Adult Degenerative Scoliosis: When a Curve in the Spine Starts Causing Pain

As we age, our bodies undergo many changes. For some, one of these changes can be the development of a curve in the spine that wasn’t there before, or a curve that was present in childhood but has gotten worse. This is known as adult degenerative scoliosis, and it can be a source of significant pain and discomfort.

At Jeffrey Moore, MD, we understand how concerning it can be to experience new or worsening back pain, especially when it’s linked to a spinal curve. My goal is to help you understand what adult degenerative scoliosis is, why it happens, and what we can do together to help you find relief and improve your quality of life. You deserve to live without debilitating pain, and we’re here to guide you every step of the way with clear, compassionate care.

What Exactly is Adult Degenerative Scoliosis?

Imagine your spine as a stack of building blocks, neatly lined up from your neck down to your tailbone. In a healthy spine, these blocks (called vertebrae) are straight when viewed from the front or back. Adult degenerative scoliosis happens when some of these blocks start to shift or wear down, causing the spine to develop a sideways curve. It’s “degenerative” because it’s usually caused by the natural wear and tear that happens to our spines as we get older.

Unlike the scoliosis many people develop in childhood (which often has no clear cause), adult degenerative scoliosis often begins after age 40 and can progress over time. It’s more common than you might think, affecting a significant portion of the older population, though not everyone with a curved spine will experience pain.

How is it Different from Childhood Scoliosis?

While both involve a sideways curve of the spine, there are key differences:

Cause: Childhood (or idiopathic) scoliosis often appears during growth spurts in adolescence and the cause is usually unknown. Adult degenerative scoliosis is primarily caused by aging and the breakdown of spinal components.
Onset: Childhood scoliosis is typically diagnosed in adolescence. Adult degenerative scoliosis usually develops later in life.
Symptoms: Childhood scoliosis often doesn’t cause pain until it’s very severe. Adult degenerative scoliosis is frequently associated with pain and other neurological symptoms.
Location: Childhood curves can occur anywhere in the spine. Adult degenerative curves most commonly occur in the lower (lumbar) spine.

Adult degenerative scoliosis can lead to significant discomfort and mobility issues as the curvature of the spine progresses. For those seeking to understand the broader implications of spinal health, the article on common lumbar spine complications provides valuable insights. It discusses various conditions that can arise from degenerative changes in the spine, including pain management strategies and treatment options. To learn more about these complications, you can read the article here: Common Lumbar Spine Complications.

What Causes This Spinal Curve to Develop?

The main culprit behind adult degenerative scoliosis is the natural aging process and the wear and tear it inflicts on our spines. Over decades, the parts of your spine that keep it straight and stable can start to weaken.

The Role of Degenerative Disc Disease

Between each of your vertebrae are soft, jelly-like cushions called spinal discs. These discs act as shock absorbers. With age, these discs can lose water content, shrink, and flatten, becoming less pliable. This is known as degenerative disc disease. When a disc degenerates unevenly on one side, it can cause the vertebrae above and below to tilt and twist, initiating a spinal curve. Think of it like a stack of deflated tires – they don’t hold their shape as well.

Arthritis and Facet Joint Degeneration

Behind each disc are small joints called facet joints. These joints allow your spine to bend and twist. Just like other joints in your body, facet joints can develop arthritis (osteoarthritis) as cartilage wears away. When arthritis affects the facet joints more on one side of the spine, it can lead to instability and contribute to the development or worsening of a scoliosis curve. Bone spurs (osteophytes) can also form, further irritating nerves and contributing to the curve.

Ligament Laxity and Muscle Weakness

Your spine is held together by strong bands of tissue called ligaments, and supported by a complex network of muscles. Over time, ligaments can stretch and become weaker, and core back muscles can lose strength. This reduced support means the spine has less to hold it straight, making it more susceptible to curving.

Compression Fractures (Osteoporosis)

In some cases, especially in individuals with osteoporosis (brittle bones), small compression fractures in the vertebrae can occur. If these fractures happen unevenly, they can cause the bone to wedge, leading to a spinal curve.

Previous Spinal Surgeries

Sometimes, prior spinal surgery, particularly fusions that affect a long segment of the spine, can place extra stress on the adjacent spinal segments. This can, over many years, lead to degeneration and a new curve forming above or below the fused area. This is sometimes called “junctional kyphosis” or “adjacent segment disease.”

What Are the Symptoms of Adult Degenerative Scoliosis?

Unlike childhood scoliosis, adult degenerative scoliosis often comes with noticeable symptoms, primarily pain. The pain isn’t always directly from the curve itself but often from the associated issues like nerve compression or muscle strain.

Back Pain: The Most Common Complaint

The most frequent symptom is chronic back pain, usually in the lower back (lumbar spine). This pain can range from a dull ache to a sharp, burning sensation. It often worsens with activity, standing for long periods, or walking, and may feel better when sitting or lying down. This is because sitting often takes some pressure off the compressed nerves or joints.

Radicular Pain (Sciatica)

When the spinal curve and associated degeneration (like disc bulges or bone spurs) pinch or irritate the nerves exiting the spinal canal, it can cause radicular pain. This is often felt as sciatica – pain that travels from your lower back down into your buttocks, thigh, and even below the knee. It can feel like an electric shock, burning, or tingling.

Numbness, Tingling, and Weakness

If the nerves are significantly compressed, you might experience numbness or tingling in the legs or feet. In more severe cases, you could develop weakness in your leg muscles, making it difficult to walk or lift your foot. This weakness can sometimes lead to a “foot drop,” where you drag your foot.

Spinal Stenosis Symptoms

Many people with adult degenerative scoliosis also have spinal stenosis, a narrowing of the spinal canal. This narrowing can put pressure on the spinal cord and nerves. Symptoms of spinal stenosis often include:

Neurogenic Claudication: Leg pain, cramping, numbness, or weakness that starts after walking or standing for a certain distance and is relieved by sitting or leaning forward.
Difficulty Walking: You might find yourself leaning on a shopping cart or bending forward to get relief while walking.

Changes in Posture and Balance Issues

As the curve progresses, you might notice changes in your posture. Your shoulders might become uneven, your body might tilt to one side, or you might find yourself stooping forward. This can affect your balance, increasing your risk of falls. Some people describe feeling “off-kilter.”

When Should You See a Doctor? (Red Flags)

While some back pain is normal with aging, certain symptoms warrant a visit to a spine specialist like me. It’s always better to get an accurate diagnosis early so we can explore effective treatment options.

Persistent or Worsening Pain

If your back pain is constant, doesn’t improve with rest or over-the-counter pain relievers, or if it’s getting progressively worse, it’s time to see a doctor. This is especially true if the pain is radiating down your leg.

New or Worsening Numbness, Tingling, or Weakness

Any new onset or progression of numbness, tingling, or weakness in your legs or feet needs to be evaluated promptly. These are signs of potential nerve compression that could worsen without intervention.

Difficulty Walking or Balance Problems

If you’re noticing significant difficulty walking, needing to lean forward to get relief, or experiencing frequent balance issues or falls, please schedule an appointment. These symptoms can impact your independence and safety.

Bowel or Bladder Changes (Emergency!)

This is a critical red flag and requires immediate medical attention. If you experience new onset of severe numbness in your groin or saddle area, along with difficulty controlling your bowel or bladder (e.g., inability to urinate, or unexpected bowel movements), go to an emergency room immediately. These could be signs of Cauda Equina Syndrome, a rare but serious condition that needs urgent surgical decompression.

Fever, Chills, or Unexplained Weight Loss

If your back pain is accompanied by fever, chills, or unexplained weight loss, it could indicate an underlying infection, tumor, or other serious condition. Seek medical attention right away.

Adult degenerative scoliosis can lead to significant discomfort and mobility issues as the spine’s curvature progresses over time. For those seeking to understand the broader implications of spinal health, an insightful article discusses how advancements in predicting cervical spine injuries could potentially reduce radiation exposure in children. This research highlights the importance of early intervention and proper diagnosis in spinal conditions. To learn more about this innovative approach, you can read the article here.

Diagnosing Adult Degenerative Scoliosis

When you come to see me, the diagnostic process is thorough but straightforward. My goal is to understand not just that you have a curve, but why it’s causing your symptoms.

Comprehensive Medical History and Physical Exam

We’ll start by talking about your symptoms: when they started, what makes them better or worse, where the pain goes, and how it’s affecting your daily life. I’ll also ask about your general health, medications, and any past surgeries.

During the physical exam, I’ll observe your posture, check your range of motion, and look for any visible signs of a curve. I’ll also perform neurological tests to check your reflexes, strength, and sensation in your legs and feet. This helps me pinpoint which nerves, if any, might be affected.

Imaging Studies: Seeing Inside Your Spine

Imaging is crucial for confirming the diagnosis and understanding the specifics of your spinal curve and the underlying degeneration.

X-rays (Radiographs): These are usually the first imaging tests done. We take X-rays from the front, side, and often with you bending to see the flexibility of your spine. X-rays show the bony structures, the extent of the curve, any tilting of the vertebrae, and signs of arthritis or disc space narrowing. We can measure the “Cobb angle” to quantify the degree of your curve.
MRI (Magnetic Resonance Imaging): An MRI provides highly detailed images of the soft tissues, including your spinal discs, nerves, spinal cord, and ligaments. It’s invaluable for identifying herniated discs, spinal stenosis (narrowing of the spinal canal), nerve compression, and any other soft tissue abnormalities that might be contributing to your pain. An MRI does not use radiation.
CT Scan (Computed Tomography): A CT scan provides more detailed images of the bony structures than an X-ray. It’s particularly useful for assessing bone spurs, facet joint arthritis, and the extent of any bony narrowing in the spinal canal. Sometimes, a CT myelogram (where dye is injected into the spinal canal before the CT scan) is used for even clearer images of nerve compression if an MRI is not possible or clear enough.

Second Opinions and Understanding Your Findings

If you’ve already had imaging done elsewhere, I’m happy to review your MRI or X-ray findings with you. Getting a second opinion is often a wise step, especially when considering significant treatment options. I’ll explain your images in plain English, ensuring you understand what the findings mean for your specific condition.

Treatment Options: Finding Relief and Improving Function

My approach to adult degenerative scoliosis is always to start with the most conservative, non-surgical treatments possible. Surgery is typically considered only after these methods have been tried and haven’t provided sufficient relief, or if there are signs of severe nerve compression or spinal instability.

Conservative Care: The First Line of Defense

Many people with adult degenerative scoliosis can manage their symptoms effectively without surgery.

Rest and Activity Modification: Sometimes, simply adjusting your daily activities to avoid movements that aggravate your pain can make a big difference. This doesn’t mean complete bed rest, but rather smart movement.
Over-the-Counter Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help reduce pain and inflammation. Acetaminophen (Tylenol) can also provide pain relief.
Heat and Cold Therapy: Applying heat (like a heating pad) can relax tight muscles, while cold packs can reduce inflammation. Experiment to see which works best for you.

Physical Therapy (PT)

Physical therapy is a cornerstone of conservative treatment. A skilled physical therapist can teach you exercises to:

Strengthen Core Muscles: Strong abdominal and back muscles provide better support for your spine, reducing strain on the curved segments.
Improve Flexibility and Range of Motion: Gentle stretches can help relieve muscle tightness and improve spinal mobility.
Enhance Posture and Body Mechanics: Learning how to move and lift properly can prevent further strain and injury.
Reduce Pain: Specific exercises and manual therapy techniques can help alleviate discomfort.

Injections and Pain Management

When oral medications and physical therapy aren’t enough, injections can provide targeted pain relief.

Epidural Steroid Injections: These involve injecting a steroid medication into the epidural space around the spinal nerves. The steroid helps reduce inflammation and can provide temporary relief from nerve pain (like sciatica). The effects can last weeks to months.
Facet Joint Injections: If your pain is primarily coming from arthritic facet joints, a steroid and anesthetic can be injected directly into these joints.
Nerve Blocks: These injections block pain signals from specific nerves.
Radiofrequency Ablation (RFA): If facet joint injections provide temporary relief, RFA can be considered. This procedure uses heat to temporarily disable the nerves that transmit pain signals from the facet joints, providing longer-lasting relief, often for 6-12 months.
Pain Management Specialists: Sometimes, working with a pain management specialist can offer a broader range of non-surgical options and help you manage chronic pain effectively.

When Surgery Becomes an Option

Surgery for adult degenerative scoliosis is typically considered when conservative treatments have failed to provide adequate relief, or when there are signs of progressive neurological deficits (worsening numbness, weakness, or balance issues) that are significantly impacting your quality of life. The goals of surgery are usually to:

Decompress Nerves: Relieve pressure on pinched nerves to alleviate pain, numbness, and weakness.
Stabilize the Spine: Prevent further progression of the curve and reduce pain associated with spinal instability.
Correct the Curve (to an extent): Improve spinal alignment, though typically not to the degree of a perfectly straight spine, but enough to improve function and reduce pain.

Types of Surgical Procedures (When Relevant)

The specific surgical approach depends heavily on the individual’s curve, symptoms, and overall health.

Decompression (Laminectomy/Discectomy): If the primary issue is nerve compression due to stenosis or a herniated disc, a decompression surgery (like a laminectomy to remove part of the bone, or a discectomy to remove part of a disc) might be performed. This aims to create more space for the nerves.
Spinal Fusion: This is a common procedure for adult degenerative scoliosis, especially if there’s significant instability or a large curve. Spinal fusion involves joining two or more vertebrae together so they heal into a single, solid bone. This eliminates motion between those vertebrae, providing stability and often reducing pain. It involves using bone grafts (from your body or a donor), and sometimes metal instrumentation (screws, rods) to hold the spine in place while it fuses.
Minimally Invasive Spine Surgery (MISS): Whenever possible, I aim to use minimally invasive techniques for fusion. MISS involves smaller incisions, less muscle disruption, potentially less blood loss, and a faster recovery compared to traditional open surgery.
Disc Replacement (Arthroplasty): In very specific cases, for certain types of disc degeneration in the neck or lower back without significant deformity, an artificial disc replacement might be an option instead of fusion. This aims to preserve motion at the treated level. However, it’s generally not indicated for significant degenerative scoliosis as it doesn’t address the underlying instability and curve correction needed.
Scoliosis Correction: For more severe curves, or curves causing significant balance issues, a more extensive scoliosis correction surgery may be needed. This involves a combination of decompression and multi-level fusion with instrumentation to realign and stabilize the spine.
PTP (Posterior TransPsoas Approach): This is a specific minimally invasive approach for lumbar fusion, where access to the disc space is achieved from the side of the body, through the psoas muscle. It can be advantageous in certain cases for correcting scoliosis and achieving fusion with less muscle disruption than traditional posterior approaches.
Ultrasonic Spine Care: Technologies like ultrasonic bone scalpels can be used during surgery to make precise bone cuts while minimizing damage to surrounding soft tissues like nerves and blood vessels. This can enhance safety and precision during complex spine procedures.
Computer-Guided Navigation: For complex surgeries, particularly fusions, computer-guided navigation systems act like a GPS for the spine. They help surgeons precisely place screws and instruments, improving accuracy and reducing risks.

Your Journey to Relief

Dealing with adult degenerative scoliosis can be challenging, but you don’t have to face it alone. As a fellowship-trained orthopedic spine surgeon, I am committed to providing you with the highest level of care, using plain language to explain your condition and treatment options. My team and I are here to support you every step of the way, from diagnosis to recovery, with a calm, clear, and compassionate approach.

If you are experiencing back pain, leg pain, numbness, or weakness that you suspect might be related to a spinal curve, I encourage you to seek evaluation. Let’s work together to help you regain your mobility and improve your quality of life.

Ready to take the next step towards relief?

Call us at (405) 645-5475, book online through our website, or request a FREE MRI review to get started. We serve patients in OKC, Edmond, Norman, Yukon, Moore, Mustang, Midwest City, and nearby areas.

CALL (405) 645-5475

FAQs

What is adult degenerative scoliosis?

Adult degenerative scoliosis is a condition where the spine develops an abnormal sideways curvature in adulthood, typically due to the degeneration of the spinal discs and joints. This can lead to pain, discomfort, and other symptoms.

What are the symptoms of adult degenerative scoliosis?

Symptoms of adult degenerative scoliosis may include back pain, stiffness, muscle weakness, numbness or tingling in the legs, and changes in posture or gait. In severe cases, it can also lead to difficulty breathing and other complications.

How is adult degenerative scoliosis diagnosed?

Adult degenerative scoliosis is typically diagnosed through a physical examination, medical history review, and imaging tests such as X-rays, MRI, or CT scans. These tests help to determine the severity of the spinal curvature and identify any underlying causes.

What are the treatment options for adult degenerative scoliosis?

Treatment for adult degenerative scoliosis may include pain management, physical therapy, bracing, and in some cases, surgery. The specific treatment plan will depend on the severity of the condition, the presence of other medical issues, and the individual’s overall health.

Can adult degenerative scoliosis be prevented?

While adult degenerative scoliosis cannot always be prevented, maintaining a healthy lifestyle, including regular exercise, proper posture, and avoiding smoking, can help reduce the risk of developing spinal degeneration and related conditions.