Scoliosis in Adults: The Complete Guide to Symptoms, Diagnosis, and Treatment

Before we get into the details, it’s important to have a basic understanding of what scoliosis is.

The simple definition is that scoliosis is an abnormal side-to-side curvature of the spine. Viewed from the back, the spine may look like an "S" or a "C" instead of a straight line.

The severity of the curve, known as the degree, is measured by something called the Cobb Angle. A curve with a Cobb Angle of 10° or more is the threshold for scoliosis (2).

It might surprise you to learn that there’s more than one type of scoliosis. In this section, we’ll discuss the three different types of adult scoliosis as well as what the symptoms of adult scoliosis are.

Type I: Adult Degenerative Scoliosis

Degenerative scoliosis is the most common kind of scoliosis in adults. It’s sometimes called “De Novo” scoliosis, meaning that it’s a curvature of the spine that develops in adulthood instead of during childhood (3). This kind of scoliosis typically results in curves in the lumbar spine (lower back area).

Type II: Adult Idiopathic Scoliosis

Idiopathic scoliosis is scoliosis with an unknown cause. In many cases, adults with idiopathic scoliosis have suffered from undiagnosed scoliosis since adolescence, with symptoms only becoming apparent in adulthood (1). Adult idiopathic scoliosis can affect any part of the spine.

Type III: Secondary Degenerative Adult Scoliosis

Secondary degenerative scoliosis is scoliosis that is caused by another condition. Legs that are different lengths, hip issues, other spine issues, and osteoporosis in conjunction with arthritis are all potential causes of adult scoliosis (4).

Scoliosis Symptoms

Mild scoliosis is quite common in older adults and often doesn’t result in any symptoms. As the spine becomes more misshapen, scoliosis can cause symptoms such as:

• Back pain (this is the most common symptom of scoliosis) (5)
• Uneven shoulders, hips, and/or waist
• Bump, bulge, or other deformity in the back
• Loss of height
• Spinal stenosis
• Numbness, tingling, weakness, or shooting pain in the legs
• Fatigue
• Shortness of breath
• Feeling full quickly when you eat

As we discussed, certain cases of adult scoliosis develop from complications of adolescent-onset conditions. But in de novo cases – the most common type for adults – what is the root cause of scoliosis?

The Cause of Adult Degenerative Scoliosis

To understand how and why adult degenerative scoliosis develops, it’s important to first understand the structure of the spine.

Your spinal column is made up of 33 vertebrae. These bones are stacked on top of each other. Each vertebra has four facet joints – one pair on the top, and one pair on the bottom. The facet joints connect your vertebrae to each other and allow your spine to move, bend, and twist. Your vertebrae are separated and cushioned by intervertebral discs, which keep your spinal bones from rubbing together (7).

Everyone’s spinal discs and joints degrade as they age. In some cases, this natural degeneration is more accelerated. If the joints and discs begin to wear away more on one side of the spine than on the other, degenerative scoliosis can develop.

Advances in medicine have made diagnosing adult scoliosis easier than ever. In this section, we’ll talk about the tools that your doctor will use to figure out if you have scoliosis.

History and Physical Exam

If your doctor suspects you have scoliosis, the first thing they’ll do is review your medical history. Your doctor may ask about:

• Your family history
• When you started to notice changes in your spine
• Where your pain is

Your doctor may also perform a physical exam, in which they’ll examine the shape of your spine and see if your waist or shoulders seem uneven. They might check for signs that scoliosis is affecting your nervous system by doing reflex and muscle-strength checks. You may be asked to perform the Adam’s Forward Bend Test, in which you bend forward 90° at your waist. This will allow your doctor to more easily spot any asymmetry in your body shape and spinal curves (8, 9).

Imaging

In order to make an accurate diagnosis, your doctor may need to order imaging studies. The type of imaging they order will depend on the severity of your case and if your doctor thinks other systems might be involved. Some of the tests your doctor might order include:

• X-Ray: Standing X-rays taken from the front and the side will help your doctor measure the curve of your spine.
• MRI (magnetic resonance imaging) or CT (computed tomography) scans: Advanced medical imaging techniques will give your doctor a more complete picture of your spine.
• Discogram: This is an invasive X-ray procedure where dye (known as contrast) is injected into your intervertebral discs. Discograms aren’t very common in diagnosing scoliosis, but your doctor may recommend one if you’re going to have spinal fusion surgery (10).

Evaluation

Once your doctor has the results of your imaging, they will evaluate your spine based on a few different criteria.

• Coronal Curve: The Coronal Curve refers to the side-to-side alignment of your spine (3, 11). It’s measured by the Cobb Angle. If the curvature of your spine has Cobb Angle greater than 10°, then you likely have scoliosis (2).
• Sagittal Alignment: This is the front-to-back alignment of your spine. Patients with adult idiopathic scoliosis tend to have sagittal imbalance in their lower back (12).
  

Treating adult scoliosis is different than treating childhood scoliosis. In cases of childhood scoliosis, the intent of treatment is to stop the spinal curve from worsening. In adults, the goal typically isn’t to fix scoliosis, but rather to relieve pain and improve quality of life (1).

The type of scoliosis treatment your doctor recommends will depend on how severe your spinal deformity is, the symptoms you’re experiencing, and any other conditions you might have (1).

In this section, we’ll cover both nonsurgical and surgical treatment for scoliosis in adults.

Nonsurgical Treatment Options

Many adults with scoliosis wonder if they’ll need spinal surgery. Fortunately, for most patients with adult scoliosis, nonsurgical care options are effective. Treatments like physical therapy, braces, and pain medications are most effective for patients with Type I Scoliosis, but can also be effective for patients with Type II and Type III Scoliosis (13).

Exercise & Physical Therapy

Exercise and physical therapy are often recommended as the first treatment for patients with mild to moderate scoliosis. Here we’ll cover two common physical therapy techniques for adults with scoliosis, Schroth Method and SEAS.

Schroth Method

According to Johns Hopkins, Schroth Method exercises are used to “de-rotate, elongate and stabilize the spine in a three-dimensional plane” (14). The Schroth Method focuses on muscular symmetry, rotational angular breathing, and postural awareness.

SEAS

Scientific Exercises Approach to Scoliosis – also called SEAS – was developed in the 1960s in Italy. SEAS focuses on the patient’s ability to self-correct their spinal deformity by teaching them to make conscious adjustments to the curve (15).

Over-The-Counter NSAIDs

Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen and naproxen (Aleve), can help decrease pain and inflammation.

Prescription Pain Medications

In some cases, doctors may prescribe stronger medications to help with scoliosis pain. Tricyclic antidepressants, gabapentin (an anticonvulsant), and muscle relaxers have proven effective in treating pain associated with scoliosis in adults (3).

Braces

Braces in adults are primarily used to provide support and for pain relief. Rigid and flexible braces can both be useful for scoliosis, but flexible braces are more commonly prescribed (16).

Injections

Injections of steroids or medical-grade cement can help relieve persistent pain due to scoliosis (17, 18).

Scoliosis Surgery

Surgery can be a potential course of action for patients who haven’t responded well to nonsurgical treatment, who have poor quality of life due to scoliosis, or who have debilitating back pain, leg pain, or spinal imbalance. The goal of scoliosis surgery is to relieve nerve pressure and correct spinal alignment (19).

The surgical procedure that your doctor recommends will depend on your exact condition and symptoms.

Decompression Surgery

In decompression surgery, part of the vertebra is removed. This enlarges the spinal canal and relieves pressure from the spinal cord. This kind of surgery is often used in patients with spinal stenosis (a narrowing of the spinal canal which puts pressure on the nerves of the spine, often causing leg or back pain).

Spinal Fusion

Fusion surgery removes problematic joints by permanently joining vertebra together. Your surgeon will use either bone or synthetic graft material. In some cases, your surgeon will perform stabilization surgery in addition to spinal fusion, which involves attaching hooks, wires, and screws to the spine and using metal rods to link the anchors together. The rods reinforce the spinal column and help hold it in place.

Osteotomy

In an osteotomy, your surgeon will cut and realign segments of your spine. In the case of a vertebral column resection – which is a specific kind of osteotomy – entire vertebral sections are removed. Vertebral column resections are only performed when other surgical measures can’t correct the spinal deformity (20).

No medical treatment is without risk. In this section, we’ll talk about the potential side effects of different scoliosis treatments.

• Braces: In order to be effective, braces have to be worn for long periods of time. This can lead to muscle atrophy and weakness, and can contribute to accelerating the degenerative process. Wearing braces long-term has also been associated with feelings of depression and lowered self-esteem (21).
• NSAIDs: Long-term use of NSAIDs has been associated with a number of negative side effects (22), including increased risk of stomach ulcers, kidney failure, stroke, and heart attack
• Injections: Both steroid and medical-grade cement injections come with an increased risk of infections as well as potential damage to nerve tissue. Steroid injections can also cause headaches.
• Surgery: In addition to the risks associated with any surgery, in the case of scoliosis surgery, there’s a possibility that one surgery might not be enough. One study showed that over 40% of patients who had one scoliosis surgery needed to have another one within 6 years (23).
  

If you’re experiencing lower back pain, numbness or tingling in your legs or back, or have a visible spinal curve, you should talk to your doctor about adult scoliosis. There are many effective treatment options – both surgical and nonsurgical – that can provide pain relief and improve your quality of life.