Degenerative Scoliosis

Degenerative Scoliosis

Degenerative scoliosis, also known as adult scoliosis or adult onset scoliosis, describes a side-to-side curvature of the spine cause by degeneration of the facet joints. The condition occurs most frequently occurs in people over 65 years of age.

The scoliosis curve, which typically forms a "C" shape, is located in the lumbar spine.

Causes of Degenerative Scoliosis

Degenerative scoliosis is caused by a gradual deterioration of the facet joints. This is the same process that causes osteoarthritis of the spine; however, in degenerative scoliosis the pressure of these deteriorating facet joints causes a straight spine, as viewed from the back, to begin to shift so that the spine curves to one side.

Pain from Degenerative Scoliosis

Pain is present in some patients, but not all, and is similar to the pain of osteoarthritis of the spine, which is caused by the same joint deterioration process. Patients may experience stiffness and pain in the mid to lower back and/or pain, numbness, and weakness in the legs and feet.

When the pain is severe, physicians must determine:

  • If the degenerative scoliosis itself is causing pain or;
  • Whether or not other conditions (such as a muscle strain) are causing the patient's pain, and if the scoliosis is incidental.
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Degenerative scoliosis is a common condition, estimated to occur in 6 to 68% of older adults, depending on how scoliosis is defined.1,2,3 Spinal curvature is measured in degrees, so some professionals consider an individual with spinal curvature of just 10%, which is not visible to the untrained eye, to have degenerative scoliosis.

Adult Scoliosis vs. Adolescent Scoliosis

Many patients have heard of adolescent scoliosis (also called idiopathic scoliosis), but are not sure how adolescent and adult scoliosis differ. Adolescent scoliosis occurs in children 10 to18 without cause. In severe cases, it can progress rapidly as the child grows, requiring a scoliosis brace or surgery to slow or stop the curvature. Patients rarely feel pain because of the scoliosis itself.

Unlike adolescent idiopathic scoliosis, degenerative scoliosis has a known cause: the deterioration of the facet joints in the back due to aging. The inflammation of the degenerating facet joints is the cause of pain, not the curve, which typically progresses slowly at about 1 to 2 degrees per year. Therefore, treatment is not centered on slowing the curvature, but instead is focused on relieving pain.

Degenerative Scoliosis Symptoms

Pain mainly results from the deterioration of the facet joints, which, when healthy, are like hinges that help the spine bend smoothly. In some people, aging naturally erodes the cartilage that protects the joints. This erosion process, the same as in osteoarthritis of the spine, can cause the joints to become irritated and inflamed by the bone of the vertebrae. The inflammation is the cause of the patient’s pain, not the curvature of the spine.

Typical symptoms include:

  • Pain comes on gradually. Back pain from degenerative scoliosis does not occur suddenly but worsens gradually over time, and is associated with activity.
  • The pain tends to be worse first thing in the morning, and tends to improve after the patient gets up and around for a while. The pain then worsens later in the day.
  • Sitting feels better than standing/walking. This is because the facet joints generate most of the pain, and facet joints have more loading (pressure) in the standing position. Sitting takes the stress and weight off the joints.
  • Leg pain in one or both legs when standing/walking. As irritated facet joints become enlarged, they can constrict the lumbar spinal canal (a condition called lumbar stenosis). This constriction is even narrower when standing or walking, because this position causes blood to become enlarged around the nerve root. Since the nerve roots that leave the lower spine serve the legs, patients may feel leg pain. Sitting opens up the space and allows the blood to flow out, relieving pain.

References:

  1. Ploumis A, Transfledt EE, Denis F, "Degenerative Lumbar Scoliosis Associated with Spinal Stenosis," The Spine Journal, 2007:7:428-43.
  2. Schwab F, Dubey A, Gamez L, El Fegoun AB, Hwang K, Pagala M, Farcy JP, "Adult Scoliosis: Prevalence, SF-36, and Nutritional Parameters in an Elderly Volunteer Population," Spine, 2005:30:9:1082-5 journals.lww.com/spinejournal
  3. Kobayashi T, Atsuta Y, Takemitsu M, Matsuno T, Takeda N, "A Prospective Study of De Novo Scoliosis in a Community Based Cohort," Spine, 2006:31: 2:178-82 www.ncbi.nlm.nih.gov
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