by Dr. David Borenstein M.D. updated 4/2020
Scoliosis is lateral curvature of the spine over 10 degrees from midline. Scoliosis includes several different categories:
- Adult scoliosis includes individuals younger than 40 years with spinal deformity beginning in adolescence without degenerative changes. Adult scoliosis occurs in up to 7.5 percent of adults, with the prevalence increasing age. Men and women are affected equally with curves of 10 degrees or less; curves greater than 20 degrees occur five times more frequently in women.
- Adult degenerative scoliosis includes patients older than 40 years with spinal deformity and degenerative changes, including elderly who develop curvatures as a result of osteoarthritis of the spine. Adult degenerative scoliosis affects the L2-3 or L3-4 levels most frequently.
- Kyphosis is an increased forward curvature in the thoracic spine.
- Kyphoscoliosis is a combination of anterior and lateral curvatures.
What are the Symptoms of Scoliosis?
Most individuals with scoliosis are pain free initially. Over time, fatigue in the lumbar spine occurs at the end of the day, which results in an increase in pain as individuals remain upright and improves with lying down. Greater curvature is associated with greater pain. Certain movements of the spine tend to be more painful depending on the structures of the spine that are stretched and compressed. On occasion, nerves may be compressed, resulting in pain that may radiate down a leg (sciatica).
How is Scoliosis Diagnosed?
The diagnosis of scoliosis is suspected on physical examination and is confirmed by measurement of spinal angles on X-rays of the spine. The curve is significant in an adult if it is more than 40 degrees. Many of these curves will progress by one degree annually. Spinal curves less than 40 degrees in adults do not progress and are less often a cause of pain.
How is Scoliosis Treated?
Non-surgical therapy is effective for individuals with curves less than 40 degrees. Many individuals respond to physical therapy, exercises, and anti-inflammatory analgesic medicines. Exercises help lengthen the short side of the scoliosis and improve overall core strength.
In older patients, scoliosis has a greater opportunity to be associated with nerve compression and sciatica. Surgery is indicated for unremitting back pain, curve progression, or sciatica. The goal of surgery with the placement of internal fixation devices is stabilization of the spine, pain relief, and improved function.