When Scoliosis occurs (or is discovered) after puberty, the condition is called 'Adult Scoliosis'.
Adult scoliosis can be the result of untreated or unrecognised childhood Scoliosis, or it can actually arise during adulthood. The causes of scoliosis that begins in adulthood are usually very different from those of childhood Scoliosis.
Many adults who have Scoliosis actually developed an abnormal curvature to their spine when they were children. As they grow older, the curve may have worsened, a process that doctors call "progression." Many times, progression can cause certain segments of the spine to wear out and become painful, or the abnormal posture that is created by the scoliosis may become uncomfortable by itself and make it difficult to stand or sit for long periods of time.
Progression, or worsening of the curve is a gradual process, and usually occurs at a rate of about a degree per year when it happens. Curves that are smaller have less chance of progressing. So patients with curves that are less than 30 degrees on average have little chance of progressing and these patients have no more back pain throughout their life than patients with straight and "normal" spines. However, studies have shown that adults with spinal curvatures of more than 50 degrees have the greatest chance of progression.
Degenerative Adult Scoliosis occurs when the combination of age and deterioration of the spine leads to the development of a Scoliosis curve in the spine. Degenerative Scoliosis begins after the age of 40. In older patients, particularly women, it is also often related to Osteoporosis. The Osteoporosis weakens the bone making the bone more likely to deteriorate. The combination of these changes causes the spine to lose its ability to maintain a normal shape. The spine begins to "sag" and as the condition progresses, a Scoliotic curve can slowly develop.
The Presence or Absence of Pain - Not all cases of Scoliosis produce pain. However, if there is pain, the doctor will need to know where it is, what brings on or intensifies the pain, and if there is any radicular pain. Radicular refers to pain that radiates away from the spine to other parts of the body. This usually comes from irritation of the nerves as they leave the spine.
Severe pain and disability, and very severe curves in the spine are the more common reasons why a patient will undergo spinal fusion surgery for Scoliosis as an adult. Surgical correction of moderate curves for cosmetic reasons is not usually performed because a spinal fusion is a big operation for an adult to undergo. Most patients with severe back pain and scoliosis will make every effort to treat their pain with a combination of medications, physical therapy, and regular exercise. A combination of anti-inflammatories, narcotic pain relievers, and anti-depressants may be necessary in order to effectively control the pain. The advantages and disadvantages of undergoing a spinal fusion as an adult for Scoliosis needs to be discussed in detail with a surgeon who is an expert in spinal deformity, and this decision needs to be made with care.
The goals of spinal fusion surgery for Scoliosis in adults are a reduction in pain, increase in function, and partial correction of the deformity. No surgery comes with a guarantee for complete pain relief, and in fact, significant pain relief may only be possible 65 or 70% of the time. At the same time, it is often difficult to correct the abnormal curvatures of the spine because the adult spine is much stiffer than the spine of a child or adolescent. As a result, the spine is often fused in place, with only partial correction of the Scoliosis.
Adults who have Scoliosis can also develop nerve root compression when the vertebral bodies press on the nerves that exit the spinal canal. This process can be aggravated by the Scoliosis, since an abnormal tilting of the vertebral body can allow it to slip out of its normal position, decreasing the amount of room available for the nerves to the legs. The warning signs of this condition include weakness, numbness, tingling, and a lack of bowel or bladder control. Surgical procedures may become necessary in this situation in order to enlarge the openings for the nerves, and more information about this type of surgery can be found in the section on Spinal Stenosis.