Does Lumbar Scoliosis Get Worse with Age? An Expert Guide

According to the American Academy of Physical Medicine and Rehabilitation, adult degenerative scoliosis most often develops in those over 50. This article explores the critical question: does lumbar scoliosis get worse with age? We will cover the specific reasons for progression and what you can do about it.

Quick Summary

The answer is yes, lumbar scoliosis can and often does worsen with age, primarily due to the spine's natural degenerative changes. Progression rates are influenced by the curve's size, individual bone health, and lifestyle, making proactive management crucial for seniors to maintain mobility and reduce pain.

Key Points

• Progression is Common: Lumbar scoliosis can and often does worsen with age, particularly due to spinal degeneration that occurs naturally over time.

• Types of Adult Scoliosis: Progression can occur in adults who had scoliosis as a child (AdIS) or who develop it later in life due to aging (ADS).

• Degeneration is the Cause: Factors like disc degeneration, facet joint arthritis, and osteoporosis are the primary drivers of worsening spinal curvature in older adults.

• Watch for Symptoms: Increased pain, uneven posture, and leg pain or numbness can signal that the scoliosis is progressing and requires re-evaluation.

• Conservative Treatment First: Non-surgical options like physical therapy, strengthening exercises, and pain management are often highly effective for managing symptoms and slowing progression.

• Monitoring is Key: Regular check-ups and radiographic imaging are crucial for tracking the curve over time and guiding treatment decisions.

Understanding Adult Scoliosis

Scoliosis, an abnormal sideways curvature of the spine, can manifest or progress in adulthood. Adult scoliosis is generally categorized into two main types: Adult Idiopathic Scoliosis (AdIS) and Adult Degenerative Scoliosis (ADS). AdIS is the progression of a curve that originated in childhood or adolescence, while ADS is a de novo deformity that develops after age 50 due to spinal wear and tear. Understanding which type of scoliosis is present is key to predicting its progression and determining the best course of management.

Why Scoliosis Progresses with Age

For many adults, the primary driver of scoliosis progression is age-related degeneration. As the body ages, the intervertebral discs that cushion the vertebrae begin to lose water and height, leading to disc degeneration. This causes a loss of stability in the spinal column. Similarly, the facet joints, which link the vertebrae, can develop arthritis, contributing to further instability and asymmetric loading on the spine. This cascade of degenerative changes, combined with a potential loss of bone density due to osteoporosis, can cause an existing curve to increase or a new curve to form.

Key Risk Factors for Worsening Scoliosis

Several factors can influence the rate and severity of scoliosis progression in older adults.

• Curve Size at Maturity: The larger the spinal curve at skeletal maturity (end of puberty), the higher the likelihood of significant progression over time.
• Curve Location: Lumbar and thoracolumbar (lower and mid-back) curves are often more susceptible to degenerative changes and worsening than those exclusively in the thoracic (upper) spine.
• Osteoporosis: Decreased bone density makes the vertebrae more susceptible to microfractures and collapse, accelerating the curvature's progression.
• Genetics: A family history of scoliosis may increase the risk of progression.
• Lifestyle: Factors such as obesity, smoking, and sedentary living can increase mechanical stress on the spine and accelerate degenerative changes.

Recognizing the Symptoms of Progressive Scoliosis

For adults, the worsening of scoliosis often presents as an increase in symptoms rather than a sudden, visible change in posture. Key indicators that the curve may be progressing include:

• Chronic, worsening low back pain that is often asymmetric.
• Neurological symptoms such as shooting pain, numbness, or weakness in the legs (radiculopathy) due to nerve compression.
• Changes in posture, such as an uneven waist, hips, or shoulders.
• Difficulty standing or walking for extended periods.
• Fatigue and a sensation of being off-balance.
• In severe cases, lung or heart function may be affected if the curve is large and high up.

Managing Progressive Adult Scoliosis

The goal of management is to minimize symptoms, improve function, and slow down the rate of progression.

1. Conservative Care First: Most cases of adult scoliosis can be managed effectively without surgery through non-invasive methods.
2. Physical Therapy: A key component, physical therapy focuses on strengthening core and back muscles to support the spine, improving flexibility, and enhancing posture. Specific methods like the Schroth technique can be beneficial.
3. Pain Management: Over-the-counter anti-inflammatory medications or prescription pain relievers can help manage discomfort. In some cases, epidural steroid injections may provide relief from nerve-related pain.
4. Lifestyle Modifications: Maintaining a healthy body weight reduces stress on the spine. Adopting an active lifestyle with regular, low-impact exercise like swimming or walking is highly recommended.
5. Bracing: While more common in adolescents, a brace may sometimes be used in adults for short-term pain relief or to provide support during certain activities.

Conservative vs. Surgical Intervention

Deciding between conservative and surgical treatment for adult scoliosis involves weighing the severity of symptoms, the degree of progression, and the patient's overall health.

Feature	Conservative Management	Surgical Intervention
Primary Goal	Reduce pain, improve function, slow progression.	Correct deformity, decompress nerves, stabilize the spine.
Indications	Most common, initial approach for mild to moderate curves.	Severe curves (often >40-50 degrees), significant pain unresponsive to conservative care, neurological deficits.
Risks	Low risk; potential for muscle weakening with braces.	Higher risk in older adults (infection, hardware failure, neurological issues).
Typical Patient	All adults, especially those with manageable symptoms.	Those with advanced progression or severe, disabling symptoms.

The Role of Exercise and Monitoring

Regular, targeted exercise is one of the most proactive steps you can take to manage scoliosis. Strengthening the paraspinal and abdominal muscles provides crucial support for the spine. For adults with osteoporosis, it is vital to discuss an exercise plan with a doctor to avoid high-impact activities that could increase fracture risk. Continuous monitoring is essential for all adults with scoliosis.

• Regular Check-ups: Schedule periodic visits with a spine specialist.
• Radiographic Imaging: Undergoing X-rays at regular intervals (e.g., every few years) allows doctors to measure the Cobb angle and track any curve progression accurately.
• Symptom Awareness: Paying close attention to changes in back pain, posture, or neurological signs in the legs is crucial for early intervention.

For more information on scoliosis and treatment options, the Scoliosis Research Society is a valuable resource Scoliosis Research Society.

Conclusion

While the prospect of scoliosis worsening with age can be concerning, it is not an inevitable outcome for every individual. Understanding the specific factors at play—such as the type of scoliosis, the role of spinal degeneration, and other risk factors—empowers seniors to take control of their spinal health. Through a combination of diligent monitoring, conservative therapies like physical activity, and a healthy lifestyle, the impact of scoliosis on one's quality of life can be significantly mitigated. Working closely with a healthcare team is the best strategy for a positive and active aging journey.

Frequently Asked Questions

Can lumbar scoliosis develop in older adults who never had it before?

Yes, this is known as adult degenerative scoliosis. It develops due to the wear and tear of the spine over time, typically appearing after age 50 as discs and joints deteriorate.

What is the typical rate of progression for lumbar scoliosis with age?

The rate of progression varies, but some studies show that adults over 50 may experience a progression rate of 1-3 degrees per year. This rate is influenced by the curve's size and other health factors.

Does physical therapy help prevent lumbar scoliosis from getting worse?

While physical therapy cannot reverse the curvature, it is a crucial tool for management. It helps strengthen core muscles to support the spine, improve posture, reduce pain, and can help mitigate the effects of progression.

When is surgery considered for progressive lumbar scoliosis in seniors?

Surgery is typically reserved for severe cases where the curve exceeds 40-50 degrees, conservative treatments have failed, or there are significant neurological issues like nerve compression.

Are there specific exercises to slow the progression of scoliosis?

Low-impact exercises such as swimming, walking, and specific core-strengthening exercises are recommended. Techniques like the Schroth method, guided by a physical therapist, can also be very effective.

How does osteoporosis affect lumbar scoliosis progression?

Osteoporosis weakens the bones, making the vertebrae more prone to collapse. This can accelerate the degenerative process and cause the scoliotic curve to worsen more quickly.

What are the first signs that my lumbar scoliosis is getting worse?

Early signs often include increased or new back pain, a noticeable change in posture (like uneven hips), and a feeling of fatigue in the back, especially after prolonged standing or walking.