Five interesting facts about Adult Scoliosis
Scoliosis is a lateral curvature of the spine that in adults commonly occurs for two reasons. It can be a curvature that is carried over from childhood into adulthood. This scoliosis is known as Adolescent Scoliosis in the Adult. The second reason, being the scoliosis most commonly seen in adults, is a new scoliosis that appears in adult life, generally over 40 years of age, and is due to age related degenerative changes in the spine. This scoliosis is known as Degenerative De-Novo Scoliosis.
1. Scoliosis is more usual in adults than in children
Scoliosis in adults is more common than we may think.
Within the child population scoliosis affects between 0.3 and 0.5 percent of the population. However, scoliosis can affect between 1 and 10 percent of the adult population, but really this percentage varies significantly according to gender, age, race, coexistence of low back pain and other demographic factors.
Interestingly, the number of scoliosis cases increases with age, with an average of about 5 percent of over 18-year olds having the condition, this increases to over 30 percent in the over 60-year olds.
2. Scoliosis may continue to progress in adult life
Although the growth of the spine is completed, scoliosis curves can continue increasing in adult life.
The rate of adult curve progression is reported in the literature to be between 1 to 2 degrees per year; however, this is an average increase across the whole of life. Progression in older age can be very rapid, as much as 5 degrees per year!
The progression of scoliosis curves in adults may occur as a result of postural collapse (where the muscles that maintain the posture gradually become weaker over time), or spinal degeneration (degenerative changes in the spine bones and intervertebral discs), resulting in a slow reduction in total spinal length and an increase in curve size.
3. The size of the curve is not a predictor of symptoms
Back pain or pain in the legs and muscular fatigue are the symptoms most commonly experienced by adults with scoliosis, however these symptoms are not related to the size of the curve.
Symptoms in adult scoliosis are frequently related to a side to side and/or front to back imbalanced spine and posture.
When the spine and the trunk are not balanced, some parts of the spine bear greater loads. This provokes generative changes (wear) in certain structures of the spine provoking pain and increasing the risk of curve progression.
4. Adults may also present abnormal curves in the lateral side of the spine
When looking at the spine from the lateral side it is possible to distinguish 3 normal curves.
Adults may also present a larger than normal curvature in their mid-back that is known as hyperkyphosis (rounded back).
Some adults with hyperkyphosis may experience pain due to the loss of spinal balance that results in abnormal loading of the spine.
Hyperkyphosis affects between 20 and 40 percent of adults 60 years and older.
5. Not all adults with scoliosis require treatment
Not all adults who have scoliosis or hyperkyphosis will require treatment.
The indications for treatment could be one, or more likely, a mixture of pain relief, improvement in posture, and reduction in curve progression.
The treatment plan may consist of exercises to improve the spinal balance and strengthen muscles, bracing or a combination of exercises and bracing.
Due to the passive support provided by rigid braces, this treatment option is not recommended for a prolonged period of time as it can produce muscular weakness. However dynamic braces allow improvement of the spinal alignment and posture without provoking muscle weakness or instability because the spinal movement is maintained.
In some circumstances adults may need to consult a spinal surgeon for their opinion about surgery. Surgical treatment is often necessary if the curve increases or other symptoms worsen. The type of surgical procedure varies depending on the type and size of the curve.