Treatment for Adult Scoliosis.
Adult scoliosis is increasingly prevalent in an ageing population, developing in the 6th decade of life and probably affecting more than 35% of patients over 60 years. Surveys suggest that the prevalence of adult scoliosis ranges from 35-45%.
The extent of spinal curvature determines the severity of scoliosis. Though the majority of people have mild scoliosis with a curvature less than 20Â°, acute scoliosis may feature curves that have progressed beyond 40Â°.
Bracing to prevent and /or limit scoliosis progression is an option only in the growing patient with a moderate curve (25Âº to 45Âº). Surgical treatment is considered for patients with curves greater than 40Âº to 50Âº.
In some adults, scoliosis is painless. However, in many cases, scoliosis can lead to pain, fatigue, muscle spasms, even reduced heart and lung function (rare). The main reason for adults seeking immediate relief from scoliosis is overriding pain and sheer fatigue. Adult scoliosis treatment is not very straightforward. Surgery is one of the treatment options for adults suffering from scoliosis.
Adolescent Idiopathic Scoliosis (AIS) develops in approximately 2% to 5% of the population, primarily in minor forms that do not become progressive or problematic in later life. However, a small percentage of curves do progress to a range that warrants treatment with either an orthosis or surgical arthrodesis.
The causes of scoliosis that begins in adulthood are usually very different from the childhood types. In most adults with previous scoliosis, moderate exercise is not harmful and is extremely important for maintaining healthy supportive muscles and preventing disk degeneration.
Besides pain the cosmetic impact should not be underestimated in the young adult, whereas in the elderly – where de novo degenerative scoliosis predominates, cosmesis is less important. In the older population, spinal deformity may cause nerve compression leading to severe leg pain as well as back pain.
Initial Sign and Symptoms
The early signs of scoliosis are subtle. Adolescents rarely have symptoms of pain or discomfort. Young children with scoliosis can have spinal cord involvement, which may manifest itself as difficulty walking, stumbling, and spasms. Adults can experience back pain, fatigue, sciatica, decreased walking tolerance, loss of height and leaning forward or to one side.
- A tilted head that does not line up over the hips
- A protruding shoulder blade
- One hip or shoulder that is higher than the other, causing an uneven hem or shirt line
- Leaning more to one side than the other
- In developing girls, breasts appearing to be of unequal size
- One side of the upper back is higher than the other when the child bends over, knees together, with the arms dangling down
The four common causes of scoliosis are congenital defects, genetic abnormalities, accidents and trauma, or certain diseases that cause bones to become brittle. In some cases, scoliosis exists at birth due to a congenital vertebral anomaly. The first gene clearly related to idiopathic scoliosis (scoliosis of unknown cause) was found at the conclusion of a 10-year study. In April 2007, researchers at Texas Scottish Rite Hospital for Children identified the first gene associated with idiopathic scoliosis, CHD7. Variations in this gene, CHD7, can make people more susceptible to idiopathic scoliosis.
Congenital scoliosis is a result of abnormal formation of the spinal column. Neuromuscular scoliosis results from abnormal nerve function which causes abnormal muscle activity around the spinal column. Scoliosis also can develop after spinal surgery, which is called post-laminectomy scoliosis.
There are several types of scoliosis in adults:
- Idiopathic Curve – This is the most common type. Usually there is no clear-cut reason why the spine is curved.
- Congenital Curve – The term “congenital” means that you were born with the problem. A congenital scoliosis is present at birth. Many different problems in growth and development can lead to spine problems. Fortunately, most of these are rare. Congenital scoliosis may not be recognized, or may not be severe enough to require treatment during childhood. The scoliosis may get worse later in life due to wear and tear around the abnormal area of the spine.
- Paralytic Curve – “Paralytic” means that muscles do not work. When muscles do not work around the spine, the spine itself may be thrown out of balance. Over several years, this can result in a curvature of the spine developing. This type of scoliosis is often caused by spinal cord injuries that lead to paralysis.
- Myopathic Deformity – “Myopathic” means muscle that does not work properly. Like paralytic curves described above, this curve results from a muscular or neuromuscular disease, such as muscular dystrophy, cerebral palsy, or polio.
- Secondary – Scoliosis developed in adulthood can be a “secondary” cause of another spinal condition that affects the vertebrae, such as degeneration, osteoporosis (loss of bone mass), or osteomalacia (softening of the bones). Scoliosis can also appear following spinal surgery. The surgery may cause an imbalance in the spine that leads to scoliosis.