Adult degenerative scoliosis and the low back

Adult degenerative scoliosis is a side-to-side curve that appears or worsens as lumbar discs and joints wear. It is different from the curve a teenager is screened for. People may have back pain, a feeling of leaning, or the walking symptoms of stenosis where the curve pinches a nerve. The size of the curve on an X-ray does not, by itself, say that a large reconstruction is required.

A 2009 paper in Spine looked at how radiographic measurements line up with function in adult degenerative scoliosis. A 2011 review in the HSS Journal summarized the condition for clinicians. A 2008 paper in the Journal of Spinal Disorders and Techniques described a less invasive approach to correction and fusion for selected lumbar curves.

The measurement paper is a reminder that a number of degrees is not the same as a person's walking, standing, or pain. The review treats degenerative scoliosis as a mix of curve, stenosis, and balance, so the treatment has to name which of those is the problem. Less invasive fusion has been studied for selected curves. It is one technique among others, and it is not automatically gentler in its effect on the spine just because the incisions are smaller.

Full-length standing films show the curve and the balance of the trunk. MRI shows the nerves. Some people need decompression of a single pinched nerve. Some need a limited fusion. A larger reconstruction is reserved for a curve and a balance problem that smaller surgery would not address. The person's health and goals decide how much surgery is wise.

A visit can separate a curve that is visible from a curve that is causing the symptoms, and it can keep a big operation from being the default. This note is general information and is not a personal treatment plan.