Scoliosis Treatment
Scoliosis, a word that means curvature of the spine, is not a disease but rather a term used to describe any abnormal, sideways curvature of the spine. Scoliosis affects around 2–3% of the population in the US, some 10 million people. The cause of most cases is unknown.
Scoliosis and other spinal deformities usually develop during the growth years of adolescence, or as a result of aging and “wear and tear.” In some cases, scoliosis deformities can progress during adulthood as well.
Scoliosis can affect the spine in three sections:
- the cervical (neck)
- thoracic (chest region)
- lumbar (lower back).
Degenerative Scoliosis in Adults
Degenerative scoliosis, also known as adult scoliosis or adult onset scoliosis, features the same curvature as pediatric scoliosis. However, it is caused by degeneration of the facet joints, which provide spinal stability in certain motions. This type of scoliosis occurs most frequently in people over 65 years of age.
While scoliosis in children is often discovered during a screening, scoliosis in adults is typically discovered when the condition causes pain or discomfort. The deformity in an adult may have been present since childhood or may be the result of the aging process.
It is not unusual for patients who are well into their 60s, 70s or even 80s to present with symptoms of pain and functional limitations caused by scoliosis. Research show up to say about 500,000 adults in the U.S. suffer from scoliosis and have severe sideways curvature.
What Causes Adult Onset Scoliosis?
There are many different causes of scoliosis spinal deformity in an elderly adult. Although pain may not present itself until later in life, the causes of scoliosis may have started much earlier.
The most common varieties of scoliosis include:
- idiopathic scoliosis that was present during adolescence and then became worse during adulthood.
- deformity that began in adulthood due to degenerative (wear and tear) changes in the spine and that developed later in life.
Other causes of scoliosis, though less frequent, include:
- trauma (from an injury or illness)
- bone collapse
- previous major back surgery
- osteoporosis (thinning of the bones)
- spondylolisthesis (slipped vertebrae)
- rarely, infections and tumors of the spine.
With increasing life expectancy along with more active lifestyles, the number of older adults requiring treatment for scoliosis has also risen.
Symptoms of Scoliosis in Adults
Symptoms may vary depending on the severity and location of the scoliosis deformity, although generally include:
- Side-to-side (to the left or right side) curvature of the spine
- Pain, numbness, or weakness in the legs and feet
- Difficulty breathing.
Severe Scoliosis Treatment in Adults
Many children and adults with scoliosis do not need any treatment. In other cases, scoliosis treatment may include non-invasive options, such as pain management or therapy.
Surgery may be necessary when the spinal curve is greater than 45–50 degrees (the standard measurement system is the Cobb angle). Scoliosis surgery may also be recommended when the patient has nerve damage to the legs and/or is experiencing bowel or bladder symptoms, or has breathing problems.
Is Scoliosis Surgery Successful?
Surgery for scoliosis is typically a spinal fusion, where the curved vertebrae and sometimes bone grafts are aligned and fused together to form a single, solid bone. In some cases, hooks, rods, or screws may be used to hold the bone graft in place, or a brace or cast may be used (more common for children).
With advances in technology, spinal fusion surgery is able to stop further curvature. It is also possible to significantly straighten the spine and approve appearances, up to as little as a 20–25 degree curve.
Fusionless treatment options are being tested, although it is usually in younger patients when the curvature is still growing. However, research is ongoing and fusion surgery remains the most proven, effective treatment option.
Recovery after Scoliosis Surgery
Patients will have some pain after scoliosis surgery, and medication may be prescribed for several weeks after. Many patients report that after a year, their general back pain is less than before surgery.
Recovery from scoliosis surgery varies from person to person. Patients will undergo periodic x-rays and doctor reviews to determine their exact recovery timeline and when they can resume certain activities.
Below we list a general recovery timeline on what to expect after scoliosis surgery:
- The first few days after surgery are limited to rest, pain medication as needed, a light diet, and a catheter. You might be asked to do simple movements, such as wiggling your toes or light walking.
- Some patients are discharged from the hospital after the first week, although many move on to rehabilitation. At this time, your recovery review will take into account whether you can eat, urinate and move independently, and that the wound is free of infection and draining well.
- Between 2 and 4 weeks, patients can usually return home although possibly not to work or school. Patients need to avoid twisting, turning, lifting, and frequent car rides. It is normal to tire quickly with simple tasks, and it can be useful to have household help.
- It is common to start physical therapy after a couple of weeks. This helps monitor progress and address any weak areas. Patients will start to gain strength, mobility, and activeness, and the wound should almost be healed. It usually takes around 6 weeks of recovery time after scoliosis surgery until patients can start easing movement and lifting restrictions, although some doctors may wait until 6 months.
- Non-contact sports, such as running or weightlifting, may start at around 6 months after scoliosis surgery if the doctor approves such activities.
- More intense activities need at least 6–12 months until a solid fusion has formed.
- Your doctor will monitor your healing and advise you when to return to each activity. Many patients resume a normal lifestyle after 6–12 months.
The area around the fusion will permanently have some stiffness after surgery, however, many report improvements in movement and pain after surgery. Patients typically have sufficient movement to perform most activities and sports.