Adult scoliosis

In scoliosis, the spine bends to the side instead of running straight when viewed from behind. In adults it falls into two broad groups: a curve that began in childhood or adolescence and persists into adulthood, and degenerative (de novo) scoliosis, a new curve that develops later in life as discs and joints wear unevenly. Degenerative scoliosis most often affects the lower back in older adults.

• Low back pain and stiffness that often builds gradually and with activity
• Leg pain, numbness, tingling, or heaviness with standing or walking, often from narrowing around the nerves (spinal stenosis)
• Uneven shoulders, hips, or waistline
• Leaning forward or to one side, or difficulty standing upright
• Tiring quickly when standing or walking
• Loss of height

Many adults with a mild curve have no symptoms.

Adult curves have different causes:

• Idiopathic scoliosis begins in childhood or the teen years for reasons that are not known and can persist, or slowly progress, in adulthood.
• Degenerative scoliosis develops when discs and facet joints wear unevenly with age, letting the spine tilt and rotate. It often occurs alongside spinal stenosis and can be made worse by osteoporosis and compression fractures.
• Less commonly, curves are related to neuromuscular conditions, earlier spine surgery, or other spine disorders.

A clinician examines your posture, balance, flexibility, strength, and nerve function. Standing X-rays of the full spine measure the curve in degrees (a curve of more than 10 degrees is considered scoliosis) and show how well the spine is balanced over the pelvis. An MRI or CT scan may be used to look for nerve compression or spinal stenosis, and a bone density test may be recommended to check for osteoporosis.

Non-surgical care is the first approach for most adults. Mild curves without significant symptoms are usually monitored with periodic X-rays. Physical therapy and exercise for core strength, posture, and flexibility, pain medications when appropriate, and image-guided injections for nerve pain can help manage symptoms. Bracing does not correct a curve in adults, whose spines have stopped growing, though a brace is occasionally used briefly for comfort. Treating osteoporosis, when present, supports long-term spine health.

Surgery may be considered when pain or nerve symptoms remain disabling despite non-surgical care, when the curve is large or progressing, or when spinal imbalance makes standing upright difficult. Procedures range from a decompression to relieve pinched nerves, to fusion of a few levels, to longer fusions that correct the curve with screws and rods. Adult deformity surgery can be extensive, and age, bone quality, smoking, and other health conditions affect its risks; your surgeon will review whether surgery is appropriate for you.

With non-surgical care, a regular exercise routine helps maintain strength and function. Recovery after deformity surgery depends on how many levels are treated, can take many months, and includes physical therapy. Ongoing follow-up checks the fusion and the levels above and below it, which can wear faster over time.

Scoliosis itself cannot be prevented. Staying active, keeping the core muscles strong, protecting bone health, and not smoking support the spine and help with recovery if treatment is ever needed.