Scoliosis is an abnormal curvature of the spine that is often thought of as a childhood disorder but can be diagnosed in adults. Adult scoliosis cannot be diagnosed until the growth process is considered to be complete. The scoliosis may be a deformity from childhood or a result of the aging process from physical accident, chronic conditions such as osteoporosis, slipped vertebrae, degeneration of discs, infections or tumors of the spine, or it may be idiopathic, meaning the cause is unknown. Arthritis of the spine is also a significant risk for developing scoliosis because it leads to bone spur formation offsetting the symmetry of the spine. Those with childhood scoliosis should be monitored into adulthood especially for those with a curve greater than fifty degrees that are more likely to have their scoliosis into adulthood.
Adults are more likely to have problems in all areas of the spine including the neck versus more localized problems in children. In children, scoliosis is more likely to be asymptomatic and diagnosed based on routine physical exam versus adults that typically present with back pain or lower extremity pain due to leg length discrepancy as result of the scoliosis. Depending on the severity of the back deformity, patients may also present with back stiffness, shooting pain, or numbness through the legs caused by pinched nerves. It is also possible to have shortness of breath if the thoracic spine is affected and can be life threatening if it directly affects the heart of the lungs themselves. Other signs of adult scoliosis can include shoulder asymmetry, an abnormal back hump, leaning forward, and complaints of arthritis.
The goals of treatment of scoliosis include pain management, restoring function, and correcting the curvature of the spine. Treatment plans should begin with non-operative management including observation of the curvature to determine if it is progressing and over the counter pain medications such as ibuprofen. Exercise can provide relief of pain by focusing on building the abdominal and back muscles and increasing flexibility. Patients may benefit from a short-term physical therapy course to learn the best practices and safety in performing these exercises.
Patients should be encouraged to participate in low-impact sports such as swimming to provide relief and pain management. Braces are not commonly recommended for the treatment and Pain Management of Scoliosis because it will not cause the back to actually straighten. The brace is also likely to weaken the abdominal muscles and do not provide a long-term effect.
For lower extremity issues, referral to a pain management clinic can provide relief. These treatments can include injections and nerve blocks. Specific treatment plans at a Pain Management Clinic are also indicated if the cause as known such as calcium and vitamin D for osteoporosis, decreasing inflammation associated with arthritis, and antibiotics for infections. Surgical treatment is often a last resort for patients after non-operative strategies have failed or not significantly improved symptoms. Surgery of the back and spine always has several risks so the benefits of the surgery must outweigh the risks of having the procedure itself.