5 Surprising Facts About Adult Scoliosis: What Every Neurologist Should Know

When people hear the word “scoliosis,” they often associate it with adolescents undergoing screening tests at school, but scoliosis is not exclusive to teenagers. In fact, adult scoliosis is a common yet often misunderstood condition that impacts a significant portion of the population. Though scoliosis in adults may develop from adolescent scoliosis, many cases arise later in life due to aging and degenerative changes in the spine. As a neurologist or spine specialist, understanding the nuances of adult scoliosis can aid in better diagnosis, treatment, and patient education.

In this comprehensive article, we explore five surprising facts about adult scoliosis that even some healthcare professionals might find enlightening. These insights will delve into the prevalence, causes, symptoms, and cutting-edge treatments, while also addressing common misconceptions about the condition.

1. Adult Scoliosis Is More Common Than You Think

When discussing scoliosis, we often think of children and adolescents, but scoliosis can occur at any age, and the prevalence of adult scoliosis is actually higher than most people realize. The National Scoliosis Foundation estimates that scoliosis affects 6-9 million people in the United States. A significant number of these cases are adults who may have developed the condition later in life or had adolescent scoliosis that progressed with age.

The most common form of scoliosis in adults is degenerative scoliosis, also known as de novo scoliosis, which occurs as a result of aging and spinal wear and tear. Studies suggest that nearly 40% of adults over the age of 60 have some degree of scoliosis. Unlike adolescent idiopathic scoliosis, which typically does not cause pain, adult scoliosis often presents with symptoms that can greatly impact quality of life, including chronic back pain, leg pain, and mobility issues.

One of the reasons adult scoliosis is so prevalent but often underdiagnosed is that many people believe back pain is just a natural part of aging. Without a proper evaluation by a specialist, scoliosis can be missed. This highlights the importance of awareness and routine checkups for adults, especially as they get older.

2. Adult Scoliosis Can Develop Without a History of Adolescent Scoliosis

While many assume scoliosis is a condition that either presents itself during adolescence or doesn’t appear at all, this is not entirely true. While it is correct that adolescent scoliosis can progress into adulthood if untreated, many adults develop scoliosis for the first time later in life without any history of adolescent scoliosis. This type of scoliosis is known as adult degenerative scoliosis.

Degenerative scoliosis is driven by the natural degeneration of the spine’s joints and discs due to aging. As the spine degenerates, the vertebrae can slip out of alignment, leading to curvature. Osteoporosis, facet joint arthritis, and disc degeneration are all contributing factors. This type of scoliosis can develop in patients with no previous diagnosis of scoliosis and typically starts after the age of 40.

In fact, degenerative scoliosis tends to progress more rapidly than adolescent scoliosis. The curvature may worsen over time, causing increasing pain, nerve compression, and mobility limitations. As such, the onset of scoliosis in adults is not always slow and can require proactive management to prevent the condition from becoming debilitating.

3. Scoliosis Can Impact More Than Just the Spine

When thinking about scoliosis, most people focus solely on the abnormal curvature of the spine. However, the effects of adult scoliosis can extend far beyond the musculoskeletal system. Because the spine plays a crucial role in protecting the nervous system and maintaining posture, scoliosis can lead to a wide range of secondary health problems.

• Nerve Impingement: One of the most common complications of adult scoliosis is nerve compression, also known as radiculopathy. As the vertebrae shift out of place, they can impinge on nearby nerves, causing symptoms such as numbness, tingling, and shooting pain that radiates down the legs (Sciatica). In severe cases, nerve compression can also lead to muscle weakness and loss of bladder or bowel control.
• Cardiopulmonary Issues: If scoliosis progresses to a severe degree (curvatures greater than 70 degrees), it can compress the lungs and heart, leading to difficulty breathing, reduced lung capacity, and even heart strain. This is more common in untreated cases of adolescent scoliosis that progress into adulthood but can also occur in cases of degenerative scoliosis.
• Mental Health Impact: Chronic pain and the physical deformities associated with adult scoliosis can take a toll on mental health. Many patients experience anxiety, depression, and a decreased quality of life due to the physical limitations and chronic discomfort caused by the condition. Understanding the emotional and psychological impacts of scoliosis is key to providing holistic care.

While scoliosis is primarily a spinal condition, it can have far-reaching consequences that affect multiple body systems. This makes a multidisciplinary approach to treatment essential for managing the condition effectively.

4. Exercise and Physical Therapy Are Essential Parts of Treatment

While surgical intervention may be necessary in severe cases of adult scoliosis, the majority of patients manage their symptoms through conservative treatments. One of the most effective non-surgical treatments for scoliosis is exercise and physical therapy.

Many patients are surprised to learn that scoliosis-specific exercises can actually help slow the progression of the curve and alleviate pain. Physical therapy programs such as the Schroth Method are designed specifically for scoliosis patients and focus on exercises that aim to improve posture, core strength, and spinal alignment.

Key components of scoliosis physical therapy include:

• Strengthening Core Muscles: The muscles that support the spine, including the abdominal and back muscles, play a critical role in maintaining spinal alignment. Strengthening these muscles can help stabilize the spine and reduce the likelihood of further curve progression.
• Stretching and Flexibility: Maintaining flexibility in the spine and surrounding muscles can help alleviate discomfort and improve mobility. Stretching exercises targeting the lower back, hips, and hamstrings are especially beneficial for scoliosis patients.
• Postural Training: Poor posture can exacerbate scoliosis, so postural retraining is a key element of physical therapy. Therapists work with patients to teach them how to sit, stand, and move in ways that reduce strain on the spine.

In addition to physical therapy, regular aerobic exercise such as swimming, walking, or cycling can improve cardiovascular health and reduce the risk of scoliosis-related complications. However, it's important for patients to consult with their healthcare providers before starting any exercise regimen, as certain high-impact activities (e.g., running, heavy lifting) may aggravate scoliosis.

5. Surgery Isn’t Always Necessary – But When It Is, It's Highly Effective

Scoliosis surgery is often viewed as a last resort, but it can be life-changing for adults who suffer from severe pain and functional limitations due to their spinal curvature. However, contrary to popular belief, surgery is not always necessary for adult scoliosis patients. In fact, only about 10% of adult scoliosis cases require surgical intervention. Most patients are able to manage their symptoms with a combination of physical therapy, medications, and lifestyle modifications.

When surgery is recommended, it's usually because the patient’s scoliosis has progressed to the point where the curve is causing significant pain, nerve compression, or spinal instability. The two most common surgical procedures for scoliosis are spinal fusion and decompression surgery:

• Spinal Fusion: In this procedure, the surgeon fuses two or more vertebrae together to stop them from moving independently, thus preventing further curvature of the spine. This is often done using metal rods, screws, and bone grafts.
• Decompression Surgery: This type of surgery is performed when scoliosis leads to nerve impingement, such as Sciatica. During decompression surgery, the surgeon removes a portion of the bone or tissue pressing on the nerves to relieve pain and restore function.

The good news is that scoliosis surgery has come a long way in recent years. Minimally invasive techniques and advanced imaging technologies have made scoliosis surgery safer, more effective, and less painful than ever before. For patients who undergo surgery, the outcomes are generally very positive. Studies show that 80-90% of patients experience significant pain relief and improved quality of life after surgery.

That being said, scoliosis surgery is a major procedure, and patients should be fully informed about the potential risks and benefits before making a decision. Surgeons typically reserve surgery for cases where conservative treatments have failed, and the patient's symptoms are severe enough to warrant the risks of surgery.

Conclusion

Adult scoliosis is a multifaceted condition that is more common and complex than many people realize. Whether it's understanding the high prevalence of scoliosis in older adults, recognizing the potential for scoliosis to develop later in life, or exploring non-surgical treatment options, there’s much more to adult scoliosis than meets the eye.

As neurologists and healthcare providers, raising awareness about the condition and offering patients comprehensive, individualized care can greatly improve their quality of life. By dispelling common myths and promoting a proactive approach to scoliosis management, we can help patients live more comfortably and confidently with their condition.