Adult scoliosis
Scoliosis is much more prevalent among adults. Depending on the study, the incidence of adult scoliosis ranges between 12 and 32% (22). One thing is certain: the older the age group, the higher the number of reported cases. The statistics include cases diagnosed in childhood and adolescence that progress into adulthood, as well as cases diagnosed among adults 50 and over.
Two important factors distinguish adult scoliosis from adolescent scoliosis:
- frequent pain and neurological disorders due to compression of the spinal cord and nerve roots—called central and lateral spinal stenosis* respectively—and which include:
- neurogenic claudication
- back pain
- leg pain
- hypoesthesia or anesthesia of the perineum
- weak leg muscles
- diminished osteotendinous reflexes
- incontinence
- progression of the curve is associated not with trunk growth but with degenerative joint disease (osteoarthritis), which may lead to joint instability.
* Spinal stenosis: a narrowing of the spinal canal or of the intervertebral foramen which respectively either compresses the spinal cord or nerve roots.
Chart comparing the two types of adult scoliosis
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Progression of Adolescent Idiopathic Scoliosis Into Adulthood |
Adult Degenerative Scoliosis(De Novo) |
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Deformation (wedging) of the vertebrae during the childhood development period |
No history of scoliosis; Usually in older adults (50+) No spinal deformities other than osteoarthritis (≠ wedging) |
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Leads to joint degeneration with age |
Is caused by osteoarthritic degeneration and ligament instability Leads to lateral listhesis (rotatory subluxation) and spinal stenosis |
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Not always painful |
Typically associated with spinal stenosis, neurogenic claudication, back pain, leg pain, hypoesthesia or anesthesia of the perineum, weak leg muscles, diminished osteotendinous reflexes, incontinence. |
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Slow, steady progression depending on the degree of severity (up to a Cobb angle of ≤50°) |
Possibility of very quick progression (up to 4°/year) |
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Generally not influenced by menopause |
May be influenced by menopause |
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All types of curves, usually balanced |
Lumbar curves, unbalanced and unstable |
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The sagittal plane (profile view) stays unaffected |
Loss of lumbar lordosis (kyphoscoliosis) |
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Progression of AIS into adulthood |
Adult degenerative scoliosis (de novo) |
PROGRESSION OF Adult Scoliosis
In adults, the progression risk is no longer associated with growth, but with the compressive forces of gravity which cause joint degeneration and lead to spinal instability.
Progression of Adolescent Idiopathic Scoliosis Into Adulthood
It is a widely held belief in the medical community that there is no progression risk of scoliosis in adults as they have attained full growth. However, it has been scientifically proven that this is not the case, and that adult scoliosis does progress over time. (17, 19, 20, 21, 23, 24, 25, 26, 28, 30, 31, 32, 33, 34, 35, 36, 37, 39, 41, 47, 48, 50, 51, 55, 57, 58, 60, 61, 62, 63, 64, 66, 67)
While the progression risk in adolescents is linked to trunk growth, ageing and joint degeneration due to gravitational forces on the spine are responsible for curve progression in adults, also leading to ligament instability.
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The diagram above, compiled by Longstein and Carlson, shows that progression of AIS into adulthood is proportional to the degree of severity at the time of skeletal maturation. |
Adult degenerative scoliosis (de novo) may progress much more rapidly than AIS, because of greater spinal instability and steady deterioration—up to 4° per year. (41)
Progression indicators
The same progression indicators apply for both types of adult scoliosis:
- Cobb angle of more than 30° (A)
- Overall imbalance of the spine on the coronal and sagittal planes (front and profile views)
- Regional kyphosis or hypolordosis
- Vertebra L5 in line with the intermediate line of the iliac crest (D)
- Apical rotation ≥ grade II (Nash-Moe) (B)
- Lateral listhesis ≥ 6 millimetres (C)
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Diagram compiled by Tribus (60) illustrating the main progression indicators for adult scoliosis.
Health risks
Risk of progression is slightly lower with scoliosis of the thoracic spine as the rib cage provides it stability. However, imbalance in the upper body and gravitational forces may result in the collapse of the lumbar region, leading to disastrous complications, especially at the cardiopulmonary level.
Patients suffering from scoliosis in the lumbar or thoraco-lumbar regions have an increased risk of general health problems.
In fact, the compression of the spine due to gravitational forces also puts pressure on the abdominal organs as well as the heart and lungs, reducing the patient's life expectancy. This combined with joint degeneration can lead to central stenosis by rotational subluxation of the lumbar vertebrae and in turn lead to serious neurological problems.
Symptoms of central stenosis:
- lower back pain
- unilateral or bilateral sciatica (leg pain)
- sensory deficit (anesthesia or hypoesthesia)
- motor problems (coordination, muscular strength, tone, balance, etc.)
- diminished osteotendinous reflexes
- urinary or fecal incontinence
In conclusion
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If you are an adult suffering from scoliosis—whether adolescent idiopathic or degenerative (de novo)—you should be aware of the health risks associated with the accelerated degeneration of your spine. We therefore recommended that you take action as soon as possible, whether or not you are in pain.
To find out how the SpineCor® treatment can help adults slow or even stop the progression of scoliosis, visit the SPINECOR - ADULT TREATMENT section. |
