FAQ’s on Adult Degenerative Scoliosis Treatment in Philadelphia
The normal spine is straight when viewed from the front or back. Scoliosis is defined as any lateral deviation (bend) of the spine. Adult degenerative scoliosis occurs as a result of wear and tear on the spine and supportive structures. This condition is related to aging.
What structures are affected by scoliosis?
The spine has 24 vertebrae, which are moveable bones. Each vertebra is separated from the one above and below it with a disc. Discs are fluid-filled cushions that serve as shock absorbers. The normal inward curve of the cervical (neck) spine is called lordosis, and kyphosis is the normal outward curve of the thoracic (mid-back) spine. The spinal cord travels through a small canal created by the vertebra, and spinal nerves branch off the spinal cord. These nerves supply the arms, trunk, and legs. Scoliosis can affect any of these structures, and it distorts normal spinal curvature.
What are the symptoms of adult scoliosis?
The main symptom of degenerative scoliosis is back pain. In addition, the patient may experience certain leg problems, such as tingling, numbness, and weakness. As the condition gradually worsens, the patient may experience difficulty walking.
How is adult degenerative scoliosis diagnosed?
Scoliosis is confirmed when an x-ray reveals a curvature of the spine that measures more than 10 degrees. In addition, the patient may undergo a magnetic resonance imaging (MRI) scan or a computed tomography (CT) scan to diagnose nerve problems associated with the scoliosis.
What causes adult scoliosis?
The main cause of adult scoliosis is degeneration of the spine and associated structures. Conditions that contribute to this condition include osteoporosis, vertebral compression fractures, spinal stenosis, and degenerative disc disease.
Who is at risk for degenerative scoliosis?
This form of scoliosis is more common among older people. In a recent clinical study, the mean age of those affected by degenerative scoliosis was 70 years. In addition, for those who are between ages 60-90 years of age, almost 70% have some form of spinal curvature.
How is adult degenerative scoliosis treated?
The treatment of adult degenerative scoliosis depends on the individual patient’s symptoms and the extent of his/her condition. Options include:
- Medications – The pain specialist may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs), narcotic analgesics, muscle relaxants, and/or a combination of medications.
- Spinal brace/orthotics – For patients with leg length issues, special shoe inserts will help with balance and leg discomfort. A back brace is used to provide support.
- Physical therapy – This involves a guided back-strengthening program, which conditions the muscles that support the spine, improves posture, and provides support. The therapist will also provide pain relief through electrical stimulation, heat/cold therapy, and ultrasound.
- Epidural steroid injection (ESI) – Often given in a series of three, this injection involves administering a long-acting corticosteroid (with or without an anesthetic) into the epidural space. Based on clinical studies, ESI is around 90% effective for back pain.
- Facet joint injection (FJI) – The facet joints are tiny joints along the posterior region of the spine. FJIs are done to instill a steroidal agent and anesthetic into the facet joint using x-ray guidance.
- Radiofrequency facet denervation (RFD) – When FJI is found to be effective, the doctor may choose to destroy the nerve root in question with radiofrequency energy. A recent study proved that this procedure had a 76% efficacy rate, with many patients reporting more than 50% pain relief.
- Surgery – A surgical procedure is reserved for patients who have scoliosis curves that are greater than 40 degrees. Surgery involves implantation of metal parts and bone grafts to correct the curve and hold the spine in proper position.
Riew KD, Park JB, Cho YS, et al. (2006). Nerve root blocks in the treatment of lumbar radicular pain. A minimum five-year follow-up. Journal of Bone Joint Surgery, 88(8):1722-1725.
Schawab F, Dubey A, Gamez L (2005). Adult scoliosis: prevalence, SF-36, and nutritional parameters in an elderly volunteer population. Spine, 30(9), 1082-1085.
Streitberger, K, Muller, T, Eichenberger, U, Trelle, S., & Curatolo, M (2011). Factors determining the success of radiofrequency denervation in lumbar facet joint pain: a prospective study. European Spine, 20(12), 2160-2165. doi: 10.1007/s00586-011-1891-6