Two types of scoliosis in adults:
1:Pre-existing: adolescent scoliosis which becomes adult scoliosis in adulthood.
2:De novo: new scoliosis develops in adulthood (around age 45), generally as a result of vertebral degeneration. Since de novo scoliosis is the result of degenerative instability, it is almost always progressive, and the main reason for consultation is low back pain.
De Novo or adult pain and scoliosis:
The main symptom is usually pain in the lower back, severe and resistant to conventional medical treatment. Most healthcare professionals believe that De Novo scoliosis is painless, based on a study showing pain-free children with large vertebral deformities. This notion is false. What's more, in adults aged between 50 and 80 suffering from low-back pain, research shows that De Novo scoliosis is present in 40% of our patients. The pain observed in adult scoliosis is not related to the severity of the curve. In fact, very good studies show that there is little or no relationship between scoliosis size and pain.
Clearly, a 20-degree curve and a 55-degree curve are equally likely to cause pain in an adult.
2 key factors linked to pain in adults:
1/ Curve location: adult scoliosis is often associated with lower back pain, and the majority of new adult scoliotic curves are found in the lower back.
2/ General balance of the spine: what we mean by "balance" is the sagital (front/back) and coronal (right/left) axes. This shift is not necessarily related to the size of the curve. More importantly, adults with scoliosis, who have a "forward" posture or those who are bent forward i.e. where the sagital axis exceeds 40 mm forward, will develop more pain than those with a neutral or backward posture.
Treatment of scoliosis in adults:
Standard care ranges from analgesics and anti-inflammatory treatments to back-strengthening exercises, and surgery in extreme cases.
On the whole, these treatments don't help manage pain in the medium or long term, because they don't help treat the underlying condition causing the pain, which is scoliosis.
More conservative treatments are available, such as the use of 3-D corsets to treat, relieve and stabilize scoliosis. Unfortunately, as adults have finished growing, the potential for correction is limited. However, in many cases, scoliosis does not need to be corrected to reduce pain. Since the majority of adult scoliosis patients suffer pain because of their overall balance, rather than because of the size of the curve, conservative treatments make sense and can be beneficial.
In some cases, pain relief and stabilization can be achieved through intensive specialized physiotherapy that works on the balance of the spine, not just by strengthening the core muscles but by teaching the patient to correct themselves in mirror-image posture. In short, the aim of these programs is to teach the patient the overcorrected position and ask them to practice these positions in everyday life.
Adult corsets:
1/soft: temporarily to relieve pain in various situations or activities.
e.g.: some patients suffer and develop pain during exercise. Choose to wear them during exercise or at the gym.
2/rigid 3D scolibrace or overcorrection corset:
It can be used as an intensive rehabilitation device, to try to strengthen posture and muscles enabling the body to maintain a corrected posture giving medium- to long-term relief.
These corsets can be used on a continuous basis for the most severe cases (or surgery impossible) where there is a collapse of the spine. The corset reduces pain, supports the spine and improves quality of life.
Surgery in adults is often complicated and more risky. One problem in particular: osteoporosis. Bones weakened by osteoporosis are more difficult to fix with pins and bone grafts. As surgery is no guarantee of pain relief either, it remains, in some cases, the only option when traditional and conservative treatments have failed.
