Understanding Scoliosis in Older Adults
Scoliosis is often associated with adolescents, but it can and does affect adults. For older adults, particularly those in their 70s and beyond, the development of scoliosis is a distinct condition with a different cause and progression. Unlike adolescent idiopathic scoliosis, where the cause is unknown, adult degenerative scoliosis is tied directly to the aging process and the wear and tear on the spinal column over time.
The Difference Between Adult and Adolescent Scoliosis
It is important to differentiate between the types of scoliosis that affect different age groups. Adult scoliosis can be categorized into a few types:
- Idiopathic scoliosis progressing into adulthood: Some individuals are diagnosed as adolescents with a mild curvature that remains stable for many years. As they age, and degenerative changes occur, this pre-existing curve can begin to progress and cause symptoms.
- Adult degenerative (de novo) scoliosis: This is the form of scoliosis that begins later in life, typically after age 50, in a person with a previously straight spine. The spine's sideways curvature is a direct result of age-related deterioration.
What is Degenerative (De Novo) Scoliosis?
De novo, a Latin term meaning 'of new,' precisely describes this condition. It affects a large portion of the elderly population as the spine naturally ages. The slow and progressive degeneration of spinal discs and facet joints leads to instability and an asymmetric collapse of the vertebral column. This causes the spine to twist and curve, leading to the condition. This process is distinct from the rapid, growth-related curvatures seen in adolescents.
Causes and Risk Factors for Scoliosis at 70
The primary driver of de novo scoliosis in older adults is the natural, cumulative effect of aging on the spinal structures. Several factors contribute to this process.
Age-Related Degeneration
Over decades of use, the components of the spine begin to wear down. This includes:
- Disc Degeneration: The soft, fluid-filled discs that cushion the vertebrae lose hydration and height. As they become flatter and less pliable, they can no longer properly support the spine. Asymmetrical disc degeneration can cause the spine to tilt and curve sideways.
- Facet Joint Arthritis: The small facet joints that connect the vertebrae can develop arthritis. Uneven arthritis in these joints contributes to the asymmetric collapse and rotation of the spine.
Osteoporosis and Compression Fractures
Osteoporosis, a condition of low bone density, is a significant risk factor, especially for post-menopausal women. Weakened bones can lead to compression fractures of the vertebrae, causing them to collapse and deform. This can worsen or initiate a scoliotic curve.
Symptoms of Adult Degenerative Scoliosis
While a mild curve may not cause any symptoms, degenerative scoliosis often manifests with specific pain patterns and postural changes. Identifying these signs is crucial for early management.
Common Pain Patterns
Unlike adolescent scoliosis, which is typically painless, adult degenerative scoliosis is frequently associated with pain. The most common symptoms include:
- Lower Back Pain: This pain is often described as a dull, aching sensation that worsens with standing and walking but is relieved by sitting or lying down. It is often caused by muscle fatigue from trying to hold the spine upright against the curvature.
- Sciatica and Leg Pain: The spinal curvature can narrow the space around the nerve roots (spinal stenosis), leading to nerve compression. This can cause radiating pain, numbness, tingling, or weakness in the buttocks and legs.
- Muscle Fatigue: The back muscles must work harder to stabilize the imbalanced spine, leading to chronic muscle fatigue and soreness.
Postural Changes and Imbalance
In addition to pain, individuals may notice visible changes in their posture over time. These can include:
- Uneven hips or shoulders
- A visible prominence of the ribs on one side
- A leaning forward or to the side when standing
- A feeling of being off-balance
Diagnosis and Monitoring
Diagnosis typically begins with a physical examination and a review of the patient's symptoms. This is followed by imaging tests to confirm the diagnosis and measure the curve's severity.
- X-Rays: Full-length, standing X-rays of the spine are the standard for measuring the curve's angle (Cobb angle). Dynamic X-rays in flexion and extension may be used to assess spinal instability.
- MRI and CT Scans: These advanced imaging techniques provide more detailed information about the neural elements, soft tissues, and the extent of spinal stenosis, helping guide treatment decisions.
Regular monitoring is key to tracking curve progression, as degenerative scoliosis is almost always progressive.
Comparison of Scoliosis Types in Adults
| Feature | Adolescent Idiopathic Scoliosis in Adults | Adult Degenerative (De Novo) Scoliosis |
|---|---|---|
| Onset | Childhood/adolescence, progresses into adulthood | After age 50, previously straight spine |
| Cause | Unknown (idiopathic) | Age-related degeneration (disc/joint breakdown) |
| Typical Pain | Less common until combined with degeneration | Common, often significant back and leg pain |
| Primary Location | Any spinal region (often thoracic) | Primarily the lumbar (lower) spine |
| Progression Rate | Variable; accelerates with age-related changes | Consistent progression, usually 1-3 degrees per year |
| Associated Factors | Often combined with secondary degeneration | Osteoporosis, arthritis, spinal stenosis |
Treatment Options for Seniors
For older adults, the goal of treatment is typically to manage symptoms, improve quality of life, and prevent further progression rather than full correction. Treatment is tailored to the individual's specific symptoms and overall health.
Non-Surgical Management
Conservative treatments are the first line of defense for most patients with adult degenerative scoliosis.
- Physical Therapy (PT): A trained therapist can develop a customized exercise program to strengthen core muscles, improve balance, and reduce pain. The Schroth Method, a specialized PT approach, can be particularly beneficial for adult scoliosis.
- Pain Management: Over-the-counter anti-inflammatory medications can help with mild to moderate pain. For more severe pain, prescription medications or targeted spinal injections may be necessary.
- Activity Modification: Adjusting daily activities to reduce stress on the spine can help manage symptoms.
- Weight Management: Maintaining a healthy weight reduces stress on the spine and can slow the degenerative process.
Surgical Considerations
Surgery is typically reserved for severe, progressive cases where conservative treatments have failed, or for patients with significant neurological symptoms. Surgical techniques have advanced significantly, allowing for less invasive options. The decision to pursue surgery involves a careful risk-benefit analysis, considering the patient's overall health and the potential for complications.
Conclusion: Managing Scoliosis at 70
For someone asking, "can you get scoliosis at 70?" the answer is a definitive yes, and it's a condition that can be managed effectively. While often associated with significant pain and disability, understanding the degenerative nature of this late-onset condition is the first step toward effective treatment. A multi-modal approach combining pain management, targeted physical therapy, and lifestyle adjustments can help seniors maintain an active and fulfilling life. Consulting with a spinal health specialist is the best way to get a proper diagnosis and develop a personalized care plan.
For more in-depth information on spinal health and treatment options, you can visit the Scoliosis Research Society.
