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How to Manage Adult Scoliosis

You may remember reporting to the nurse in middle school to be evaluated for scoliosis. If you were diagnosed with scoliosis in childhood, you likely wore a plastic brace as you grew. When most people hear of scoliosis they think of a younger teenager, but adults can develop scoliosis, too.   

“Adult scoliosis isn’t a new diagnosis, but it’s still growing in recognition. The treatment for adults is much different than the treatment for adolescents,” says Brigham and Women’s Hospital (BWH) neurosurgeon John Chi, MD, MPH.

What is adult scoliosis? 

Scoliosis is commonly referred to as an adult deformity. It’s defined as an abnormal curvature of the spine. The spine is naturally curved, but individuals with scoliosis have curves that cause it to bend from side-to-side in an unnatural “C” or “S” shape (see picture). Any curve beyond 20 to 25 degrees is considered abnormal. 

“In adolescent patients, the deformity is often painless and causes more of a cosmetic problem, but adult patients with scoliosis may seek care because of pain and neurologic dysfunction,” says James D. Kang, MD, a spine specialist and Chair of the Department of Orthopaedic Surgery at BWH. 

Why does scoliosis develop in adulthood? 

While scoliosis can sometimes be hereditary, or the result of a past trauma, the primary cause of adult deformity is aging, or natural wear-and-tear, as well as degenerative arthritis that occurs within the joints of the spine.

“As a result of natural degeneration and arthritis, mild scoliosis is fairly common in advanced age. For some patients, however, deformity can progress and develop into spinal stenosis where nerves begin to get pinched,” says Dr. Kang. 

The primary symptom of scoliosis is pain in the legs caused by these pinched nerves, as well as low-back pain. Some scoliosis patients may not experience symptoms. To diagnose scoliosis, doctors use X-ray and MRI imaging. 

What are the treatment options for adult scoliosis?

There are two main treatment options for adults with scoliosis: Surgery and non-surgical interventions. 

“Only a small percentage of patients with adult scoliosis will ever need surgery, but if surgery is deemed necessary it’s generally due to dysfunction related to back and leg pain,” explains Dr. Kang. “Patients who need surgery can benefit tremendously, but surgery is most likely not the best option for more than 90 percent of adults with scoliosis.”

For patients who are considering surgery, Dr. Chi and Dr. Kang always remind them that spinal surgery is a major event. These are invasive surgeries, so the decision can warrant a second or third opinion. Both spine specialists counsel patients and help them deeply consider the surgical option.

Types of surgery

The most common spinal surgery used to treat scoliosis is spinal fusion. During this procedure, the spine is fused to bone grafts or substitutes to hold the spine in a straighter position. Fusion is often incorporated into other surgical procedures, including, but not limited to:

  1. Decompression fusion: Pressure is relieved by removing nerves or tissue pressing on the spine, followed by fusion. This procedure is typically performed when the deformity is not severe, and the priority is to relieve symptoms from spinal stenosis (leg pain).
  2. Surgical stabilization: If scoliosis becomes more severe, screws and rods can be attached to the spine, which are then linked together by metal rods, followed by fusion.
  3. Osteotomy: Osteotomy is the surgical cutting of a bone. To operate on the spine, a surgeon cuts vertebrae so that the spine can be bent into the desired position and then fused into place. This procedure is performed when the deformity must be corrected beyond what rods and screws can achieve.
  4. Vertebral column resection: In this procedure, entire sections of vertebrae are removed, followed by a realignment of the spine by osteotomy and then fusion. This procedure is reserved for the most severe deformity, and can carry a higher complication rate.  

If you are considering surgery, there are three things to keep in mind:

1. Surgery is the right option for a very select group of people.   

“Surgery is invasive. It’s not the best option for most adult scoliosis patients. If you’ve had scoliosis your whole life, you most likely won’t need surgery in your later years. However, if you were diagnosed earlier and your condition is worsening, you may be an appropriate candidate for surgery,” says Dr. Chi.

2. Make sure you fully understand spinal surgeries and the possible complications. 

For more advanced scoliosis deformities, there’s a 30 to 40 percent complication rate following complex invasive spinal surgery. Such complications may include: damage to the rod and screws, and/or breakdown at the ‘stress points,’ which are the junctions where a surgeon has finished the fusion. Both complications require additional surgery. In rare cases, paralysis may occur.

3. Choose an experienced team you feel you can trust.  

Drs. Chi and Kang both encourage patients to research the available spinal surgeries and the background and experience of surgeons before making a commitment to a surgical team.

Pain management for scoliosis

Most patients with scoliosis have mild forms of the condition that are easily treatable with conservative treatment. For these individuals, there are many options for managing pain and improving posture.  

According to Drs. Chi and Kang, it’s best to exhaust the following non-surgical, conservative treatments before consulting with a surgeon.   

A simple lifestyle change that can lower your risk of developing adult scoliosis 

Posture plays a role in back deformity. It’s difficult to avoid bad posture today. We bend our necks to use our phones, we slouch at our desks, and we often lift more than our backs can handle.  

Be thoughtful about your posture during your day-to-day activities. Drs. Chi and Kang advise patients with back pain to stand up straight, even if they experience stiffness. With practice and awareness, the back can be conditioned to maintain better posture. The proper way to hold your body is to keep your head over your shoulders and your shoulders over your hips.   

“With physical therapy and exercise, you can maintain better posture and thereby help prevent the need for surgery, because it’s possible to feel better once you’re in better posture,” says Dr. Chi.

Scoliosis treatment at BWH  

Prior to undergoing spine surgery, an orthopaedic surgeon or neurosurgeon can provide alternative treatment options. Both alternative and surgical treatment options are available at the Comprehensive Spine Center at Brigham and Women’s Faulkner Hospital. 

The Comprehensive Spine Center brings together a multidisciplinary team of neurosurgeons, orthopaedic surgeons, physiatrists, pain specialists and physical therapists to help patients with a variety of spinal disorders, including adult scoliosis.

- Anna G.