What Is The Outlook For Adult Scoliosis
The outlook for adult scoliosis can vary depending on the type and severity of symptoms. Non-operative treatment, with modalities such as physical therapy, a regular exercise program, and over the counter anti-inflammatory medications is always the first line of care. Maintaining an ideal body weight and maintaining a regular exercise program are excellent ways to minimize symptoms associated with adult scoliosis.
Surgical treatment of adult scoliosis can improve a patients quality of life and deal with pain connected to the condition. The results of adult spinal deformity surgery are typically very good, if done well and for the right reasons. With that said, the surgeries are associated with significant risk, and should be avoided if at all possible.
Last reviewed by a Cleveland Clinic medical professional on 09/25/2019.
References
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What Are The Symptoms
Scoliosis is not a single disease. It falls along a spectrum, from mild to moderate to severe. Symptoms include pain or stiffness in the mid-to-lower back, and numbness or weakness in the legs or feet. Not all adults with degenerative scoliosis experience pain. When pain does occur, a pinched nerve is typically the cause, not the curvature.
In more severe cases, scoliosis can cause shooting pain down the leg , an inability to stand up straight, and an inability to walk more than a short distance. Symptoms of severe, progressive scoliosis are similar to those of stenosis, but with visible spinal imbalance. This imbalance can result in strain on the hips and knees, the inability to walk a straight line, and falls.
Patients with kyphosis have lost their ability to stand up straight. Hunched over while standing, they may become quickly fatigued and have difficulty talking to others or maintaining eye contact. They also may have difficulty lying flat.
Common Symptoms Of Scoliosis In Adolescents
Remember, scoliosis can range in severity from mild to moderate and severe to very severe, and experienced symptoms can also vary based on important patient/condition characteristics such as patient age, curvature location, severity, and causation.
In adolescent idiopathic scoliosis, the most common symptom, and earliest sign of scoliosis, is postural deviation.
As scoliosis introduces a lot of uneven forces to the body, the main visual effect is a disruption to the bodys overall symmetry.
The earliest telltale signs of scoliosis in adolescents can include:
- Uneven shoulders
- Uneven waistline
- Arms and legs that appear to hang at different lengths
As a result of these types of postural deviations, clothing can become ill-fitting, and changes to gait, coordination, and balance can also develop.
Now, in terms of back pain, as mentioned, back pain isnt a common part of the adolescent experience of life with scoliosis, and this is because it doesnt become a compressive condition until adulthood when skeletal maturity has been reached.
While still growing, the lengthening motion of a growing spine counteracts the compressive force of a scoliotic curve, which is why most young patients with scoliosis dont experience back pain.
So now, lets move on to addressing back pain and scoliosis in adults.
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Rates Of Idiopathic Scoliosis Rise Dramatically With Age
A 2014 review published in American Family Physician found that approximately 85% of scoliosis cases are classified as idiopathic, or of unknown cause.1 So, 85% of the people who get diagnosed with scoliosis get no explanation as to what has caused it.
The same review found that between 2% and 4% of teenagers have scoliosis. According to a retrospective study done at Johns Hopkins University, the rate of scoliosis increases to more than 8% in adults over the age of 40.7 And a 2005 study of 75 healthy adults over the age of 60, with no previous diagnosis of scoliosis or spinal surgery, found the rate of scoliosis to be 68%.8
This increasing prevalence with age is a strong indicator that muscular contraction from repetitive activities, injury, and stressthe effects of which increase with ageplay a role in developing the condition.
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Scoliosis Pain Management Treatment
Depending on the type of pain, there are treatments called complementary therapies that might help, in addition to pain medication. These include things like hydrotherapy and massage and are usually done alongside medical treatments.
An exercise that strengthens the core muscles such as yoga, Pilates, stretching, and swimming can also help with back pain.
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The Relationship Between Scoliosis And Sciatic Pain
Scoliosis is a spinal condition that leads to a curvature that can cause pinching and constriction along the vertebrae.
Sciatic pain is a source of extreme discomfort and sensitivity along the sciatic nerve. This nerve starts in the lower lumbar spine, leading down near the heel of both legs.
So, what is the relationship between scoliosis and sciatic pain? Since scoliosis pinches and compresses the spine indirectly through unnatural curvature, it can squeeze the sciatic nerve. This squeezing produces troubling sciatic pain that can often be debilitating for people who have scoliosis.
The symptoms of sciatic nerve pain can be similar to the symptoms of scoliosis. If you want to learn the causes, symptoms, and treatments of scoliosis and sciatic nerve pain, read on.
Summary Recap Can We Help You
Scoliosis is a lateral curvature of the spine of 11 degrees or more. Scoliosis is usually discovered during adolescence and is called idiopathic scoliosis, a fancy term meaning the doctor has no idea what caused scoliosis.
In common language, scoliosis means that the spine is crooked. The spine is held together by the same thing that holds all the bones together, ligaments. The patient often experiences pain at the site where the spine curves. At the apex of this curve, the ligaments are being stretched with scoliosis, and localized ligament weakness is one of the etiological bases for it.
Traditional treatments for scoliosis, especially during adolescence, include observation, bracing, and surgery Observation of a crooked spine does not sound very helpful, bracing has been shown to decrease the progression of mild scoliosis, and surgery involves placing big rods in the back to stabilize the spine. Surgery is generally utilized for severe scoliosis when bracing has failed to stop the progression.
We hope you found this article informative and it helped answer many of the questions you may have surrounding your back problems and spinal instability. If you would like to get more information specific to your challenges please email us: Get help and information from our Caring Medical staff
Brian Hutcheson, DC | Ross Hauser, MD | Danielle Steilen-Matias, PA-C
References:
This article was updated July 19, 2022
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Back Pain And Scoliosis In Adults
As mentioned, once skeletal maturity has been reached, meaning the body and spine is no longer growing, the condition becomes compressive.
What this means for adults with scoliosis is that the condition is likely to cause compression, not just of the spine but also its surrounding muscles, ligaments, and nerves.
The most prevalent form of scoliosis in adults is idiopathic, and these patients are cases of AIS that went undiagnosed and untreated during adolescence.
Idiopathic Scoliosis in the Adult
While it might seem difficult to imagine that a person could mature through adolescence with scoliosis unaware, remember, there are varying degrees of scoliosis, some mild, and in AIS, mild scoliosis isnt known to cause overly-noticeable postural changes, functional deficits, and as explained, the condition isnt commonly painful.
Although no one wants to experience pain, it does serve a purpose when it comes to early detection and diagnosis, which is why so many cases of AIS go unnoticed and undiagnosed until adulthood, when the condition becomes compressive and starts causing more-noticeable symptoms, like back pain.
The unfortunate reality is that had these patients received treatment during adolescence, their spines would be in far better shape than by the time they come to see me: before significant progression has occurred, before the spine has become more rigid, and prior to the body has had time to adjust to the unnatural spinal curves presence.
Degenerative Scoliosis
Scoliosis And Back Pain Current Opinion
Research is unclear, but many believe scoliosis causes back pain
For some time, it has been suggested that scoliosis might be responsible for back pain. Although the issue has been debated, some evidence suggests there is a link A recent study of almost 2000 patients less than 21 years-old referred for a spine evaluation reported that when an underlying condition was identified as the cause of the pain, the most frequent diagnosis was scoliosis , followed by Scheuermanns kyphosis.
Although this evidence suggests there may be a link, other studies which have considered the issue have produced mixed results. On the one hand, Ramirez et al. reported on more than 2400 subjects with AIS. Of these, 23 % reported back pain at the time of diagnosis a substantial number. An additional 9%, initially free of pain and managed with observation alone, developed pain during follow-up.
Sato et al. examined more than 30,000 adolescents with various spinal issues and concluded that the subgroup with scoliosis had an approximately 3 to 5 fold increased risk of back pain in the upper and middle right part of the back.
On the other hand, Lonner et al. compared three groups of adolescents including 894 with AIS and 31 control individuals without, when considering pain score using the SRS pain score method, they found that the differences between the AIS and control group were not significant.
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Muscle Degeneration At The Local Level
An August 2021 paper in the Global Spine Journal investigated the effect of paraspinal muscle degeneration in degenerative lumbar scoliosis cases where patients had corrective surgery. In this study:
- 98 degenerative lumbar scoliosis patients were examined through an average 38.3 months follow-up after corrective surgery.
- The T1 pelvic angle, lumbar lordosis, and pelvic incidence were measured preoperatively, immediately postoperatively, and at last follow-up.
- Patients were divided into the lumbar lordosis maintenance group and the lumbar lordosis loss group .
- Explanatory note. Lumbar Lordosis Loss or Flat Back Syndrome has been described for decades. In 1988 Dr. Michael O. LaGrone wrote in the journal The Orthopedic clinics of North America: Symptomatic loss of lumbar lordosis is a disabling complication of scoliosis surgery. This so-called flat-back syndrome is characterized by an inability to stand erect and by upper back pain. Distraction instrumentation extending into the lower lumbar spine or sacrum is the most frequently identified etiologic factor responsible for loss of lordosis.
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Adolescent Scoliosis And Pain
Adolescents with scoliosis experience pain very differently from adults with the condition. The most common age of diagnosis is between 10 and 18 years of age. This age group experiences the most rapid phase of growth, known as puberty. During this stage, the body is constantly growing and changing.
While the body is growing, the spine is experiencing an upward growth motion as the body is elongating. That upward growth is why adolescent scoliosis patients report very little, if any, pain.
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Chest Pain And Scoliosis
Particularly for scoliosis that occurs in the thoracic section of the spine , this can affect the chest. Again, the more severe a persons condition is, or if it has been left untreated for long periods of time and allowed to progress, the more likely it is that extreme symptoms such as chest pain or lung impairment will become an issue.
As an abnormal spinal curvature becomes more and more pronounced, the more the biomechanics of the entire spine is affected, and this can produce a number of seemingly-unrelated complications.
For example, as the thoracic spine bends and twists, it pulls at the rib cage more and more, contorting it and producing that rib arch commonly associated with scoliosis.
The more the ribs become affected, the more the chest can feel it in a number of ways such as pain and muscle spasms.
In extreme cases, this can also impact the lungs and the hearts pulmonary artery flow.
As the rib cage twists and contorts, the space available for the lungs is limited, and this can affect the ability to inhale/exhale deeply. This can result in a feeling of restricted pressure on the chest.
If lung function is impaired, the heart has to work harder to pump blood through the lungs, potentially causing cardiac issues.
While lung impairment and related cardiac issues arent a common symptom of scoliosis, in extreme cases, or cases that have been left untreated, chest pain caused by impairments felt by the lungs and heart can become a factor.
Scoliosis And Neck Pain
Scoliosis can, indeed, be the culprit of neck pain. Especially in cases of abnormal cervical spine positioning, neck pain can be a scoliosis symptom.
When the cervical spine has lost its healthy lordosis , it alters the positioning of the cervical spine, neck, and head. When there is a loss of the cervical spines healthy forward curve, whats known as forward head posture can be introduced with this, the neck can become straighter in an attempt to support the increasing weight of the head.
As a result, the neck muscles can become sore and strained, causing neck pain and discomfort.
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Differential Diagnosis Of Back Pain In Adult Scoliosis
Conference
In conclusion, it is not possible to predict health related quality of life in adults from their baseline pre-adult condition. Back pain is multifactorial and lumbar scoliosis could constitute a subgroup within the low back pain population . Adults with painful scoliosis need a complete clinical history, physical exploration and complementary explorations in order to establish whether their pain is related to the scoliosis or not. When pain/disability is present, some radiological parameters correlate with self-reported pain/disability and assessment of those parameters is essential to establish the relationship: deformity level and curve type according to the SRS classification for adult spinal deformity , frontal and sagittal olisthesis, lumbar lordosis , thoracolumbar kyphosis , end plate L3 obliquity , rotation, MRI degenerative changes at the apical level and junctional zones and global frontal and sagittal imbalance. Cobb angle does not correlate with back pain although those patients without pain use to present smaller curves and in some studies incidence and degree of back pain was higher in more severe curves . Age did not correlate with pain although pain /disability is the main reason to go under surgery in older adult scoliosis patients. Pain/disability can be assessed by using VAS, SRS questionnaires and SF-36.
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Scoliosis And The Spine
According to the National Scoliosis Foundation, there are currently close to seven million people living with scoliosis in the United States alone. Amongst school-aged children, it is the most common spinal deformity.
Given the prevalence of the condition, many people have heard of scoliosis or know someone who has been diagnosed. What many people dont realize is just how much of an affect the condition can have throughout the body.
Any disorder that affects the brain or spine can come with a myriad of symptoms and related complications. In light of how the spine works in tandem with the brain to control virtually all working systems within the body, you can see how the effects of scoliosis can be felt in multiple areas.
When scoliosis develops, the spine has an abnormal lateral curvature with rotation this is why true scoliosis is considered a 3-dimensional condition. This leads us into discussing the various severity levels of scoliosis as this is a big factor in determining how painful a condition is.
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Surgery As A Remedy For Pain
Many people who suffer from scoliosis-related pain choose spinal-fusion surgery out of fear. Some think it might be the only option to alleviate their pain, or they feel surgery is a preemptive strike against increasing pain levels associated with aging.
I respond to these concerns by pointing out to my patients that surgery is neither their only, nor their best option. While surgery can be successful in terms of making the spine straighter, it can have a big cost in terms of flexibility, functionality, and overall body health. Often, pain at the fusion site or infection can also be prevalent and lead to further complications and subsequent surgeries.
Surgeons do their very best to minimize negative outcomes and surgical side effects, but the bottom line is that spinal-fusion surgery is costly, invasive, and has the potential to affect the body in numerous negative ways.
What Are The Symptoms Of Adult Scoliosis
Most cases of adult scoliosis dont cause symptoms, though pain may develop. Back pain occurs for many reasons including arthritis, inability to stand upright, and/or due to weakness of the core musculature and loss of conditioning. Leg pain/numbness/weakness may develop if there is pressure on the nerves in the lumbar spine.
In some cases, changes in the body may include:
- Height loss
- Uneven alignment of the pelvis and hips
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Can Chiropractic Spinal Manipulations Help Scoliosis
A December 2020 study To investigate the effect of spinal manipulation on degenerative scoliosis by evaluating patients visual analog scale scores, Cobb angles , the sagittal vertical axis which is a measurement of the spine to assess imbalance , and apical vertebral rotation and to explore factors that influence treatment effect.
What were the results of this study?
- A total of 55 patients with degenerative scoliosis received 4 weeks of spinal manipulation. Spinal manipulation relieved pain and improved sagittal imbalance in patients with degenerative scoliosis. It did not lessen the severity of coronal curvature of vertebral rotation.
An earlier study suggested: that Spinal leveraging manipulation for degenerative scoliosis could regulate muscle balance on both sides of the spine, correct coronal imbalances in the spine, recover the normal sequence of the spine, reduce and remove oppressions and stimulation of nerve root, relieve pain in leg and waist and further improve quality of life.
A May 2022 paper investigated chiropractic care for scoliosis.