What is Age Related Scoliosis?
Age-related scoliosis, more formally known as adult degenerative scoliosis, is a condition characterized by a sideways curvature of the spine that develops in older adults. This is distinctly different from the scoliosis that is diagnosed in children and adolescents, which is often idiopathic, meaning the cause is unknown. The primary driver of age-related scoliosis is the natural process of aging, specifically the degeneration of the spine's structures.
Over many years, the intervertebral discs that cushion the vertebrae begin to wear down, lose water content, and become thinner. This uneven disc degeneration can cause vertebrae to tilt and shift, leading to a spinal curve. Similarly, the facet joints, which connect the vertebrae, can also wear out due to arthritis, further contributing to the spinal instability that leads to the curvature. In some cases, age-related scoliosis may be a progression of a milder form of scoliosis from youth that becomes more pronounced with age and spinal wear.
Symptoms and Diagnosis
Symptoms of adult degenerative scoliosis can vary widely among individuals and depend on the severity of the curve. Some people may have a significant curve with no pain, while others may experience severe discomfort from a smaller curve. The most common symptoms include:
- Back pain: This is often the primary symptom and is typically localized to the lower back. The pain may worsen with walking or standing and improve with sitting.
- Leg pain, numbness, or weakness: This can occur if the spinal curve puts pressure on the nerves exiting the spine, a condition known as lumbar spinal stenosis.
- Feeling of imbalance or leaning to one side: The uneven spine can affect a person's posture, causing them to feel off-kilter.
- Fatigue: The body has to work harder to maintain balance with a curved spine, which can lead to increased muscle fatigue.
- Visible deformity: In more advanced cases, a patient may notice a difference in shoulder height, an uneven waist, or one side of the rib cage protruding.
Diagnosis typically involves a comprehensive physical exam, a review of a patient's medical history, and imaging studies. An X-ray is the most common diagnostic tool, allowing doctors to measure the angle and location of the spinal curve. An MRI or CT scan may also be used to get a more detailed view of the nerves and discs, helping to pinpoint the source of pain and inform the best treatment approach.
Comparison of Adolescent and Adult Degenerative Scoliosis
| Feature | Adolescent Idiopathic Scoliosis | Adult Degenerative Scoliosis |
|---|---|---|
| Onset Age | Generally between 10 and 18 years old | Typically over 40-50 years old |
| Primary Cause | Largely unknown (idiopathic) | Spinal degeneration (wear and tear) |
| Symptoms | Often asymptomatic, minimal pain | Back pain, nerve pain, fatigue |
| Disc Health | Healthy, plump discs | Degenerated, thinned discs |
| Progression | Often progresses during growth spurts | Tends to progress with ongoing degeneration |
| Treatment Focus | Bracing (moderate curves), surgery | Pain management, physical therapy, surgery (severe cases) |
Non-Surgical Treatment Options
The vast majority of people with age-related scoliosis do not require surgery and can effectively manage their symptoms with conservative treatments. The goal of non-surgical treatment is to reduce pain and improve function.
- Physical Therapy: A customized exercise program can strengthen the core and back muscles, improving posture, increasing flexibility, and reducing pain. It may also include stretches and targeted exercises to address specific muscular imbalances.
- Medications: Over-the-counter anti-inflammatory drugs (NSAIDs) can help manage pain and inflammation. In some cases, stronger prescription pain medication may be used for short periods.
- Epidural Injections: These injections deliver steroids directly into the epidural space of the spine to reduce inflammation around the nerves, providing temporary but effective pain relief.
- Bracing: While less common and generally not used to correct the curve in adults, a brace can sometimes provide support and pain relief, especially during activities that exacerbate symptoms.
When is Surgery Considered?
Surgery is typically reserved for a small number of patients with adult degenerative scoliosis who experience severe, debilitating pain that has not responded to extensive conservative treatments. Surgical options are also considered when the spinal curve is progressing rapidly or causing severe neurological symptoms, such as significant leg weakness or bladder/bowel issues.
Surgical procedures aim to address the underlying spinal instability and decompress any nerves being pinched by the curved spine. Common surgeries include spinal fusion, which stabilizes the vertebrae with bone grafts and metal hardware, and decompression surgery to relieve pressure on the nerves. The complexity and goals of surgery can vary depending on the patient's age, overall health, and the severity of their condition.
Living with Age-Related Scoliosis
Managing age-related scoliosis involves a proactive approach to spinal health. Adopting a healthy lifestyle can significantly impact symptoms and quality of life. Consider the following tips:
- Maintain a healthy weight to reduce stress on your spine.
- Engage in regular, low-impact exercise such as swimming or walking.
- Practice good posture and incorporate ergonomic principles into your daily life.
- Regularly perform core-strengthening exercises as recommended by a physical therapist.
- Manage pain effectively through medication, heat, or cold packs as advised by your doctor.
- Stay informed about your condition and work closely with your healthcare team to develop a personalized management plan. An excellent source for further reading and research on spinal health is the National Institutes of Health.
By understanding what is age related scoliosis and its implications, individuals can take meaningful steps toward maintaining spinal health and function well into their golden years. With proper management, many people with this condition can lead full and active lives.
