33%)[6]
  • Patients diagnosed with AIS at age 15 are 42% more likely to report back pain at age 18.[7]

In truth, whether or not scoliosis causes pain is less of an issue when it comes to adolescent scoliosis since most cases in young people are noticed either as a result of screening or due to visual symptoms. In adults, however, pain may well be a significant symptom which (since “back pain” is such a common condition today) many older people simply ignore.

Perhaps the link between de-novo scoliosis and pain was best summed up in a comment by Manuel Rigo, a scoliosis clinician with the Institut Elena Salvá in Barcelona, Spain, in a presentation to the 7th international conference on the conservative treatment of spinal deformities – according to Rigo (our emphasis added):

“Adult patients attending our institution – a scoliosis-specific rehabilitation centre – could be divided into two main groups: Group I: Patients attending the clinic with a clear self-conscience of belonging to the scoliosis population because they were mostly diagnosed during childhood or during adolescence – treated or not treated-; Group II: Patients belonging to the back pain population referred to us by their doctors, mostly because they showed a bad response to general rehabilitation and such a bad response was related to a non-previously diagnosed scoliosis condition. Generally speaking, we could identify patients with idiopathic, congenital and secondary scoliosis in Group I while most of the patients in Group II have developed de novo degenerative scoliosis or scoliosis secondary to any pelvic or lower limbs biomechanical disturbance.”

Degenerative or “De-Novo” scoliosis

Therefore, while it is unclear exactly how well de-novo scoliosis and pain are correlated – pain is well worth considering as a possible symptom in older individuals. Indeed, many of our patients presenting with de-novo scoliosis do initially complain of pain. Indeed, the UK Scoliosis association now also recognises that patients with degenerative scoliosis will often also have back pain and muscle fatigue and that people with degenerative scoliosis sometimes also have back stiffness and leg symptoms, including pain, numbness, and weakness.

The positive message overall though, is that research does show that conservative approaches, such as part-time bracing can have a positive effect in reducing it where it does exist.[8] One such approach is our latest generation brace, the ScoliBrace. Unlike many scoliosis braces, ScoliBrace is a fully customised, 3D designed, CAD/CAM manufactured brace which is low profile, comfortable and easy to use, alongside specialist scoliosis exercises, part-time bracing with ScoliBrace can provide a significant improvement in quality of life for those suffering from De-novo scoliosis.

 

 

[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] Back Pain and Adolescent Idiopathic Scoliosis: A Descriptive, Correlation Study’,
Theroux Jean, Le May Sylvie, Labelle Hubert [University of Montreal, Quebec, Canada; Murdoch University, Perth, WA, Australia], Spine Society of Australia 27th Annual Scientific Meeting (8-10 April 2016)

[3] Dimar 2nd JR, Glassman SD, Carreon LY. Juvenile degenerative disc disease: a report of 76 cases identified by magnetic resonance imaging. Spine J. 2007;7:332–7.

[4] Ramirez N, Johnston CE, Browne RH. The prevalence of back pain in children who have idiopathic scoliosis. J Bone Joint Surg Am. 1997;79:364–8

[5] Sato T, Hirano T, Ito T, Morita O, Kikuchi R, Endo N, et al. Back pain in adolescents with idiopathic scoliosis: epidemiological study for 43,630 pupils in Niigata City. Japan Eur Spine J. 2011;20:274–9

[6] Jean Theroux et al. Back Pain Prevalence Is Associated With Curve-type and Severity in Adolescents With Idiopathic Scoliosis Spine: August 1, 2017 – Volume 42 – Issue 15

[7] Clark EM, Tobias JH, Fairbank J. The impact of small spinal curves in adolescents that have not presented to secondary care: a population- based cohort study. Spine (Phila Pa 1976) 2016; 41:E611–7.

[8] 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.

 

Think Scoliosis Just effects children? Think again!

While it’s true that Scoliosis is a major issue for younger people, the fact that scoliosis only affects them, or even primarily affects them isn’t quite correct. Today, for example, we know that at least one child in every school class will develop scoliosis – bud did you know that as many as 1 in 3 people over the age of 60 also suffer from scoliosis ? This means that scoliosis, while often more serious in younger people due to the high risk of progression, is actually far more frequently seen in older individuals.

 

The overs 60’s get scoliosis?

De-Novo Scoliosis

The over 60’s are certainly at a high risk of scoliosis, but you’d be forgiven for being unaware of this fact. Over the last 10 years, there has been much more interest in the treatment of adolescent and juvenile scoliosis – prominent cases such as that of Princess Eugene have certainly contributed to this attention as have numerous other celebrities who have openly discussed their childhood scoliosis. What’s been much less discussed is scoliosis in adults – a condition which primarily affects the over 60’s.
Unlike scoliosis in juveniles and adolescents (the exact cause of which is still unclear) we do know that De novo (or “new”) scoliosis is caused by wear and tear to the spine. Adults scoliosis is also worsened by wear and tear but is primarily the development of existing scoliosis, rather than an entirely new occurrence. Although the cause might be different, the symptoms are the same – scoliosis sufferers often notice undesirable physical symptoms, such as the Rib cage sticking out on one side, hips or waist sticking out and being unable to stand up straight easily. Scoliosis is also frequently the cause of back pain and discomfort, ranging from moderate to acute. Many suffers also have to live with pain in the legs or pins and needles due to nerve root pressure. That annoying back pain might, in fact, be the early signs of De-Novo scoliosis.

 

Does scoliosis in adults matter?

De-Novo scoliosis

Just as with children, the key issue is the degree of scoliosis. A very small curve may present with few if any symptoms, but, if left untreated, scoliosis can progress to such an extent that normal physical function can be impaired – first making walking and moving about difficult, and then eventually even affecting breathing.
Many adults simply accept aches and pains as part of “getting older” – but no matter the case this isn’t a smart approach. The first reason for this is that small, but persistent, aches and pains can be the first sign of a more serious problem which requires treatment. The second and more important reason is that you do not need to live your life in pain! Pain itself, while once thought not to be correlated with scoliosis is now believed to have at least some link to the condition.
Where scoliosis isn’t painful, it may also cause difficulties with movement or a noticeable postural or physical deformation of the spine which for some people can be embarrassing and stressful. The overall result for most older adults is a reduction in their ability or desire to socialise, exercise and get about day to day. This is especially problematic given that research is increasingly showing that keeping fit and active is the key to ageing gracefully and enjoying a long and healthy life.

 

Can scoliosis in adults be treated?

The good news is that through the same treatment approaches which are being used to treat adolescent scoliosis today, its also possible to treat adult scoliosis. Historically, it was thought that only surgical treatment was effective in correcting scoliosis – so with many people unwilling to go under the knife, scoliosis has become a life-limiting factor for many of us. Today, however, conservative methods such as bracing and specialist exercise programs are a time, cost and risk effective way to treat the condition.
For smaller curves, a scoliosis-specific exercise program can be an ideal intervention but by far the best option is a customised scoliosis brace, designed to gently guide the spine back into the proper alignment. Far from the braces used many years ago, our cutting edge ScoliBrace is a low profile, comfortable brace which looks more like a piece of sports equipment than a medical device. Best of all, bracing has been shown to effectively reduce scoliosis and its symptoms, and in some instances can have a noticeable impact in a matter of weeks. Pain especially seems to be reduced through part-time bracing in older adults.

 

How can I get treatment for scoliosis?

While your GP might be the first stop for most conditions (and its certainly worth a visit to rule out anything more serious) there’s a limited amount that your GP can do for you through the NHS. Instead, speak with a spinal specialist, such as a Scoliosis Clinician. At the UK Scoliosis clinic, many of our patients are adult scoliosis sufferers – so if you suspect you may be suffering from adult scoliosis, why not give us a call today and arrange a consultation?

At what age am I at the greatest risk of scoliosis?

Scoliosis, like many conditions, is most common in certain age groups – and as a consequence, we recommend that these individuals be the most careful when checking for symptoms. The simplest answer to the question is that young adults are generally considered to be at the highest overall risk – but in fact, this question is a complicated one which is worth some discussion.

 

Scoliosis and age of diagnosis

Scoliosis is a difficult condition to diagnose – in large part, this is due to the complex nature of the condition and the fact it causes an individualised, three-dimensional shift in the spine. The rate at which scoliosis develops also varies, and is usually associated with growth spurts, rather than being steady.

One major challenge with scoliosis cases is estimating exactly when the condition began. Because scoliosis is very hard to detect (unless an individual is properly screened) until it has become large enough to cause visual distortions to the patient’s body, a diagnosis is often not made until the condition has existed for some time. Ideally, we would like to know when scoliosis began, as this has an impact on future prognosis – but in most cases, scoliosis is simply classified by the time it is diagnosed, not necessarily when it actually began.

 

Scoliosis in children is typically grouped into one of three types:

Infantile scoliosis – diagnosed in children from 0 -3 years old

Juvenile scoliosis – diagnosed in children from 4 – 10 years old

Adolescent scoliosis– Diagnosed in children and young people from 10 – 18 years old

 

Scoliosis first diagnosed in individuals older than 18 is classified as adult scoliosis and could be either a case of scoliosis which has progressed undetected throughout childhood (common in younger individuals) or a case caused by degeneration of the spine and supporting structures, known as de-novo scoliosis. (Very common in the over 60’s)

 

Which age group is most at risk?

While much of the literature on scoliosis focuses on scoliosis in younger people, the statistics are clear – the most affected group is actually the over 60’s, mainly from De-Novo scoliosis. While about 3 or 4 % of young people suffer from scoliosis, nearly 40% of the over 60’s have the condition.

Statically, Infantile scoliosis is the least common of all and comprises only about 1% of all idiopathic scoliosis in children. Unlike most forms of Scoliosis infantile scoliosis is more common in males – about 60% of patients are boys.

Juvenile scoliosis is less common than adolescent scoliosis but more common than infantile scoliosis – Juvenile scoliosis comprises approximately 10-15% of idiopathic scoliosis cases and is slightly more common in younger males and older females within this age range.

Adolescent scoliosis makes up the majority of cases in young people, somewhere between 80 and 85%. Whereas infantile and younger Juvenile scoliosis cases are more common on boys, 80% of all adolescent cases are girls. The very highest point for diagnosis is around 11-12 years of age in girls and slightly later in boys.

 

Risk of progression and severity – the key factors

If it’s actually older people who are most likely to suffer from scoliosis, why does most scoliosis treatment focus on the young? It’s an important question which goes to the heart of scoliosis itself and its treatment.

Scoliosis can vary hugely in its severity and its speed of progression – but in all cases, once scoliosis has started to develop, it generally does not stop until a young person has reached skeletal maturity. This means that the younger a scoliosis patient, the longer the condition has to develop to the point at which it becomes debilitating or requires major surgery to correct.  What’s more, scoliosis is closely linked to growth spurts – often worsening substantially over just a few months during a growth phase. Since younger children have much growth ahead of them, the risk of progression is significant.

It’s this risk of progression and the initial degree of the curvature which means cases in younger people are often considered as more serious – De-novo scoliosis, the form most commonly found in older adults, while a problematic condition, tends to be much less substantial in magnitude and much slower in progression. Addressing the problem can lead to a significant improvement in quality of life, but urgency is less of a factor.

By contrast, some research has demonstrated that Juvenile scoliosis greater than 30 degrees almost always increases rapidly and presents a 100% prognosis for surgery, whereas curves from 21 to 30 degrees are more difficult to predict but can frequently end up requiring surgery, or at least causing significant disability.[i]

Today, with modern bracing technology, it has been demonstrated that timely conservative treatment with a brace is highly effective in treating juvenile idiopathic scoliosis – and research has suggested drastically different outcomes. In one recent study of Juvenile 113 patients treated with bracing, the vast majority achieved a complete curve correction, and only 4.9% of patients eventually needed surgery.[ii]

While cases detected in adolescents do have less time to develop, they are often more severe once detected (they may well have began as a Juvenile anyway) and the high volume of cases in this age range means that this group are considered to be at the most risk. It’s thought that the changes which occur during puberty may be linked to the onset or progression of scoliosis, which may account for the spike in cases in this age range. If 3 or 4% of young people in this age bracket will develop scoliosis, that’s about one in each class at school and in most cases,  there will still be enough time for scoliosis to progress to the surgical threshold or at least cause significant disability.

 

So, who is at the greatest risk?

The answer to this question is simply that everyone should be aware of scoliosis, and take the simple steps needed to screen for the condition and address it early on. Our ScoliScreen tool is a great place to start.

Scoliosis in infants is certainly rare, but obviously presents the greatest possible opportunity for the condition to worsen over time. Juvenile scoliosis is also fairly uncommon, but the prognosis is not good if the condition is not treated early on. Most younger scoliosis patients are diagnosed as adolescents, meaning that children from 11-15, in particular, should be screened regularly.

Older individuals, while likely to develop a less severe form of scoliosis, have about a 4 in 10 chance of developing the condition over the age of 60.

If you are concerned about scoliosis, why not try out ScoliScreen tool, or get in touch today to arrange a professional consultation.

 

 

[i] 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.

[ii] ‘Brace treatment in juvenile idiopathic scoliosis: a prospective study in accordance with the SRS criteria for bracing studies – SOSORT award 2013 winner‘ Angelo G Aulisa, Vincenzo Guzzanti, Emanuele Marzetti,Marco Giordano, Francesco Falciglia and Lorenzo Aulisa, Scoliosis 2014 9:3 DOI: 10.1186/1748-7161-9-3