There are two main types of adult scoliosis – Pre-existing (usually adolescent scoliosis), which in adulthood becomes known as Adolescent Scoliosis in Adult (ASA); and the development of a new scoliosis in adults, usually as a result of spinal degeneration which is known as Degenerative De-Novo Scoliosis (DDS). Adults with ASA may or may not have previously been diagnosed with adolescent scoliosis. ASA may be progressive or stable, depending on the individual case. In those with a previous diagnosis of AIS monitoring progression is easy as comparison of current x-rays to adolescent x-rays can be done. In those where the scoliosis is discovered in adulthood, determining if the scoliosis is a pre-existing adolescent condition or a new onset of degenerative scoliosis can be difficult.
DDS usually develops in middle aged and older adults and is typically seen starting around 45 years of age onwards. Because DDS is a result of degenerative instability, it is almost always progressive. However the main complaint usually associated with DDS is lower back pain.
Pain and Adult Scoliosis
Although some forms of adult scoliosis can be progressive, the main complaint is usually lower back pain. Often this pain is severe and little relief has been found from usual medical and complementary care. A common misunderstanding still perpetuated by most health professionals is that scoliosis does not cause pain. This is not true. This notion has come about because the majority of children suffering from adolescent idiopathic scoliosis do not present with a primary complaint of pain and quite often even large deformities in children do not cause pain. However, in adults between the ages of 50 and 80 who suffer from chronic lower back pain, research shows that up 40% will have an adult scoliosis.
This misconception has led to a diagnostic and treatment approach that largely ignores the role of scoliosis in chronic lower pain in adults and, as a result, less than satisfactory outcomes for many of these patients.
The pain seen in adult scoliosis is not related to the size of the curve. Several good studies show there is little to no relationship between the size of the cuve and pain. i.e a 20 degree and a 55 degree curve have the same chance of causing pain in an adult. There are two key factors related to pain in adults.
1) Location of the curve. Almost all complaints of pain in adult scoliosis are of lower back pain. The majority of new DDS curve are lower back curves. It is rare for a single curve in the upper spine to cause lowe rback pain. However in some cases patients with ASA who have an “S” shaped curve, the bottom half of the curve in the lower back may cause pain as an adult.
2) Balance of the spine. What is meant by “balance” is the forward/backwards, left right/shift of the spine that does not necessarily related to the size of the curve. Most importantly adults with scoliosis who have a forward shifted posture, or those that are bent forward, will develop more pain than those in a neutral or backwards shifted posture.
Treatments for Adult Scoliosis
The usual care recommended for patients suffering back pain with adult scoliosis is pain killers, anti-inflammatory or other drug treatments, back strengthening exercises, surgical decompression and the whole range of other medical and complementary treatments used to treat common lower back pain. On the whole these treatments do not manage the pain over the medium to long term as they generally do not help to treat the underlying condition causing the pain, which is the scoliosis.
Specialised conservative scoliosis treatments and specialised surgical treatments have been developed to treat adult scoliosis. Unfortunately as adult spines have finished growing, the potential to make correction is limited to the inherent flexibility of the scoliosis and is usually very limited. However in many cases, the scoliosis need not be corrected to reduce pain. As the majority of adult scoliosis patients suffering pain do so because of the altered spinal balance and not because of the size of the curve, both conservative and surgical treatments that specialise in treating adult scoliosis can be beneficial.
In some cases, pain relief and stabilisation can be achieved with intensive specialist physiotherapy which works on spinal balance, not just strengthening core muscles. The goal of these programs is to teach the patient to overcorrect the abnormal position the scoliosis causes in their posture. Once the patient can make these correction movements, there a series of exercises can be used to re-enforce the correction and assist the body to maintain the correction itself.
Adult Dynamic Bracing
Dynamic bracing works in a similar way to physiotherapy, in that the goal of the brace is to use the elastic straps to help teach the patients body to correct the abnormal posture caused by the scoliosis.
A dynamic brace brace can be used in various ways in adults.
1) It can be used temporarily to give patients pain relief during certain activities or situations and worn for support. For example some scoliosis suffers that develop pain during exercise choose to wear it during exercise or while at the gym.
2) It can be used as an intensive rehabilitation device, to try and strengthen the posture and muscles allowing the body to maintain a corrected posture giving medium to long term relief.
3) It can be worn on an ongoing basis for the most severe cases where there is spine collapse but the brace overs a reduction in pain and support.
Rigid Bracing in Adults
In some cases, research supports wear of a customised rigid brace, to support the spine, reduce pain and improve quality of life.
Surgery in adults is often more complicated and risky. One issue in particular that causes difficulty is if a patient has osteoporosis. When the bones are weakened by osteoporosis it makes attaching rods and bones grafts a more difficult task. Surgery is also not a guarantee of pain relief, but in some cases is the only option when both traditional and conservative care have failed.