Adult Degenerative Scoliosis
Adult scoliosis is a degeneration caused by the spinal degeneration in later ages which is seen in conjunction with destruction, osteolysis in spinal bones, weakening ligament strength, thickening ligaments, weakening of the muscles and hernias. The age of onset is around 60 years. It is seen in between 2% and 32% of the population. It progresses rapidly in osteoporotic patients. It may be seen alongside a narrow lumbar canal.
The patient’s history and examination are very important. As a result of the aging in the spine, thickening of joints and ligaments, the collapsing of disc gaps and the displacement of the spine, compression of nerve structures occur. As a result, strength and sensory deficiencies and defects may occur in the legs. Patients often apply with severe lower back, back pain, and gait disorders. The patient is forced to stop due to numbness, tingling and burning sensations in their legs and feet. This condition is called neurogenic claudication. In addition, patients walk by leaning forward or sideways due to poor posture.
For a complete and detailed preoperative evaluation, standing waist x-rays, mobile 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, the type of scoliosis, spinal displacements, stenosis of the canal, and the location and type of the curve are determined.
It is very difficult to predict the natural course in patients with adult spine deformity. Spinal narrow canal, osteoporosis, lumbar disc hernia, lower back pain, and spine and body imbalance also affect the spinal pathology of these patients. In addition, systemic diseases such as diabetes, which may emerge over time, may also make it difficult to understand this natural course because of the advanced age of the patients.
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 monitored. Corset applications, physical therapy, rehabilitation, narcotics, interventional procedures and bed rest can be tried during conservative treatment. In this way, the condition of patients who only have mild complaints may be improved or completely treated. In particular, patients with a curvature below 30° are not expected to progress further. In addition, patients without osteoporosis or high-risk surgical patients may also receive conservative treatment. Some patients should not lose time in conservative treatment. This is to ensure that the patients do not needlessly experience pain, the existent nerve compression is not worsened and the deformity does not progress any further.
Patients with very severe leg or lower back pain, and whose quality of life has decreased significantly due to the same, whose walking distance is very limited, and who cannot satisfactorily perform daily functions may undergo surgery. Patients with a curvature above 50° are candidates for surgery because they have a high risk of progression. Patients whose curvature progresses and who does not benefit from conservative treatment are candidates for surgical treatment. The surgery is performed to remove parts of the spine with osteotomies, remove the thickened ligament structures and bones that cause nerve compression, and to realign the vertebrae. Adult deformity surgeries have a higher complication rate than pediatric deformity surgeries. If surgery is performed at an early age, concomitant diseases may be avoided to a higher extent.