Degenerative adult scoliosis is a condition where the spine begins to sag, and an S-shaped curve slowly develops. This condition usually begins after age 40 years, and is often related to osteoporosis, which weakens the bones. Any scoliosis that develops after puberty is adult scoliosis, and when it is caused by degeneration, it is called degenerative adult scoliosis.
What causes scoliosis?
In order to understand your symptoms and treatment choices, you should start with some understanding of the general anatomy of your spine. This includes becoming familiar with the various parts that make up the spine and how they work together. Adult scoliosis develops from a secondary condition that affects the vertebrae of the spine. Causes include degenerative disc disease, spinal arthritis, osteoporosis (bone mass loss), and osteomalacia (softening of bones).
What symptoms are associated with degenerative scoliosis?
Degenerative scoliosis usually causes low back pain initially, and upper back pain occurs later on. The curvature causes a deformity that makes the back look strange. When the spinal components press on nerve roots, the patient may experience pain shooting down the buttock into the leg, as well as numbness, tingling, and weakness of one or both extremities. In severe cases, spinal cord and nerve compression may cause loss of coordination in the leg muscles, making walking and movement difficult.
How common is degenerative scoliosis?
Degenerative scoliosis has a prevalence rate of around 10% in the adult population. For people aged 65 and older, the rate goes up to 60%.
How is degenerative scoliosis diagnosed?
Degenerative scoliosis results from progressive degeneration of the spine’s structural elements and spinal column malalignment. The Boulder pain management doctor can diagnose this condition on visual inspection of the spine, but x-rays are usually done to measure the degree of curvature.
Any past x-rays are used for comparison, and the doctor will also make note of changes in your height. In addition, the doctor will measure the size of the rub hump deformity, and check flexibility with bending in certain directions. Additional tests ordered could include a magnetic resonance imaging (MRI) scan, as well as a computed tomography (CT) scan.
How is degenerative scoliosis treated?
The treatment of degenerative scoliosis varies, as all treatments do not work for everyone. Treatment options include:
- Medications – Several medications are prescribed for back pain related to degenerative scoliosis. Examples are nonsteroidal anti-inflammatory drugs, such as ketoprofen and ibuprofen, as well as narcotic analgesics, such as tramadol and hydrocodone.
- Spine braces and orthotics – A spinal brace offers some pain relief, but it does not straighten the spine. If you have a difference in leg lengths, special shoe inserts (orthotics) help lift one leg to the level of the other to reduce your back pain.
- Epidural steroid injection (ESI) – This treatment is used for chronic back pain. Injecting a corticosteroid agent into the epidural space near the spinal cord will relieve nerve irritation and pain. In a recent study, researchers followed patients who had injections of methyl prednisolone 80 mg and 0.5% bupivacaine in 8 ml of normal saline. At 6-month follow-up, 81% of the patients had significant reductions in pain.
- Intradiscal electrothermal therapy (IDET) – This procedure involves treatment of low back pain related to degenerative disc disease and scoliosis. A small needle with catheter is positioned near the affected disc, and a heated wire runs through the catheter. The heat is used to thicken collagen, which closes minor tears and cracks.
- Lumbar nerve block – When pain goes down the leg related to nerve compression, the doctor can use radiofrequency energy or a neurolytic substance to destroy affected nerves. In a recent clinical study, nerve blocks were found to have a 90% success rate, with long-term results for more than 50% of patients.
- Intrathecal pump implant – With this procedure, a small pump is surgical placed in the lower abdomen or buttock. A catheter runs from the pump and is placed near the spinal cord. Medication is infused directly into the spine to bypass the gastrointestinal tract.
- Spinal cord stimulation (SCS) – For pain that does not respond to other treatment modalities, SCS can help. The spinal cord stimulator is a small device that is placed into the body, and it has wires that attach to surgically implanted electrodes along the spinal cord. The unit delivers mild electric current to the spinal cord, which blocks pain signals. According to studies, 90% of people report success using SCS for pain treatment.
- Surgery – For serious degenerative scoliosis, surgery may be necessary. This involves removal of spurs and bony deformities that crowd the spinal canal and lead to nerve root compression. In addition, spinal fusion is done to stabilize vertebrae (fuse them together). This is done to vertebrae that are deteriorating, which straightens the spine to stop the progression of the scoliosis curve.
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