Neel Anand, M.D.
Idiopathic scoliosis involves an abnormal curvature of the spine as well as a rotation of the vertebral bodies.
Although many people are familiar with scoliosis as a disease affecting school-aged adolescents, it can and does affect adults, too, even if they didn't have it as a child. The disease in adolescents and adults is marked by the same parameter (an abnormal curvature of the spine), and both types can become quite painful and debilitating. However, certain differences do exist between adult and adolescent scoliosis populations with regards to onset, diagnosis and treatment recommendations. Understanding these differences can help paint a clearer picture of what is physiologically taking place in the spine and how best to address it. Let's look at the three main categories of scoliosis and how they relate to each other:
The most common form of scoliosis that affects adolescents is idiopathic scoliosis – a form of the disease discovered in early childhood, with no determinable origin. Idiopathic scoliosis involves an abnormal curvature of the spine as well as a rotation of the vertebral bodies. When this form of the disease continues into adulthood (due to the condition not being treated early or even going unnoticed during childhood or adolescence), it's referred to as adult idiopathic scoliosis, which is also one of the two most common forms of scoliosis seen in adults.
The other common scoliosis form seen in adults is referred to as degenerative scoliosis. As the name suggests, this type of scoliosis usually develops during adulthood as the result of asymmetrical aging/degeneration of the spinal discs (those gel-like cushions between each of the vertebrae in the spine), causing tilting of the vertebrae and eventually resulting in spinal curvature. Other conditions, such as degenerative disc disease or small compression fractures of the spine due to osteoporosis, can also cause changes to the symmetry of the vertebrae and sometimes act as catalysts for this type of scoliosis.
The main goal in the treatment of both idiopathic and degenerative types of scoliosis remains the same: to restore and maintain a natural alignment of the spine with the head balanced over the pelvis. However, there are some variations in when and why surgical treatment of the disease is recommended.
For adolescent scoliosis, surgical treatment is usually recommended once the curvature of the spine becomes greater than 40 to 50 degrees or is progressing rapidly. Treatment at this point is critical to help the patient avoid the development of debilitating or disabling symptoms as they progress into adulthood. On the other hand, the type of scoliosis treatment recommended to adults is usually governed by the presence of pain, and most patients with adult scoliosis do not require surgery. In fact, the discovery of a slight scoliosis curvature in adults who aren't experiencing symptoms is often made in imaging studies or examinations for an unrelated issue. Now, it's important to note here that for any type of physical deformity to resolve, surgery will be necessary. Unfortunately, spinal deformity will not go away on its own, nor will a deformity be "cured" by a brace, exercise or physical therapy. For adults, if pain is a bigger concern than deformity, non-surgical options such as physical therapy, acupuncture, exercise and massage can be tried first. In fact, it's recommended that patients try non-surgical treatments for at least 3 to 6 months before making the decision to undergo spine surgery. If non-surgical options have failed to relieve the severe back pain associated with adult scoliosis within that time frame, surgery may be recommended and discussed.
When scoliosis surgery is the path a patient takes to resolve the pain and deformity associated with the disease, I am pleased to confidently reassure patients that surgical treatment of scoliosis has evolved immensely over the past few decades, and can now (in most cases) be treated using minimally invasive techniques. These techniques include smaller incisions that enable surgeons to preserve delicate tissues surrounding the spine, reduce the risk of some complications and aid in the patient's ability to recover faster, usually with a fraction of the pain often associated with "open" surgical correction of scoliosis. As always, open communication with a skilled, experienced and trusted spine surgeon will best guide you down the path to an accurate diagnosis/classification of adult scoliosis, as well as appropriate treatment plan options.