What it is
Adult degenerative scoliosis is a curve that develops in a spine that was previously straight, as discs and facet joints wear asymmetrically. It is usually accompanied by stenosis, and it is often the nerve compression rather than the curve itself that brings people to clinic.
Alongside the curve, the question Dr. Long pays most attention to is balance: whether you stand upright over your pelvis, or have to compensate with your hips and knees to stay level.
Symptoms
- Back pain, often worse through the day and with standing
- Leg pain, heaviness or numbness from narrowed nerve exits
- Visible change in posture, leaning forwards or to one side
- Increasing fatigue with standing and walking
- A sense that you are becoming shorter or stooping
How it is diagnosed
Full-length standing X-rays are essential — a curve cannot be assessed on a lying-down MRI or on films that show only part of the spine. These measure the curve, the balance of the head over the pelvis, and the pelvic parameters that determine what, if anything, needs correcting. MRI shows where the nerves are compressed.
Non-surgical treatment
Physical therapy, conditioning, weight management, anti-inflammatory medication and targeted injections. Many adults with a measurable curve live comfortably with it and never need an operation, which is the first thing worth establishing.
When surgery is considered
When nerve compression is causing symptoms that do not settle, when balance is failing, or when the curve is clearly progressing. Surgery ranges from a limited decompression at the symptomatic level through to realignment of the whole spine, and the two are very different undertakings. Dr. Long's training is in exactly this decision — doing the smallest operation that solves the actual problem, rather than the largest the films would permit.