Features October 2018 Issue

Adult Scoliosis: Are You Behind the Curve?

Millions of older adults live with curvature of the spine, yet most don’t know they’ve got scoliosis.

If you attended middle school in the 1960s, 70s, or 80s, you may remember the ritual scoliosis screening: You’d raise your shirt and bend over in front of a medical professional, who’d look for the telltale asymmetry in your lower spine or shoulders that signaled a spinal curvature.

Your risk for scoliosis hasn’t gone away now that you’re an adult. Nearly 70 percent of adults ages 60 and over have evidence of a curved spine on X-ray.

The Roots of Scoliosis

Your spine is made up of a series of stacked bones, called vertebrae. The bones are connected by joints, and cushioned by shock-absorbing pads called disks that sit in between each vertebra.

scoliosis

© urfinguss | Getty Images

Correct High Hip Severe Scoliosis

Everyone’s spine has natural, subtle curves. In scoliosis, there is a sideways C- or S-shaped curve. In adults, the curve can be a continuation of childhood scoliosis (called adult idiopathic scoliosis), or it can develop later in life due to wear and tear on the spinal disks and joints (called adult degenerative scoliosis).

“The bigger group is patients who develop degenerative scoliosis,” says R. Douglas Orr, MD, a physician at the Cleveland Clinic Center for Spine Health. “As the spine degenerates, you start to lose height in your disks. In some people, the disks collapse asymmetrically.”

Damage to the disks can cause symptoms like back pain, numbness and shooting pain down your legs (if the collapsed disks press on nerves that supply feeling to your legs). But generally, “you won’t have any symptoms and you’ll have no idea you’ve got scoliosis unless you have an X-ray for another condition,” says Dr. Orr.

It’s Not About the Curve

Treating scoliosis in children has everything to do with the curve. Kids with a curve of more than 25 degrees will typically wear a brace. Those whose curve is greater than 50 degrees may need surgery.

That’s not the case in adults. “We don’t treat the deformity unless it is causing symptoms,” Dr. Orr says. “In many cases, the deformity is not the cause of symptoms.” To decide whether treatment is needed, your doctor will consider how much pain you’re in from spinal degeneration, and whether you’re balanced–in other words, if your head is positioned squarely over your hips. It’s harder to hold your body upright when you’re out of balance.

Treating Symptoms

Doctors almost never recommend back braces for adults. They can actually worsen the problem. Any brace that provides support means you’re not using the muscles. “Muscles you don’t use get weaker, and weak muscles cause pain,” says Dr. Orr.

Instead, your doctor will start with conservative treatments like physical therapy, anti-inflammatory drugs, such as ibuprofen (Advil®, Motrin®) or naproxen (Aleve®), and nerve medications like gabapentin (Neurontin®) for leg pain. “When surgery is considered, you’ll get the least invasive procedure possible,” says Dr. Orr.

Two common surgeries used to treat scoliosis are decompression and spinal fusion. Decompression removes the degenerated disk or bone that’s pressing on spinal nerves. It’s often combined with spinal fusion, which welds together two or more vertebrae to stabilize the spine.

Odds are you’ll never need a procedure. “For the majority of people, scoliosis is not going to be an issue,” says Dr. Orr. “For most, we can manage their symptoms without getting to the point of surgery.”

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