Understanding Adult Spinal Curvature
Many people are familiar with scoliosis as a condition affecting adolescents, but it can also manifest or progress in adulthood. The key difference lies in the cause. While adolescent idiopathic scoliosis (AIS) has an unknown origin, adult spinal curvature is often a result of natural aging and degenerative changes. There are two primary categories of adult scoliosis: adult idiopathic scoliosis, which is a progression of a pre-existing childhood curve, and de novo or degenerative scoliosis, which is a new curvature developing in adulthood.
Degenerative Scoliosis: A Deeper Look
Degenerative scoliosis, the most common type of adult spinal curvature, typically occurs after age 40 and is driven by the breakdown of the spine's structural elements. The intervertebral discs, which act as cushions between the vertebrae, lose water and shrink over time. When this happens unevenly, it can cause the vertebrae to tilt, rotate, and shift out of alignment, leading to a new sideways curve. This asymmetric degeneration can lead to nerve compression, causing pain and other neurological symptoms.
The Role of Kyphosis
Beyond the sideways C- or S-shaped curve of scoliosis, adults can also develop kyphosis, an excessive forward rounding of the upper back. This is often what people refer to as a "dowager's hump". Kyphosis can develop with age as spinal disks degenerate and vertebrae weaken. One of the most significant risk factors for adult kyphosis is osteoporosis, which can cause vertebral compression fractures that lead to a hunched posture. Kyphosis can occur independently or in conjunction with scoliosis, a condition known as kyphoscoliosis.
Factors That Contribute to a Curved Spine Later in Life
Several factors can contribute to the development or progression of a curved spine in adulthood:
- Age: The natural wear and tear on the spinal discs and joints is the primary driver of degenerative scoliosis. Discs lose height and elasticity, and facet joints can develop arthritis, leading to instability and misalignment.
- Osteoporosis: This condition weakens bones, making them fragile and more susceptible to compression fractures in the vertebrae. These fractures can cause the spine to curve forward, resulting in kyphosis.
- Genetics: While the cause of idiopathic scoliosis is unknown, genetics are believed to play a role, and a family history can increase risk.
- Lifestyle: Poor posture over many years can contribute to spinal issues. Additionally, smoking is known to cause degenerative changes in the spine, and maintaining a healthy weight can reduce strain.
- Previous Surgery: In some cases, previous spinal surgeries can lead to instability or unequal load-bearing on the spine, causing a curve to develop or worsen over time.
Symptoms of a Curved Spine in Adults
Unlike childhood scoliosis, which is often painless, adult spinal curvature typically presents with symptoms related to nerve compression and instability. Common symptoms include:
- Back Pain: This is the most common symptom and may be worse when standing or walking and relieved by lying down.
- Uneven Posture: Visible signs can include uneven shoulders or hips, one arm hanging lower than the other, or a prominent rib hump when bending forward.
- Leg Pain and Numbness: As the curve progresses, it can pinch nerves, causing shooting pain, tingling, or weakness in the legs and feet, a condition known as sciatica or neurogenic claudication.
- Fatigue: The muscular effort required to maintain balance with a curved spine can cause fatigue, especially in the lower back and legs.
- Loss of Height: Gradual height loss can occur as spinal discs compress and vertebrae flatten over time.
Comparison of Adult Scoliosis Types
| Feature | Degenerative (De Novo) Scoliosis | Adult Idiopathic Scoliosis | Kyphosis |
|---|---|---|---|
| Cause | Asymmetric degeneration of spinal discs and facet joints due to aging | Progression of a curve that began in childhood or adolescence | Compression fractures, disc degeneration, or poor posture |
| Typical Onset | After age 40, most common after 50 | Diagnosed in childhood but becomes symptomatic later | Can occur at any age, but often associated with aging and osteoporosis |
| Curve Direction | Side-to-side (lateral) in the lumbar spine | Side-to-side (lateral) in the thoracic, lumbar, or both | Forward rounding (anterior) of the upper back |
| Primary Symptom | Back pain due to instability and nerve compression | Back pain that worsens with age as degeneration occurs | Back pain, stiffness, and potentially balance issues |
| Progression | Can progress about 1-3 degrees per year after 50 | Can progress as degenerative changes add stress to the existing curve | Can worsen over time, especially with additional compression fractures |
Treatment Options for Adult Spinal Curvature
Treatment for adult spinal curvature focuses on managing symptoms and improving function, rather than reversing the curve entirely.
Nonsurgical Treatments
For most adults, nonsurgical methods are the first course of action:
- Physical Therapy and Exercise: Strengthening core muscles, improving posture, and stretching can help reduce pain and improve mobility. Low-impact exercises like swimming and cycling are often recommended.
- Pain Management: Over-the-counter NSAIDs (nonsteroidal anti-inflammatory drugs) can help with inflammation and pain. Injections, such as epidural or nerve blocks, can provide temporary relief for leg pain caused by nerve compression.
- Bracing: A brace may be used for short-term pain relief by providing support, but it does not correct the curve in adults.
- Lifestyle Changes: Maintaining a healthy weight, avoiding smoking, and practicing good posture are important for managing symptoms and slowing progression.
Surgical Treatments
Surgery is typically reserved for severe cases where pain is debilitating, the curve is progressing significantly, or there are neurological deficits that have not responded to conservative treatments. Surgical options include:
- Spinal Fusion: This is the most common surgery, involving fusing two or more vertebrae to stabilize the spine and correct the curve.
- Decompression: For cases with nerve compression, surgery may be performed to remove bone or tissue pressing on the nerves.
- Osteotomy: This involves cutting and realigning bones to correct severe deformities.
Conclusion
In conclusion, it is entirely possible to develop a curved spine later in life, primarily due to the natural wear and tear of the aging process. Degenerative scoliosis and kyphosis are common conditions that can cause significant pain and reduced mobility for older adults. While treatment strategies differ from those for adolescents, a range of effective nonsurgical and surgical options are available to manage symptoms and improve quality of life. For anyone experiencing persistent back pain, changes in posture, or leg numbness, seeking a professional medical evaluation is the first step toward a proper diagnosis and treatment plan.
How to find an expert
When seeking medical advice or treatment for a curved spine, it's best to consult with a specialist. You can find qualified orthopedic surgeons and neurologists through hospitals specializing in spine disorders, such as the Hospital for Special Surgery or the Mayo Clinic. For nonsurgical options, physical therapists specializing in spine care can also provide guidance.
