Adult Degenerative Scoliosis
Scoliosis refers to a bending and twisting of the spine. In children this is usually due to a genetically determined growth disturbance of the bones and muscles. Usually this curvature stops progressing once growth stops. Rarely, it is due to a major neurologic disorder.
In adults this disorder is quite different. In the adult spine this curvature is usually due to wear and tear of the natural supports to the spine. These supports can be weakened by arthritis, osteoporosis, past surgery and the like. When these supports fail, the spine begins to fall over, slip, and rotate on the remaining structures.
The three factors that usually bring a patient with degenerative scoliosis to see the spine doctor are:
Deformity: As the spine rotates and falls off, patients begin to notice a change in posture, possibly the presence of a rib prominence, or a difference in shoulder height. In some patients this deformity can become rapidly progressive and require prompt treatment.
Back Pain: There is some debate as to the causes of back pain. The three main factors that cause back pain are: 1) instability (inappropriate motion of joints in your spine); 2) painful, arthritic joints in your spine; and 3) painful, worn-out discs.
Leg Pain: Leg pain is usually caused by pressure on one of the nerve roots exiting your spine. Usually this pressure occurs at the hole where the nerve leaves the spine, called the foramen. The walls of this hole are partly made up by the disc and the facet joint. With wear and tear the facet joint can get arthritis causing bone spurs to form in the hole, pinching the nerve. Also, with wear and tear, the disc can bulge or break and put additional pressure on the nerve. Finally, with inappropriate motion and curvature the nerves can be pinched and pulled causing leg pain.
WHAT TREATMENTS EXIST?
The initial treatment is to prevent it from happening. Proper treatment for osteoporosis, and strong back and stomach muscles can stop this from occurring or slow it down once it has started.
Non-steroidal, Anti-inflammatory Medications: These medications (ie: Ibuprofen, Relafen, Lodine, Voltaren, Naprosyn, DayPro, etc.) can decrease pain and inflammation. Taken along with an exercise program, they can significantly relieve your pain. Patients may react differently to each of these medications. Often patients need to try several before the best one is found. Some new medications only need to be taken once or twice a day and are easier on your stomach.
Epidural Steroids: You may be given an injection of a steroid around the nerves, which are being squeezed. For acute flares of pain, epidural steroids can alleviate your pain and allow you to return to your pre-flare state. A steroid is the most powerful anti-inflammatory medication. Through this injection, a small amount of the most powerful medication is inserted exactly where your problem occurs. An x-ray machine is utilized to easily place the medication on the exact location. While this does not “cure” the problem, it can quickly calm it down, occasionally for many months. Often, when combined with a therapy program, this improvement can be nearly permanent. If needed, these injections can be repeated periodically.
With more active problems, physical therapy combined with a back brace and anti-inflammatory medication can provide good relief.
Surgery: For those patients who have been unsuccessful with less invasive treatments or have a case that is progressing or causing nerve damage, surgery may be required. This surgery usually attempts to do two things:
1) It attempts to take the pressure off of the nerves. The surgeon removes bone, ligament, and disc until s/he is confident that there is nothing compressing the nerves.
2) The surgeon attempts to stabilize, or “fuse” the spine. This is done to stop the pain coming from instability of the spine, as well as to prevent future curvature causing more pain. Often the goal of the surgery is not to get the spine straight, but rather to keep the curve from getting worse. Many techniques exist to get a fusion to occur. Your surgeon will explain which one s/he feels is best in your case.