Scoliosis affects children and adults differently, especially in the context of pain and progression. Adults over the age of 65 who develop scoliosis can be particularly vulnerable to injury through a fall, so treatment works towards improving the spine’s balance and stability.
Although scoliosis is more commonly diagnosed during childhood, it also affects adults. Adults over the age of 65 can develop degenerative scoliosis caused by degenerative instability in the spine. Cases of degenerative scoliosis are almost always painful and progressive so care options are important.
As a patient’s scoliosis-journey starts with an assessment, let’s explore the signs of adult scoliosis.
Recognizing Scoliosis in Older Adults
While scoliosis is more often diagnosed during adolescence, the actual rate of scoliosis increases among the elderly population, and this is due to the prevalence of degenerative scoliosis.
It’s estimated that approximately 35.5 percent of adults over the age of 60 have adult scoliosis, and in patients between 60 and 90 years of age, estimates are as high as 68 percent (9).
Scoliosis can develop at any time, and degenerative scoliosis is also known as degenerative de novo scoliosis (DDS) because it doesn’t involve a prior history with scoliosis (9).
The main type of scoliosis to affect adults is adolescent scoliosis in adult (ASA) and its prevalence highlights the importance of early detection.
Most adults with idiopathic scoliosis didn’t develop their scoliosis in adulthood, but rather during adolescence; in mild cases, symptoms can be subtle, difficult to recognize, and as scoliosis doesn’t generally become painful until skeletal maturity is reached, adolescent scoliosis isn’t always easy to diagnose (2).
Adults being assessed for scoliosis usually undergo a standing assessment followed by a forward bend assessment.
Cases of idiopathic scoliosis in adults are pre-existing.
Adult Scoliosis Symptoms
It’s not uncommon that an adolescent doesn’t receive a diagnosis or treatment during adolescence because the patient is unaware of their scoliosis, but when growth stops, conditions become compressive, and pain can alert these patients to the need for assessment; pain is the number one symptom that brings adults in for assessment, diagnosis, and treatment.
So adolescent scoliosis that’s neither diagnosed nor treated doesn’t just go away; it becomes adult scoliosis which is more difficult to treat (2, 5, 8).
In addition to muscle, back, and radiating pain, additional signs of adult scoliosis to watch for can include:
- A prominent forward lean or lean to one side
- Loss of standing and/or sitting height
- Changes to balance, coordination, and gait
- Postural collapse
- More falls
- Changing quality of life
Muscle pain can be caused by the development of a muscular imbalance, and back pain in the main spinal section affected is common, as is pain that radiates into the extremities due to nerve compression.
Adult scoliosis pain can range from mild and intermittent to chronic and debilitating, and as scoliosis is progressive, pain levels can increase over time.
If warning signs are present, don’t hesitate to reach out for a comprehensive assessment as there are care options available.
Degenerative De-Novo Scoliosis
Most cases of degenerative scoliosis are caused by spinal degeneration that’s age-related (8).
When assessing and diagnosing adult scoliosis, it has to be determined whether the scoliosis is pre-existing or a new onset.
New-onset cases involve degenerative de novo scoliosis and are most likely to affect adults over the age of 45; this type is also more likely to be diagnosed in females due to menopausal changes that affect bone health and hormone levels.
Because degenerative scoliosis is caused by the spine becoming increasingly unstable due to degenerative changes, it’s almost always progressive, and the main symptom is lower back pain.
Pain isn’t only shaped by an adult patient’s curve size, but also the location of the scoliosis within the spine and the spine’s level of balance and stability.
So assessments don’t just involve assessing an adult patient’s curve size, but also a number of other variables that can shape a patient’s symptoms and treatment needs.
Care Options for Older Adults with Scoliosis
A challenge to treating adult degenerative scoliosis is spinal rigidity; because adult spines have stopped growing, they are going to be more rigid so there is less potential to correct the curve through a significant reduction (8).
The good news is that when it comes to pain management and improving the spine’s stability, curves don’t always need to be fully corrected to make improvements; making improvements to a patient’s posture, pain levels, and improving spinal function may be possible and can have a big impact.
Postural awareness and restoration is a focus of scoliosis treatment at any age, and improving posture and pain levels will only improve the spine’s general biomechanics.
As an adult’s pain level doesn’t solely depend on the size of the scoliosis, but also on the spine’s balance and stability, treatment that improves these areas can also make a big impact, particularly when it comes to an older patient’s quality of life.
Traditional care options for older adults with scoliosis commonly involve the prescription of pain medications, but that does little to address the underlying cause of the pain: the spine’s increasing degeneration and instability.
Bracing and Physical Therapy
If corrective bracing is deemed an appropriate treatment option, this can involve short- or long-term use (3).
Early intervention with bracing can help improve the spine’s balance through facilitating a straight and upright posture; postural restoration can increase the spine’s strength and flexibility while reducing the uneven forces being exposed to the spine (7).
The ScoliBrace® can also help with pain management as it can mean less movement/instability within the spine, and it’s thought that these general improvements to spinal alignment and stability can also help slow progression/further degenerative changes.
An additional facet of degenerative scoliosis care can include ScoliBalance®, and for adults, the individualized scoliosis-specific exercise program aims to restore posture and core/spinal stability (3).
When combined, Scolibrace® and ScoliBalance® can help older adults make significant improvements, not so much to the size of their scoliosis, but to its impact on the spine’s flexibility, balance, and stability (3).
The ScoliBrace® can restore stability by facilitating a straight and upright posture; it can also manage movement within the spine for pain relief, and when c
ombined with a customized scoliosis-specific exercise program, the spine’s surrounding muscles can be strengthened for a stronger core, more stability, and more support for the spine.
These types of improvements can help alleviate pain, and the risk of injury through frequent falls is also reduced because the patient’s posture and balance are restored.
Conclusion
There are never treatment guarantees, and while there are challenges to addressing scoliosis in adults over the age of 65, improvements capable of impacting quality of life can be worked towards.
As degenerative de novo scoliosis commonly affects adults over the age of 45, pain and instability are common concerns.
As degenerative scoliosis is caused by age-related spinal degeneration that often starts in the intervertebral discs, almost all cases are progressive and painful.
Pain relief is a focus of adult scoliosis treatment, and when it comes to older adults, increasing levels of spinal instability have to be addressed not just due to pain but because this increases the risk of injury through falls.
Symptoms of adult degenerative scoliosis can include a prominent forward lean or lean to one side, varying levels of pain, changes to balance and coordination, a loss of sitting and/or standing height, and many patients experience disruptions to quality of life.
While severe scoliosis can involve recommendations for spinal fusion surgery, the older a patient is, the more risky scoliosis surgery becomes, and many cases of adult onset scoliosis can be improved through the customization of treatment plans combining the power of corrective bracing and scoliosis-specific exercise.
Non surgical treatments for adult scoliosis are less invasive and safer than traditional decompression surgery and/or scoliosis surgery.
Conservative treatments have the potential to improve spinal alignment, posture, relieve pain, strengthen core muscles, increase spinal flexibility, strength, and balance, and these combined effects may slow curve progression and further degenerative changes.
The ScoliCare approach is patient-centered, so regardless of a patient’s age, the ultimate treatment goal is long-term improvement to quality of life.
References:
- A Grauers, E Einarsdottir P Gerdhem. Genetics and Pathogenesis of Idiopathic Scoliosis: National Library of Medicine
- Active self-correction and task-oriented exercises reduce spinal deformity and improve quality of life in subjects with mild adolescent idiopathic scoliosis: National Library of Medicine
- Weinstein SL. The Natural History of Adolescent Idiopathic Scoliosis. J Pediatr Orthop. 2019 Jul;39(Issue 6, Supplement 1 Suppl 1):S44-S46. doi: 10.1097/BPO.0000000000001350. PMID: 31169647.
- Marchese R, Du Plessis J, Pooke T, McAviney J. The Improvement of Trunk Muscle Endurance in Adolescents with Idiopathic Scoliosis Treated with ScoliBrace® and the ScoliBalance® Exercise Approach. J Clin Med. 2024 Jan 23;13(3):653. doi: 10.3390/jcm13030653. PMID: 38337346; PMCID: PMC10856658.
- Negrini S, Donzelli S, Aulisa AG, Czaprowski D, Schreiber S, de Mauroy JC, Diers H, Grivas TB, Knott P, Kotwicki T, Lebel A, Marti C, Maruyama T, O’Brien J, Price N, Parent E, Rigo M, Romano M, Stikeleather L, Wynne J, Zaina F. 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis Spinal Disord. 2018 Jan 10;13:3. doi: 10.1186/s13013-017-0145-8. PMID: 29435499; PMCID: PMC5795289.
- Scoliosis in Children and Teens: National Institute of Arthritis and Musculoskeletal and Skin Diseases
- Comparison of Functional Outcome and Quality of Life in Patients With Idiopathic Scoliosis Treated by Spinal Fusion: National Library of Medicine
- Screening for the Early Detection of Idiopathic Scoliosis in Adolescents: American Academy of Orthopaedic Surgeons
- Marty-Poumarat, Catherine MD*; Scattin, Luciana MD†; Marpeau, Michèle MD*; Garreau de Loubresse, Christian MD‡; Aegerter, Philippe MD, PhD§. Natural History of Progressive Adult Scoliosis. Spine 32(11):p 1227-1234, May 15, 2007. | DOI: 10.1097/01.brs.0000263328.89135.a6
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