A certain degree of curvature is normal in the human spine. When you look at your body from the side, you can see the gentle inward and outward curves of the neck, upper back and lower back, which are necessary for keeping the body properly balanced and aligned over the pelvis. But when viewed from the back, the vertebrae of a healthy spine should form a straight line.
In someone with scoliosis, the spine looks more like an “S” or a “C” than an “I”. The vertebrae involved in the curve also may rotate to some degree, which can further contribute to the appearance of an uneven waist or shoulders.
There are several warning signs that may signal the development of adult scoliosis. They include:
There are a variety of reasons why scoliosis may develop in adults. Curvature in the mature spine may be:
Should you notice any one or more of the above potential indicators of scoliosis, please make an appointment with your doctor for a thorough spinal and physical examination.
If scoliosis is suspected, the diagnosis can be confirmed using diagnostic tools such as x-rays, computed tomography (CT) and magnetic resonance imaging (MRI). To determine the extent to which a curve has progressed, it’s measured using the Cobb Method and categorized in terms of degrees. Generally speaking, a curve is considered significant if it is greater than 25 to 30 degrees. Curves exceeding 45 to 50 degrees are considered severe and often require more aggressive treatment.
For those who have already reached skeletal maturity, the considerations and goals of treatment are somewhat different than those whose bones are not yet fully formed. There are a variety of options for treating adult scoliosis, including surgery. However, most surgeons view surgery as a last resort, and usually recommend non-surgical treatment, such as medication, exercise, physical therapy and/or bracing as the first line of defense against the pain and physical symptoms that may accompany a curved spine.
Spine surgery for scoliosis is a major undertaking for adults, and the likelihood of post-surgical complications following spinal surgery for adult scoliosis tends to increase with age. With advancing age, degenerative changes may lead to stiffening of the spine, making it less amenable to realignment and correction. If osteoporosis is a factor, as it frequently is for people – especially women – over age 65, it may be difficult for surgeons to successfully attach the instrumentation required for the surgical procedure to the vertebral bodies.
Your surgeon may consider surgical correction if:
Surgical goals for treating adult scoliosis typically include:
Toward this end, your spine surgeon may recommend spinal fusion, the goal of which is to correct the spinal deformity as much as possible and fuse, or join together, the vertebrae in the curve to be corrected. The procedure involves approaching the spine either from the front (anterior approach), the back (posterior approach) or both. Your procedure may be minimally invasive, and/or also involve a discectomy (removal of disc material, a procedure that may be included in an anterior approach) to relieve pressure on the spinal cord.
The decision to treat adult scoliosis surgically requires careful consideration between you and your doctor. Factors to be considered include your specific condition and overall physical health. Discuss your condition thoroughly with your doctor, and rely on his or her judgment regarding which treatment option is most appropriate.
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