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SPINAL DISORDERS ADULT SCOLIOSIS

Scoliosis

Adult Scoliosis

Adult Idiopathic Scoliosis



This is a condition which begins painlessly during childhood, and presents its signs (pain, poor posture,etc.) with increasing age. (Figure 1).

The cause of this type of scoliosis, which may occur during childhood, is not known therefore it is named idiopathic scoliosis.

Adult Degenerative Scoliosis

Erişkin scoliosisu

Adult degenerative scoliosis is the type of scoliosis which occurs due to a wear of the spine. It mostly occurs in people over the age of 50. Osteoporosis, which is another problem seen in this age group, can both be a cause of degenerative scoliosis or aggrevate the degree of the curve. Osteoporosis is a condition in which calcium in the bone is decreased, it is also known as atrophy of the bone among people. (Figure 2)

Which areas are most commonly affected by degenerative scoliosis?

Degenerative scoliosis caused by wear can occur in any of the areas including the neck, back or waist areas of the spine; however it occurs most commonly in the lower back region.

The stability and balance of the spine can be disrupted in people with advanced degenerative scoliosis. This can lead to sideways deviation of the spine and the body on the front-back plane and deviation of the torso to the front due to the decreased anatomic angle of the lower back region.

These imbalances may lead to an increase in the severity of the curve, also affect the movement capabilities of the patients and may result in pain. This process is generally slow.

The spinal curve has a concave and a convex side. The compressive forces on the concave side result in overloading on the facet joints, and this compression may cause the nerves to be compressed in the canal. In addition extra bone that has formed in the joints due to the wear of the spine or reactive thickening of the soft tissues may increase nerve compression.

As a result, patients with adult degenerative scoliosis may suffer from back-lower back pain and pain alongside the nerve’s pathway (radiculopathy) and weakness in the muscles innervated by the nerve. In some cases, a vertebra can move forwards, backwards or sideways as a result of the excessive deformation of the spine or as a result of pressure. These deformities can also occur along with adult degenerative scoliosis, and it is called spondylolisthesis when there is forward movement of the spine, retrolisthesis when there is backwards movement, and lateral listhesis when there is sideways movement. The sliding movements in the bones of the spine may lead to pain, also leg pain and muscle weakness resulting from entrapment of the nerves and/or the spinal cord

In adolescent idiopathic scoliosis, the degeneration of the facet joints can cause considerable amounts of pain. The excessive deformation that may occur in the thoracic cage may negatively affect respiratory functions, and the patients may sufffer from easy fatigue and shortness of breath.

What are the symptoms of adult scoliosis?

Adolescent scoliosis is often noticed by the patients themselves due to the deformities and disturbances in the balance. The patient also becomes shorter as a result of the curve, so their clothes no longer fit or do not look good. However, lower back pain and loss of certain abilities are the two complaints which bring the patient to the doctor. Other complaints are difficulty getting up after sitting for a long time, difficulty during the initial steps of walking, spasm of the back and lower back muscles, a progressive decrease in the walking distance over the years, and a feeling of tiredness in the legs. A loss of strength and numbness in the legs can occur in patients with severe nerve compression. Shortness of breath and easy fatigue may be seen in patients with adult idiopathic, thoracic (back area) scoliosis.

How is the diagnostic process for adult scoliosis?

Hastanın şikayetleri ve scoliosisun eğrilik derecesi tedavi kararını etkileyen önemli unsurlar arasındadır. Kişi doktora şikayetleri konusunda ayrıntılı bilgi vermelidir. Bu süreçten sonra doktor, hasta şikayetlerini değerlendirerek şu tetkikleri isteyebilir:

The patient's discomfort and the level of the curve are important factors which influence the decision of treatment. The patient should give detailed information to the doctor regarding his or her complaints. The doctor may then request the following tests:

Direct radiography:

X-ray of the back from the front -back and sides, and the standing scoliosis X rays.

MRI:

If you have pain radiating to your legs, loss of strength, and change in your bladder and bowel functions, then magnetic resonance imaging may be necessary.

Computer tomography (CT) – Myelo-CT:

The doctor may order a CT scan in order to see more details about the bones. If the degree of the curve of scoliosis is high and the doctor believes that the compressions may not be seen well with MRI he/she might also request a Myelo-CT.

Electrodiagnostic tests:

These tests are mainly carried out on patients with leg pain (radicular) in order to determine the level of nerve compression, and also on patients with diabetes in order to clarify whether the nerve damage is caused by diabetes or the spinal disorder.

How is adult scoliosis treated?

The method of choice in the management of adult scoliosis is determined based on the degree of pain and curve, and whether the curve is progressive or not. The initial treatment methods are generally nonsurgical. Exercises to improve physical fitness, and also stabilization, strengthening and stretching exercises carried out with a physiotherapist can relieve muscle cramps, thereby alleviating the pain. However, it has not been conclusively shown that these exercises can reduce the progression of scoliosis that will progress.

Brace treatment for adult scoliosis

Brace treatment can be used in combination with exercises in patients with adult scoliosis. However, brace treatment should be considered for a short period of time, and complementary to exercise and physiotherapy. Long-term treatment with a brace causes more damage than good in patients with adolescent scoliosis.

Painkillers can be prescribed in addition to physiotherapy and exercises to patients who have pain. In addition, to eliminate the irritation and inflammation in the facet joints or due to nerve compression, non-steroidal anti-inflammatory drugs can added to the treatment.

Spinal injections can be a viable alternative if the source of pain is worn facet joints or nerve compression. The above mentioned non-surgical treatment methods can be used individually or in combination in patients with adult scoliosis. There is no agreement in the literature about which treatment method should be used first or is more effective. The doctors will choose the best method for each patient depending on the type of scoliosis and the physical condition of the patient.

When is an operation necessary for adult scoliosis?

In adult scoliosis, pain and loss of function and balance are more predominant than the degree of curve and the change in appearance. However, even if they are pain-free some cases of scoliosis may an require surgical treatment to prevent further progression.

Scoliosis surgery may be a significant alternative treatment method in patients who have not responded to any of the nonsurgical methods, whose pain has increased, and who have developed loss of abilities during this time (6 weeks – 6 months). If the patient has severe canal stenosis or loss of bladder and bowel control or weakness in the muscles, then scoliosis operation can be selected again as the management method.

Operations for adult scoliosis are more difficult compared to those in the pediatric or adolescent scoliosis group. The length of the operations or the number of operations may also be greater. Heart and lung diseases, diabetes and osteoporosis are also important information for a scoliosis operation which must be given to the doctor.

What kind of treatment is used in adult scoliosis operation?

The aim of the scoliosis operation is to correct the curve to the point where balance is restored, fuse the vertebrae and eliminate the nerve compression (decompression). Your doctor will decide on the extent which is necessary. While a long fusion and decompression are necessary in some patients, a shorter fusion and decompression is sufficient in others.

After the adult scoliosis operation the patient generally remains in the intensive care unit overnight. On the first day after the operation, the patient will be seated on the edge of the bed and leg exercises may be initiated. The patient is ambulated on the same or the following day (standing up, walking a few steps etc.).

After the scoliosis operation, the patient will remain in the hospital for 7 to 10 days for recovery and rehabilitation.

An exercise program will be given to the patient upon discharge from the hospital. The patient starts this program. The results of the treatment are assessed by regular examinations of the doctor. During this process, the aim is to provide return of the patient back to normal life as soon as possible

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