Spinal deformities in adults can have a significant impact on their quality of life. Adult scoliosis that appears during adolescence can be divided into three age categories: younger adults (18–30 years), middle-aged adults (30–40 years), and older adults (over 40 years). It is defined as a spinal deformity with a Cobb angle greater than 10 degrees in individuals who have completed their growth and development.
Adult scoliosis most commonly occurs as a consequence of untreated or inadequately treated adolescent idiopathic scoliosis. Adult patients with scoliosis have a different clinical and radiographic presentation compared to patients with adolescent idiopathic scoliosis. These differences include degenerative changes in the curve, the natural history of deformity progression, and clinical symptoms.
Degenerative changes lead to increased asymmetric loading and, as a result, progression of the deformity. The presence of osteoporosis contributes to curve progression, especially in postmenopausal women. Degeneration of the intervertebral discs, facet joints, and joint capsules can also lead to changes in lumbar lordosis, making the spine unstable.
Pain is one of the most common symptoms in adults with scoliosis. The pain is usually located along the convex side of the curve and may often be the result of muscle fatigue and spasm. However, it may also be due to degenerative changes in the facet joints, which is why clinical, radiographic, and neurological examinations are very important. Back pain may be present only in an upright position, most often due to prolonged standing or sitting, or only during certain movements or physical activity.
When discussing adult scoliosis, it is inevitable to mention “de novo” scoliosis. De novo scoliosis is a term used for adult patients who have no history of scoliosis during adolescence but develop a spinal deformity in adulthood, which may have a progressive course and is associated with degenerative changes in the spine. This type of scoliosis rarely appears before the age of 40. Osteoporosis, degenerative disc changes, and spinal canal stenosis accelerate the development of degenerative scoliosis. Patients with degenerative lumbar scoliosis often experience pain in the back or lower limbs.
It should be noted that adult scoliosis can be treated both surgically and non-surgically. Surgical treatment should be considered only if non-surgical treatment has no effect and does not promise significant long-term improvement. The initial stage of non-surgical treatment for degenerative scoliosis usually begins with medication, postural exercises, and pool-based therapy.
It is important to note that the goal of treatment for adult scoliosis is not based on correcting the curve, but on reducing pain and any accompanying neurological problems. In some cases, the use of a brace may be helpful for better control and stabilization of the spine.
When it comes to postural exercises, the Schroth Method has proven to be one of the most effective approaches for scoliosis correction. The goals of Schroth treatment differ between children and adults. In adolescence, the focus is on stopping and reducing the scoliotic curvature, while in adults treatment is based on improving function, reducing pain, and preventing further progression of the scoliotic curve. Unlike in children, radiographic reduction of the curve is not possible in adults.
Taking all of this into account, timely diagnosis and treatment of adult scoliosis are very important, as the condition can significantly affect quality of life.
