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Degenerative Scoliosis : Adult Scoliosis, Causes, Symptoms

Adult scoliosis is a lateral curvature of the spine that occurs after the age of 20. Like any scoliosis, it can cause shoulder and hip unevenness, waist and shoulder asymmetry, and a rib hump. In adults, it is usually caused by osteoarthritis of the spine and co-occurs with the loss of lumbar lordosis.

 

 

Fig. 1 Degenerative skolysis caused by degenerative disease of the lumbar spine.
Poor image quality due to advanced osteoporosis.

 

 

Causes

In adults, scoliosis usually arises secondary to osteoarthritis of the spine or is associated with other diseases of the spine or the nervous and muscular systems.

 

The most common causes

  • spinal stenosis
  • degenerative disc disease
  • osteoporosis
  • vertebral compression fractures

 

 

Symptoms of adult scoliosis

  • change of own, familiar figure
  • "Collapse" of the torso
  • the mobility of the spine is limited
  • protruding shoulder blade
  • rib hump
  • waist asymmetry
  • uneven hip line
  • tilt the torso
  • in severe cases:
    • deterioration of the gait mechanism, limp
    • chronic or sharp lower back pain
    • sciatica: very blue, pain in the leg or foot
    • burning sensation, tingling and numbness in the leg or perineum
    • leg weakness (paresis), foot drop and loss of sphincter control
    • symptoms worsen in upright positions and when walking - neurogenic chromium.

 

 

Diagnosis

During the consultation, body silhouette: shoulder and pelvic line assessment, torso, shoulder blades and pelvis symmetry, presence of the rib hump, shape and mobility of the spine, examination of tendon reflexes and lower limb strength and leg length will be examined.

Imaging tests

The basic test for the diagnosis of scoliosis is an x-ray of the spine (always standing up), which measures the size, extent and shape of the curvature, as well as the patient's entire silhouette. In adult scoliosis, MRI is always performed, and sometimes 3D computed tomography.

 

 

Treatment

 

Inoperable treatment.

Inoperable treatment allows you to control the pain, but it does not affect the neurogenic claudication distance and torso balance. This means that standing and walking are the cause of a significant deterioration in the quality of life.

  • Exercise therapy. In the case of osteoarthritis of the spine, the repeated flexion flexion - forward flexion of the torso is usually checked.
  • Painkillers used to reduce pain - this is only symptomatic treatment, there is no causal substance. In this case, a series of non-steroidal anti-inflammatory drugs or steroids can be used. There is no pharmacological causal treatment for osteoarthritis.
  • Periorbital, epidural and intervertebral blockades are injections of analgesic and steroid medications. It is a method of reducing pain (sciatica) and swelling of the nerve structures in patients who do not improve after previous treatment.

 

Operational surgery - scoliosis surgery.

Indications for surgery:

  • deterioration of the gait mechanism, limping,
  • chronic or sharp pain in the lower back,
  • sciatica: very blue, pain in the leg or foot,
  • burning sensation, tingling and numbness in the leg or perineum,
  • leg weakness (paresis), foot drop and loss of sphincter control
  • symptoms worsen in upright positions and when walking - neurogenic chromium.

Correction of curvature is carried out using titanium implants. Thanks to this, it is possible to stop the progression of curvature, balance the trunk, decompress the squeezed nerve roots and stiffen the instability. Consequently, the patient's quality of life improves.

 

In surgery for curvature of the spine in adults, correction of curvature and stiffening of the spine is performed. Depending on the shape and size of the curvature, you can use front or rear brace. The decision on the method of surgery is always made individually based on the diagnostic tests performed. However, in the curves associated with degenerative disease we try to operate from posterior access, which allows for a wide release of the nerve roots,

 

 

Important! After surgery for osteoarthritis and curvature of the spine , non-steroidal anti-inflammatory drugs should not be used because they inhibit wound healing.