Adult Degenerative Scoliosis

Adult scoliosis is a degeneration caused by the spinal degeneration in later ages which resulted as destruction, osteolysis in spinal bones, weakening of the strength in and thickening of the ligaments, weakening of the muscles and hernias. The age of onset is around 60 years. It is seen between 2% and 32% in the community. It progresses rapidly in osteoporotic patients. It may be seen with the narrow lumbar canal.

Diagnosis

The patient’s history and examination are very important. As a result of aging in the spine, thickening of joints and ligaments, the collapse of disc distances and sliding of the spine result in compression of nerve structures. As a result, strength and sensory defects may occur in the legs. Patients often consult with severe low back, back pain, and gait disturbance. The patient has to stop due to numbness, tingling and burning sensation in his legs and feet. This condition is called neurogenic claudication. In addition, patients walk by leaning forward or sideways due to poor posture.

For complete and detailed preoperative evaluation, standing waist x-rays, moving waist x-rays are used and to assess posture and body balance standing scoliosis radiographs are used. With magnetic resonance imaging (MRI), nerve tissues and soft tissues are examined in detail. The spinal canal and nerve compression are evaluated. Computed tomography (CT) can be used for detailed and three-dimensional examination of the bones and joints. After all these radiological examinations have been completed, the type of scoliosis, spinal shifts, stenosis of the canal, and the place and type of curvature are decided.

Natural course

It is very difficult to predict the natural course in patients with adult spine deformity. Spinal narrow canal, osteoporosis, lumbar disc hernia, low back pain, and spine and body imbalance also affect the spinal pathology of these patients. In addition, systemic diseases such as diabetes, which may be added over time, may also make it difficult to understand this natural course because patients are older.

Treatment

It is difficult to determine the natural course and indications for definitive treatment in adult deformity patients. Conservative treatment is usually tried first and the patient is followed up. Corset applications, physical therapy, rehabilitation, narcotics, interventional procedures and bed rest can be tried in conservative treatment. In this way, the complaints of patients who do not have very severe complaints can be reduced or even recovered. Especially patients with a curvature below 30° are not expected to progress. In addition, patients without osteoporosis or at risk of surgery may also receive conservative treatment. Some patients should not lose time in conservative treatment. This is because for patients to do not suffer redundant pain, do not increase existing nerve pressures and do not progress deformity.

Patients with very severe leg or low back pain, whose quality of life has decreased significantly, whose walking distance is very reduced and patients who cannot perform their daily functions may have surgery. Patients with a curvature above 50° are candidates for surgery because they have a high risk of progression. Patients whose curvature progresses and does not benefit from conservative treatment are candidates for surgical treatment. In surgery, osteotomies are used to remove parts of the spine, remove thickened ligament structures and bones that cause nerve compression, and instrumentation to re-arrange the spine. Adult deformity surgery has a higher complication than pediatric deformity surgery. If surgery can be performed at an early age, concomitant diseases may be avoided more.