Adult Degenerative Scoliosis

Over time in adult degenerative scoliosis the facet joints and discs can degenerate.

Adult Degenerative scoliosis

What is degenerative scoliosis?

Adult degenerative scoliosis is divided into two categories; Degenerative (getting worse over time) and De Novo (new).

Degenerative scoliosis happens to an adult who has had a history of scoliosis. The spine starts to show wear and tear due to age and this wear can cause the spine to collapse, causing the curve of the spine to increase.

De novo (new) scoliosis first appears in adulthood without any history of the condition. Again, this is due to wear and tear as the person grows older and results in a curve of the spine.

In both types of this condition the facet joints and discs in the spine can degenerate and the pressure created by this degeneration can cause the spine to curve, this results in a diagnosis of adult degenerative scoliosis.
Adult degenerative scoliosis is typically diagnosed after an adult reaches the age of 50.

What has caused my adult degenerative scoliosis?

Adult degenerative scoliosis is caused by the degeneration of the facet joints and discs in the spine.

Facet Joints: Joints are the places in the body where two bones meet and the facet joints are between each of the vertebrae in your spine, they allow your back to be flexible and allow you to bend or twist. The pressure created by the degeneration of these joints can cause the spine to curve.

Discs: Discs are a part of the spine. They are round and flat on the top and bottom and are slightly flexible. They stop your vertebrae from rubbing against one another and also work like shock absorbers for the spine. Injury to, or degeneration of discs can lead to lower back pain and leg pain and can also cause numbness and weakness. 

Because the facet joints and the discs are affected in adult degenerative scoliosis, adults can experience a curve in the spine, back pain, weakness in legs and/or feet and a loss of flexibility.

How will my adult degenerative scoliosis be diagnosed?

The specialist will use your medical notes and talk to you about your experiences to build a full history of your developing condition, they will ask you about any pain and discomfort you are experiencing. They will also examine your back to see if there is a visible curve or if one shoulder is higher than the other. Investigations may include one or more of the following:

  • A standing X-ray to show the curve of the spine
  • A CT scan (computed tomography scan) to produces detailed images of many structures inside the body, including the internal organs, blood vessels and bones
  • An MRI scan (Magnetic resonance imaging) which uses strong magnetic fields and radio waves to produce more detailed pictures of the spine. This helps check that there are no problems with the spinal cord or the development of the nerves

What treatment will I receive?

Non-surgical interventions

Most patients with adult degenerative scoliosis are given non-surgical treatment which may include anti-inflammatory drugs for pain relief, physiotherapy for improving overall mobility, and low impact exercises to improve strength. If the medications and therapy do not help your condition, steroid or local anaesthetic injections into the muscle, joints, or spinal canal can help you manage your pain.

Surgical intervention

If these treatments do not help you to manage your condition a scoliosis specialist may talk to you about having a surgical procedure, often called ‘fusion surgery’, to correct the curve. The aim of this surgery is to relieve your pain and correct the adverse changes in your posture or balance. Surgery for adults is more challenging than for young people as adults may have other health concerns and recovery can also take longer, but your scoliosis specialist will explain the risks and benefits of surgery so that you can make an informed decision.

How will adult degenerative scoliosis affect my life?

Living with scoliosis can be challenging and sometimes painful and it is important that a person with scoliosis sees a scoliosis specialist. The pain created by a spinal curve can be treated in lots of different ways, often with very good outcomes, but everyone’s experience of living with scoliosis is different and this is why it is important for everyone to see a specialist who can advise them on a case by case basis.

It is important to note that curves in adults of less than 30 degrees rarely get bigger, but curves in adults that are 50 degrees or more in size may increase by an average of 1 degree per year and, in this instance, surgery is often advised.

If you need help or advice please call our Helpline on 020 8964 1166 or e-mail: info@ssr.org.uk.

Frequently asked questions

Below is a selection of common questions we are asked by callers on our Helpline.
What causes degenerative scoliosis?

Degenerative scoliosis occurs in adults for two main reasons. First, scoliosis may have started when the patient was younger and may have worsened with age. The second degenerative, or de novo, type of scoliosis starts after the age of 40 and is thought to be caused when discs and facet joints (the hinge joints at the back of the spine) start to collapse in the lumbar spine (lower part of the spine). When discs and facet joints collapse the vertebrae can slip out of place, which makes the spine curve.

After diagnosis you should make sure that you are seen by a scoliosis specialist. There are around 30 scoliosis centres across the UK and you can find your nearest specialist by calling or emailing . You will need to take the names of the specialists to your GP, who will organise a referral. You will then receive a letter in the post with your appointment date and time.

At your first appointment with the specialist you will be examined, X-rays will be taken, and you will be told the Cobb angle. The Cobb angle is measured in degrees, and will tell you how big the curve is. The specialist will then talk to you about your scoliosis and possible treatments. It is important to remember that every scoliosis is different and there is no standard treatment so consulting a specialist is essential.

In Scotland things are done in a slightly different way. After diagnosis, you will be referred to an orthopaedic surgeon, who will assess you and organise the referral to the national service if necessary. Please see the Scottish web page on the for more information.

Degenerative scoliosis is a curve that worsens as the years go by. Some patients with progressive scoliosis may have pain, breathing difficulties, or problems with mobility.

Adults under age 30 years are usually treated in much the same way as adolescents, although their curvatures are often a little stiffer than in a younger person. This stiffness can mean that surgery is more complicated.

Surgery can still be an option for some adults over 40. However, an operation would usually be done to treat pain rather than correct the curve. Surgery can be more complicated for an older person and it is less easy to predict the outcome. The scoliosis specialist would discuss all risks and benefits with the patient if surgery was an option.

Scoliosis can only be prevented when it is due to rickets or poliomyelitis, which can both be treated. Happily both these diseases are now very rare.

Scoliosis is not caused by bad posture, carrying a heavy backpack, or anything you did or did not do.

If you take the names of your nearest scoliosis specialists to the GP, they will usually be happy to arrange the referral. However, sometimes they will not want to. It is important to ask why this is. There may be a good reason why the referral can’t be made. This could be a reason to do with the hospital, or your area may have a different process for making such referrals.

If there is no clear reason, we suggest making an appointment with another GP at the practice. If this is not successful, you can write to the Practice Manager and ask them to look into the matter.

In Scotland things are done slightly different. After diagnosis, you will be referred to an orthopaedic surgeon, who will assess you and organise the referral to the national service if necessary.

It is normal to feel confused about what course of treatment to choose. There is a lot of information to take in and some of the questions about scoliosis have no clear answer. It is absolutely fine to ask your specialist further questions, or for a second opinion.

If you need names of other centres or specialists then you can get this information from us by calling or emailing us.

You may also find that it helps to talk through the specialist’s advice with someone. The friendly SSR team are always happy to offer advice, support, and a listening ear. You can ask us as many questions as you like and we will try to help. It sometimes helps to speak to people who have been in a similar position.

Treatment has developed a lot over the last 5 to 10 years. There are more options for older people now, and assessment by a scoliosis specialist will give you more information about your curvature and the future. However, surgery for older people does carry higher risks than for young people. Our bones weaken as we age and this makes surgery much more challenging.

In adults over the age of 40 recovery happens more slowly than for younger people. As their spines are older and the bones weaker it can be harder to predict what the results of surgery will be. Any surgery is usually done to relieve pain rather than to correct the curve. However, the surgery may lessen the curve too. A scoliosis specialist will talk to the patient about the risks and benefits.

Pain management is a difficult subject because everyone has different experiences. What works for one person does not always work for the next.

If possible, most people should do light exercise. Swimming, yoga, and Pilates can help with pain as they make the core (stomach and back) muscles stronger. This is good for back health in general.

Over the-counter painkillers such as paracetamol and ibuprofen can help some people. If these drugs don’t work, then talk to your GP, who can refer you to a pain management clinic in your area. Pain management clinics are able to look at a wider range of treatments these can include medication and pain management courses and programmes that teach techniques to manage long-term pain.

For more information on pain management please click here.

It is your right to ask for a second opinion from another specialist at the same or a different hospital.

Also every hospital has a patient advice and liaison service (PALS). If you are unhappy with the way that you have been treated or have any other worry or concern about your care, you can seek advice from the PALS service linked to your hospital, which will be happy to help.

Support

Whether you want general guidance or advice or just to talk things through; our team are here to help.

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Research

We fund three types of research grants for work in scoliosis and other spinal conditions.

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