FAQs on Adult Scoliosis and Treatment in Nashville

Adult scoliosis, often called degenerative scoliosis or adult degenerative scoliosis, occurs frequently in adults 60 years old and older. This type of scoliosis develops after skeletal maturity. The prevalence of adult scoliosis among older adults is reported at 37%. The healthy, normal spine is straight when viewed from the front or back. Scoliosis is a lateral (side) deviation of the spine, where a curvature forms. When the spinal curve is mild, it is not easy to detect without an x-ray, whereas moderate to severe scoliosis causes notable asymmetry of the back.

What are the symptoms of adult scoliosis?

Visible signs of scoliosis include a curvature of the spine, a tilted waistline, and skin folding of the back region. The symptoms associated with adult scoliosis are due to the wear and tear (degeneration) of structures that support the spine. With aging, the disc spaces between the vertebrae narrow along with wearing of the joints. This make it difficult for nerves to pass, which is called stenosis. Spinal stenosis is one of the main causes of back pain, as well leg numbness, weakness, and tingling.

How is scoliosis evaluated?

To diagnose scoliosis, the spine specialist will obtain x-rays of the entire spine in the standing position. A diagnosis of adult scoliosis is made when the x-rays reveal spinal curvature of greater than 10 degrees. For patients with leg symptoms or problems walking, further diagnostic tests may be done to evaluate the spinal canal and nerves, such as computed tomography (CT) or magnetic resonance imaging (MRI).

How is adult scoliosis treated?

Treatment of adult scoliosis involves alleviating the various symptoms associated with the condition, as not everyone with a curved spine has back pain. However, treatment options include:

  • Physical therapy – The doctor may order a back strengthening program through physical therapy. This involves reconditioning the muscles of the spine, as well as improving support and posture. The therapist usually works with the patient for several months.
  • Back brace – Bracing helps reduce spine motion and provides increased support. This will not eliminate the need for physical therapy, however. Because some people are uncomfortable in a brace, it may be a good idea to begin wearing it for only 1-2 hours at a time, and gradually increasing the time until you tolerate the brace most of the day.
  • Medications – Mild pain from adult scoliosis is treated with nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen. Other medications used include muscle relaxers, narcotic pain medicines, neurogenic agents, and topical pain relievers.
  • Facet joint injection (FJI) – The facet joints are positioned between each vertebra, and they offer stability, mobility, and flexibility to the spine. Usually given in a series of three, the doctor positions small needles into the facet joint space using x-ray guidance (fluoroscopy) for correct placement. A long-acting steroid medication and a local anesthetic are instilled into the joint space. A recent clinical study showed moderate evidence for the use of FCIs for both short- and long-term pain alleviation.
  • Radiofrequency facet denervation (RFD) – Once the doctor confirms the FJI is effective, he/she places a catheter into the facet joint spaces. Once position is confirmed by fluoroscopy (x-ray guidance), the doctor first instills a long-acting anesthetic near the nerves and uses a special device to delivers radiofrequency energy onto the nerves, destroying function. Researchers conducted an observational study and found that RFD was 76% effective, lasting for six months or longer.
  • Lumbar sympathetic block – The doctor positions small needles through the skin and soft tissues of the low back. Once in position (verified by x-ray guidance), an anesthetic agent is instilled to confirm effectiveness. Then, the doctor instills a neurolytic substance to destroy the lumbar sympathetic nerves. This procedure was found to relieve pain in more than 66% of patients, according to a clinical study.

Resources

Birknes, JK, Harrop JS, White AP, et al. (2008). Adult degenerative scoliosis: a review. Neurosurgery, 63(3), 94-103.

Boswell MV, Colson JD, Sehgal N, Dunbar EE, & Epter R (2007). A systematic review of therapeutic facet joint interventions in chronic spinal pain. Pain Physician, 10(1):229-53.

Kobayashi T, Atsuta Y Takemitsu M et al. (2006). A prospective study of de novo scoliosis in a community based cohort. Spine, 31(2), 178–182.

Ploumis A, Transfledt EE, & Denis F (2007). Degenerative lumbar scoliosis associated with spinal stenosis. Spine Journal, 7, 428–436.

Riew KD, Park JB, Cho YS, et al. (2006). Nerve root blocks in the treatment of lumbar radicular pain. A minimum five-year follow-up. J Bone Joint Surg Am, 88(8), 1722-1725.

Streitberger, K, Muller, T, Eichenberger, U, Trelle, S., & Curatolo, M (2011). Factors determining the success of radiofrequency denervation in lumbar facet joint pain: a prospective study. European Spine, 20(12), 2160-2165. doi:  10.1007/s00586-011-1891-6