Degenerative adult scoliosis usually begins as low back pain. While
there may also be a deformity that causes the back to look abnormal,
usually pain is what motivates patients to seek treatment. The pain is
probably not coming from the curve, but rather from the degeneration
occurring in the spine.
A combination of the degeneration of the spine and scoliosis deformity may
cause pressure
on nerves and possibly even the spinal cord. This can lead to weakness,
numbness, tingling and pain in the lower extremities. In severe cases,
pressure on the spinal cord may cause loss of coordination in the
muscles of the legs, making it difficult to walk normally.
The degeneration and the scoliosis may have caused a condition
called spinal stenosis, a narrowing of the spinal canal. Spinal
stenosis results from spinal degeneration that has led to the growth of
bone spurs. Eventually the spurs take up space in the spinal canal,
causing it to become smaller. This leads to bone pressing on the spinal
cord and its nerve roots. The lack of space lessens the nerves' supply
of blood and oxygen, which can lead to numbness and pain in both legs.
Conservative Treatment
The treatment for degenerative scoliosis is usually conservative.
Treatment commonly includes medication, exercise, and bracing to
support the spine.
If osteoporosis is present, then treatment of the osteoporosis may
also slow the progression of the scoliosis. The current recommendations
include increasing your calcium and vitamin D intake, hormone
replacement therapy, and weight-bearing exercises.
Medication
Mild pain medications may be prescribed to use as needed. Usually
strong pain medications, such as narcotics, are not recommended due to
the risk of addiction.
Physical Therapy and Exercise
Adults with scoliosis may work with a physical therapist. A
well-rounded rehabilitation program assists in calming pain and
inflammation, improving mobility and strength, and helping them do
daily activities with greater ease and ability.
Exercise has not proven helpful for changing the curves of
scoliosis. However, it can be helpful by addressing pain, posture, and
spine stabilization. Therapy sessions may be scheduled each week for
four to six weeks.
The goals of physical therapy are to help
- learn ways to manage the symptoms of scoliosis
- improve spine posture
- maximize spine stabilization
Bracing
The use of a spinal brace may provide some pain relief, but in
adults the brace will not cause the spine to straighten. Once you have
reached skeletal maturity, bracing is used for pain relief rather than
prevention. If there is a difference in the length of your legs (or if
the scoliosis causes you to walk somewhat crooked), special shoe
inserts, called orthotics, or a simple shoe lift may reduce your back
pain. Learn more about braces used to treat back problems.
Surgical Treatment
Surgery may be recommended in some cases of degenerative scoliosis,
especially if you have nerve problems that are becoming steadily worse,
uncontrollable pain, or spinal stenosis. If the nerve roots are being
irritated or pinched because of the scoliosis, surgery may be necessary
to remove the pressure.
Surgery to relieve pain from scoliosis is a controversial topic.
Spinal surgery is serious and can lead to complications. Not all
physicians consider pain reason enough to recommend surgery. If the
pain is chronic and debilitating, you can discuss this option with your
doctor. The options for surgery include laminectomy and spinal fusion.
Laminectomy is a surgical procedure used to free up or "decompress" the spinal nerves.
It is sometimes called lumbar decompression, or a decompressive
laminectomy of the lumbar spine. The surgeon removes a small section of
the bone on the back of the spine (lamina). This takes pressure off the
nerve roots. Bone spurs or fragments from a degenerated disc that are
pressing on the nerve are also removed.
Laminectomy is commonly combined with a spinal fusion to straighten
the spine and stop the progression of the curve. After taking away the
damaging pressure, two or more of the vertebrae are fused together to
provide spinal stability. Once the bones are fused, they become one
long column. Because these fused spinal vertebrae are no longer made up
of separate bones and joints, there will be no movement or flexibility
in that area.
