Adult Onset Scoliosis
Adult onset scoliosis is caused by degeneration of the vertebrae that begins with the disintegration of parts of the spinal discs (Garcia-Ramos et al., 2015; Oskouian &Shaffrey, 2006; Wong, Oh, & Gray, 2017). Uneven disk space then leads to loss of vertebral integrity so that the vertebrae become wedge shaped. The wedging in the vertebrae to one side of the spinal column leads to scoliosis. Osteoporosis also predisposes the vertebrae to asymmetrical disintegration and subsequent scoliosis. (Good, Auerback, O’Leary & Schuler, 2011; Oskouian & Shaffrey). Adult degenerative scoliosis occurs most often in the lumbar spine; the lower five vertebrae of the spinal column (Wong et al.). One consequences of unequal vertebral height is spinal stenosis; the pinching of the nerves that exit the spinal cord. Another consequence is arthritis of the facet joints, the joints of the spine that guide rotation and flexion-extension spinal motions Lateral listhesis, a sideways translation of the vertebrae due to stretched spinal ligaments and spondylolisthesis and anterior or posterior translation of the vertebrae may also occur. (Garcia-Ramos et al.; Oskouian & Shaffrey; Wong et al.). All of these changes frequently result in spinal pain, symptoms that radiate into the legs, and lower extremity neurological deficits (Garcia-Ramos; Good, et al.; Wong, et al.).
The onset of degenerative scoliosis is usually after 40 years of age. The estimated of the prevalence of adult onset scoliosis are from 1.7 percent to almost 30 percent of the adult population. (Wong, et al, 2017). There are approximately 500,000 people over 50 years old with scoliosis curves (Cobb angles) over 30 degrees, and six percent of the population over the age of 50 have degenerative scoliosis (Oskouian & Shaffrey, 2006). The chances of curves progressing are greater with the translation of lateral listhesis greater than six mm and in curves whose Cobb angles[JM1] are over thirty degrees (Wong et al.).
Surgery was demonstrated to be an effective remedy for pain resulting from adult scoliosis. However the surgeries had a high degree of complications (Good et Al., 2011; Okouian7 Shaffrey, 2006; Wong et al., 2017). For this reason Wong et al. (2017) reported that surgical intervention for adult scoliosis should be attempted only after first trying non-surgical interventions.
Non- surgical interventions include drugs, bracing, and physical therapy. Wong et al. (2017) reported that that non-surgical interventions for adult scoliosis weren’t validated by research. Wong et al. also reported that bracing for adult scoliosis didn’t stop the progression of scoliosis and made spinal supporting muscles weak. However a prospective study by Mauroy, Lecante, Barral, and Pourret (2015), demonstrated that 80% of subjects who wore a lordosing bivalve polyethylene overlapping brace and did concurrent physical therapy either improved their curves or stopped them from progressing.
PSSE, physical therapy scoliosis specific exercises including Schroth therapy, are exercises designed specifically to address the physical asymmetries caused by scoliosis (Park, J., Jeon, & Park J.W., 2018). Monticone et al. (2016) found that PSSE were effective in decreasing disability and reducing in back pain in adult onset scoliosis.
I treat adult scoliosis patients using Schroth mobilizations and exercises. Most of the adult patients I have treated in the last three years have responded to Schroth therapy with decreased or abolished spinal pains. My clinical experience gives me confidence in recommending Schroth therapy for adults with degenerative or idiopathic scoliosis.
References
García-Ramos, C. L., Obil-Chavarría, C. A., Zárate-Kalfópulos, B., Rosales-Olivares, L. M., Alpizar-Aguirre, A., & Reyes-Sánchez, A. A. (2015). [Degenerative adult scoliosis]. Acta Ortop Mex, 29(2), 127-138.
Good, C. R., Auerbach, J. D., O’Leary, P. T., & Schuler, T. C. (2011). Adult spine deformity. Curr Rev Musculoskelet Med, 4(4), 159-167. doi:10.1007/s12178-011-9101-z
Monticone, M., Ambrosini, E., Cazzaniga, D., Rocca, B., Motta, L., Cerri, C., . . . Lovi, A. (2016). Adults with idiopathic scoliosis improve disability after motor and cognitive rehabilitation: results of a randomised controlled trial. Eur Spine J, 25(10), 3120-3129. doi:10.1007/s00586-016-4528-y
Oskouian, R. J., & Shaffrey, C. I. (2006). Degenerative lumbar scoliosis. Neurosurg Clin N Am, 17(3), 299-315, vii. doi:10.1016/j.nec.2006.05.002
Park, J. H., Jeon, H. S., & Park, H. W. (2018). Effects of the Schroth exercise on idiopathic scoliosis: a meta-analysis. Eur J Phys Rehabil Med, 54(3), 440-449. doi:10.23736/S1973-9087.17.04461-6
Wong, E., Altaf, F., Oh, L. J., & Gray, R. J. (2017). Adult Degenerative Lumbar Scoliosis. Orthopedics, 40(6), e930-e939. doi:10.3928/01477447-20170606-02