Dr. Zbiggy J. Brodzinsky
Consultant Orthopedic Surgeon & Head of Spine Department
Adult degenerative scoliosis (De Novo Adult Scoliosis).
Degenerative scoliosis, also known as adult onset scoliosis, describes a side-to-side curvature of the spine caused by degeneration of the facet joints and intervertebral discs which are the moving parts of the spine. This degeneration and resulting spinal asymmetry can occur slowly over time as a person age. This is a completely different cause of scoliosis from the standard adolescent onset scoliosis. De novo adult scoliosis is also a term used in adult patients who have no history of scoliosis as adolescents but then develop a coronal plane deformity that may be of a progressive nature and is associated with degenerative changes in the spinal column. Degenerative scoliosis rarely presents before 40 years of age. If degenerative scoliosis becomes symptomatic, pain can range from a dull back ache to excruciating sensations that shoot down the leg, commonly referred to as sciatica, and make walking difficult or impossible. When healthy, facet joints are like hinges that help the spine bend smoothly, and intervertebral discs are like cushions that absorb shock between vertebral bones.
Everyone experiences natural degeneration of these joints and discs due to aging—the same processes that cause osteoarthritis and degenerative disc disease—but for some people these degenerative processes are accelerated and/or cause more symptoms. If degeneration is more pronounced on one side of the spine, degenerative scoliosis can result. The degenerative scoliosis curve, which is often located in the low back (lumbar spine), forms a slight “C” shape as the spine abnormally curves on one side or the other. Any sideways spinal curve of at least 10 degrees, as measured by the Cobb angle on spinal radiographs (X-rays), is considered scoliosis. If degenerative scoliosis causes the cauda equina and/or spinal cord or a nerve root to become impinged, either through stenosis (narrowing of the spinal canal) or severe bending of the spine, nerve function could be jeopardized. Initially, this is often felt as a sharp or shock-like pain in the back that can radiate down the buttock and/or into the leg, or as tingling or numbness that can radiate down into the leg. This is commonly referred to as sciatica or sciatic pain. The medical term for this type of radiating pain is radiculopathy. While unlikely, it is possible for degenerative scoliosis to cause permanent leg weakness or problems with bladder/bowel control the patient must be operated as emergency. Most cases of symptomatic degenerative scoliosis can be treated non-surgically with self-care and/or guidance from a medical professional including PT/rehab and interventional pain management. If non-surgical treatment methods have been ineffective at managing the patient’s degenerative scoliosis, surgery may be considered (decompression with or without fusion). All methods we do provide at VCH and approach the patient holistically always as a dedicated team to provide the best quality of service.