Adult scoliosis
Scoliosis is a condition in which the spine develops one or more abnormal curvatures, which in turn can affect the overall balance of the body and alignment, as well as possibly lead to other physical and health problems. Although the condition can develop at any age, it is more common to appear during the early teenage years.
A certain degree of curvature is normal in the human spine. For example, the smooth inner and outer curves of the neck, back and lower back are necessary to keep the body properly balanced and aligned over the pelvis. When viewed from behind, the vertebrae of a healthy spine should form a straight line. In someone with scoliosis, however, the spine looks more like an "S" or a "C" than an "I". The vertebrae involved in the curve can also rotate to a certain extent, which can also contribute to the appearance of an asymmetry in the waist or shoulders.
There are several warning signs that can signal the development of adult scoliosis. They include:
Shoulders have different heights - one shoulder is more prominent than the other
Head is not centered directly above the pelvis
Appearance of a prominent, prominent hip
Ribs are at different heights
Uneven waist
Changes in the appearance or texture of the skin covering the spine (dimples, hair tufts, color changes)
Whole body tilted to one side
Clothes no longer seem to "fit right" on the body; sleeves of shirts, skirts and pants may appear more on one side than the other
There are a variety of reasons why scoliosis can develop in adults. The curvature of the spine in adults can be:
Secondary - Developed in response to other conditions that affect spinal alignment and balance, such as osteoporosis or degenerative disc disease. Scoliosis that develops as a result of spinal degeneration is typically called adult degenerative scoliosis.
Idiopathic - Resulting from no specific cause, resulting from adolescent scoliosis.
Congenital - caused by a condition present at birth, but not previously detected.
Paralytic - The result of paralysis caused by a spinal cord injury. When the muscles around the spine no longer work, the vertebrae can become unbalanced.
Myopathic - similar to paralytic curvature, in which the muscles do not work properly, but as a result of a muscular or neuromuscular disease, such as muscular dystrophy.
How is adult scoliosis diagnosed?
If you notice any one or more of the above indicators with the potential to be scoliosis, please make an appointment with your doctor to get a complete physical examination of the spine.
If scoliosis is suspected, the diagnosis can be confirmed using diagnostic tools such as x-rays, computed tomography (CT) and magnetic resonance imaging (MRI). To determine the extent to which a curve has progressed, the Cobb method is used and is classified in terms of degrees. In general, unlike adolescent scoliosis, adult scoliosis leads beyond a frontal imbalance of the trunk to a lateral or sagittal imbalance. This condition is an important source of pain and disability, especially for elderly patients. Sagittal imbalance is even more disabling for the patient than frontal imbalance, and several clinical studies have been developed to understand and treat this condition.
How is adult scoliosis treated?
For those who have already reached skeletal maturity, the considerations and goals of treatment are slightly different than those whose bones are not yet fully formed. There are a variety of options for treating adult scoliosis, including surgery. However, most surgeons see surgery as a last resort, and generally recommend non-surgical treatment, such as medication, exercise and / or physical therapy as the first line of defense against pain and the physical symptoms that accompany spinal deformity.
Spinal surgery for scoliosis is a major challenge for adults, and the likelihood of post-surgical complications in adult scoliosis tends to increase with age. With advancing age, degenerative changes can lead to spine stiffness, becoming less susceptible to realignment and correction. If osteoporosis is a factor present, as is often the case - especially in women over 65 years of age - it can be difficult for surgeons to be successful with the instrumentation required for the surgical procedure.
Your surgeon may consider surgical correction if:
You are experiencing chronic disabling pain that has not responded to conservative treatment;
If the curve has contributed to the development of spinal stenosis (narrowing of the spinal canal, which causes it to press on the spinal cord or nerves);
Its spine curve continues to get worse, and has advanced to more than 40-45 degrees;
If there is a lateral translation between the vertebrae that demonstrates an instability in the spine (laterolistese)
If the physical deformity has become unbearable for you for other physical or aesthetic reasons.
If you have progressive neurological changes, such as numbness, tingling or weakness, or decreased tolerance to walk. (This may indicate neurocompressive disease of the spine.)
Surgical goals for the treatment of adult scoliosis typically include:
Reduce the curve (straighten the spine as much as possible);
Stop the progression of the curve;
Remove pressure from nerves and spinal cord;
Protect nerves and spinal cord from further damage;
In older patients, allow nerve decompression to improve the neurological function of the lower limbs.
To this end, the spine surgeon can recommend spinal fusion, the purpose of which is to correct the spinal deformity as much as possible and merge, or join, the vertebrae of the curve to be corrected. The procedure involves approaching the spine either from the front (anterior approach), from behind (posterior approach), or by the extreme-lateral approach ( XLIF / DLIF - on the side wall of the abdomen) . The procedure can be minimally invasive, and / or also involve a discectomy (removal of disc material, to relieve pressure on the spinal cord). Several high-quality scientific studies have shown that the association of XLIF with percutaneous pedicular instrumentation it is an excellent minimally invasive option for this difficult condition, and it significantly reduces the risks involved in surgery.