Adult scoliosis: Myth or reality?

Scoliosis Scoliosis does not affect only children and adolescents. It can also be present or develop in adulthood.

There are two main situations:

1. Persistent idiopathic scoliosis in adulthood
This refers to scoliosis that developed during growth and is still present in adulthood. Some curvatures remain relatively stable after skeletal maturity, while others may continue to progress.

2. De novo degenerative scoliosis
It develops in adulthood in a person who has not previously had any known scoliosis. It is particularly associated with degenerative changes in the discs and joints of the spine and primarily affects older adults.

Its progression varies. It may be associated with lower back pain, a gradual change in posture, reduced function, and, in some cases, neurological symptoms.

Pain and Scoliosis in Adults

The presence of scoliosis in adults does not necessarily mean that it is causing pain. Some patients with a significant curvature may have few symptoms, while others with a less severe deformity may experience more discomfort.

When pain is present, it can be caused by several factors: degenerative changes in the discs and joints, spinal misalignment, muscle fatigue, or, in some cases, compression of a nerve root.

The evaluation should therefore not be based solely on the Cobb angle. The overall alignment of the spine—particularly in the sagittal plane—as well as any neurological symptoms and the impact on daily activities and quality of life must also be taken into account.

The purpose of the examination is to determine the extent to which scoliosis and related changes may contribute to the symptoms in order to guide treatment.

Can scoliosis in adults progress?

Some cases of scoliosis may continue to progress after skeletal maturity, but this progression is neither systematic nor the same in all patients.

The risk of progression depends, in particular, on the type and degree of curvature, degenerative changes in the spine, and certain parameters related to spinal balance.

In a patient with known scoliosis, comparing current X-rays with previous ones is particularly useful. When indicated, X-rays taken at different times allow for an objective assessment of any changes in the Cobb angle and the overall alignment of the spine.

A gradual change in posture, the onset or worsening of pain, a decrease in function, or the onset of neurological symptoms may also warrant a reevaluation.

Follow-up should therefore be tailored to each individual rather than based on a uniform frequency of checkups for all patients.

What treatment options are available for scoliosis in adults?

Treatment depends on the type of scoliosis, its progression, the symptoms, the overall alignment of the spine, and how these factors affect daily life.

Exercises specifically designed for scoliosis may be recommended to improve, among other things, postural control, mobility, function, and active self-correction. The program must be tailored to each patient’s individual needs.

A brace may also be considered for some adults. Unlike in growing adolescents, the goal is not to guide growth. Depending on the situation, it may be used to improve postural support, function, or symptoms, and, in some cases of progressive scoliosis, to attempt to limit the progression of the deformity.

However, there is less scientific data on the use of orthopedic braces in adults than in adolescents. Therefore, the indication for use, the design, and the duration of wear must be tailored to each individual.

When symptoms or deformity become significant, or if certain neurological signs are present, a consultation with a spine surgery specialist may be recommended.

The goal is to choose the strategy best suited to the patient and to regularly reassess its effectiveness, rather than applying the same protocol to all cases of scoliosis.

Understanding Scoliosis in Adults Better

A scoliosis diagnosis in adulthood does not necessarily mean that the condition will progress or require extensive treatment. Its progression and impact vary considerably from one patient to another.

A thorough evaluation allows for an analysis of the curvature, the overall alignment of the spine, any symptoms, and their functional impact.

Depending on the situation, treatment may include monitoring, specific exercises, symptom management, and, for some patients, a custom-made brace. When warranted, a surgical evaluation may also be recommended.

At the Spine Chiropractic Center, our goal is to provide a personalized and measurable evaluation, and then to regularly reassess progress in order to tailor treatment accordingly.

SCIENTIFIC REFERENCES

1. McAviney J, Roberts C, Sullivan B, Alevras AJ, Graham PL, Brown BT.
The prevalence of adult de novo scoliosis: A systematic review and meta-analysis.
European Spine Journal. 2020;29(12):2960–2969.
DOI: 10.1007/s00586-020-06453-0.

2. Asher MA, Burton DC.
Adolescent idiopathic scoliosis: natural history and long-term treatment effects.
Scoliosis. 2006;1:2.
DOI: 10.1186/1748-7161-1-2.

3. McAviney J, Mee J, Fazalbhoy A, Du Plessis J, Brown BT.
A systematic literature review of spinal brace/orthosis treatment for adults with scoliosis between 1967 and 2018: clinical outcomes and harms data.
BMC Musculoskeletal Disorders. 2020;21:87.
DOI: 10.1186/s12891-020-3095-x.