Cause and Treatment of Lumbar Scoliosis in Older Adults
Scoliosis or curvature of the spine is often thought of as a childhood problem. But more and more, older adults are experiencing this condition, too. Studies show that bone spurs and degenerative disc disease probably start the process that leads to scoliosis.
As these changes alter the biomechanics of the spine, the vertebrae can actually start slipping sideways. The bones start to rotate resulting in lumbar scoliosis. In this article, surgeons from the Twin Cities Spine Center in Minneapolis, Minnesota review the causes, symptoms, and treatment of this type of degenerative scoliosis.
It's likely that degenerative scoliosis is more common than previously thought. Studies show that more than half of older adults have this condition. And with the aging of America, it's probably going to increase even more.
The changes that occur with degenerative lumbar scoliosis also result in a narrowing of the spinal canal called spinal stenosis. Symptoms of both conditions include low back pain. Pressure on the spinal nerves can cause pain down the leg as well. Bending forward or sitting relieves the pain. This is called neurogenic claudication.
Treatment is with conservative care to manage the pain. Antiinflammatory drugs, exercises, bracing, and steroid injections are the most common methods used. No more than four injections are used within a six to 12 month period.
Surgery is considered only after every other option has failed. The goals of surgery are to take the pressure off the nerves and stabilize the spine. Most patients are elderly and have many other health issues making surgery risky. Patients should be warned that the procedure doesn't always change their symptoms. Pain relief and improved walking are the hoped for results.
The authors suggest only doing what is absolutely necessary during surgery. Most often decompression and fusion are done. However, they do advise that all surgical steps needed should be performed at one time. When fusion is considered, bone quality should be checked first. The types of fusion possible are also reviewed.
Avraam Ploumis, MD, et al. In The Spine Journal. July/August 2007. Vol. 7. No. 4. Pp. 428-436.