Adult Scoliosis: Six Facts to Know

Scoliosis, a common spinal condition, is a sideways curvature of the spine that is most often detected during adolescence. Once a person reaches adulthood and their bones have stopped growing, screening for scoliosis becomes much less frequent. But back problems later in life can still be due to adult scoliosis.

“There are two main buckets of adult scoliosis, degenerative and idiopathic,” says Dr. Peter Angevine, director of Och Spine at NewYork-Presbyterian Westchester. “The majority of adult scoliosis is degenerative, meaning it develops in adulthood due to degeneration of the spine. But adult scoliosis can also be idiopathic, where it developed in adolescence and it either wasn’t diagnosed, it wasn’t treated, or treatment stopped when the child reached adulthood.”

Adults are often surprised when they are told they have scoliosis, says Dr. Angevine, but he adds that the implications are different from a diagnosis in childhood. With adults, the focus often is on relieving the symptoms to help patients feel better, rather than stopping the curve.

Dr. Angevine, who is also an associate professor of neurological surgery at Columbia University Vagelos College of Physicians and Surgeons, shared with Health Matters six things people should know about scoliosis in adults.

When to get tested

Adults are not regularly tested for scoliosis at annual checkups. If a person was diagnosed with or treated for it as a child, it may be a good idea to have a baseline X-ray in their 30s or 40s to re-establish the standard shape and curve of their spine and monitor any changes.

Causes of scoliosis in adults

In most cases, adult scoliosis is not caused by damage or trauma to the spine itself but is a soft tissue issue. The spine is a stack of bones held together by soft connective tissue, ligaments, and discs. As we get older, those tissues become less elastic and weaker, and they don’t hold the stack of bones straight, which can lead to a curve in the spine. Additionally, a person with a physically demanding job, may develop more spine degeneration, which might develop into scoliosis.

Smoking is bad for the spine

Smokers have more degenerative spinal disease than non-smokers. It’s thought that the same chemical processes that cause emphysema, which is a breakdown of the elastic tissue of the lungs, can affect the spine. Those chemicals can be absorbed into the connective tissue of the spine and cause weakness, leading to scoliosis.

A hunched back is not scoliosis

Forward hunching that might be seen in older men and women is not the same thing as scoliosis. Bending forward like this is called kyphosis, and, unlike scoliosis, it’s most often caused by osteoporosis, which is when bones become weaker.

Nonoperative scoliosis treatment for adults

With adult scoliosis, people should start with the same principles that apply to general good back health to help manage the symptoms:

• Maintain a healthy lifestyle
• Good ergonomics
• Core strengthening
• Good posture

In children, a brace is used to control the sideways curve and keep it small enough that it won’t progress into adulthood. Once a child’s bones stop growing, usually around 18 years old, the bracing stops. One reason is that bracing in adulthood can allow a person’s core muscles, which are the very muscles needed to help support their spines, to atrophy. Instead of bracing, physical therapy, such as the Schroth Method — a non-surgical approach using exercise to slow the progression of scoliosis — is often used to control the curve.

When surgery may be necessary

If someone with adult scoliosis reaches a point where their quality of life has decreased, that’s when their doctor may begin to talk about surgery options. This could include:

• Pain extending to a patient’s legs or arms
• Regular activities like walking or getting out of bed cause too much pain
• Someone receiving optimal nonoperative care but the symptoms remain unmanageable

As for the type of surgery, doctors will start with looking at the symptoms that are affecting the patient. For instance, often times the curve itself is not the problem but instead it’s a pinched nerve caused by the curve, and doctors can use minimally invasive techniques to decompress or remove the impacted disc to take the pressure off the nerve. That won’t treat the scoliosis, but it will address the symptoms. If there is simply no way to address the symptoms without directly addressing the scoliosis, then more complex surgery may be considered.