Understanding Degenerative Scoliosis: When Age Affects the Spine

As we age, it's not uncommon to experience aches and pains in the lower back. But in some patients, this discomfort is linked to a progressive curvature of the spine—a condition known as *degenerative scoliosis*, or *adult-onset

scoliosis*. Unlike the scoliosis we associate with teens and adolescents, degenerative scoliosis develops later in life, often as a result of wear and tear on the spinal discs and joints.

What Is Degenerative Scoliosis?

Degenerative scoliosis refers to a sideways curvature of the spine (greater than 10 degrees) that appears in adulthood due to the degeneration of spinal structures. It most commonly affects the lumbar spine (lower back) and typically develops after the age of 50. This condition is not just about curvature—it also involves rotation and collapse of the spinal segments, leading to *imbalance, nerve compression*, and *chronic pain*.

What Causes It?

The spine is a complex structure of bones (vertebrae), intervertebral discs, and joints. Over time, these components undergo natural aging:

• Disc degeneration*: Loss of hydration and height in the discs leads to instability.
• Facet joint arthritis*: The small joints that connect vertebrae become inflamed and stiff.
• Bone spurs (osteophytes)*: These may develop in response to instability.
• Weakening of ligaments and muscles*: Leading to spinal imbalance and further curvature.

The result is a progressive, often painful curvature that can interfere with walking, standing, or daily activities.

Symptoms to Watch For

While not every spinal curve causes symptoms, degenerative scoliosis can lead to:

• Lower back pain* (often dull, aching, or stiff)
• Sciatica* or radiating leg pain
• Muscle fatigue* from imbalanced posture
• Numbness or tingling* in the legs or feet
• Difficulty walking* or standing for long periods
• Loss of height or visible curvature

Pain may worsen at the end of the day or with prolonged activity, and in severe cases, spinal stenosis (narrowing of the spinal canal) can compress nerves and reduce mobility.

Diagnosis

A careful diagnosis starts with a *comprehensive evaluation*, including:

• Medical history & physical exam
• X-rays* to assess curvature and spinal alignment
• MRI* or *CT scans* to examine disc health, nerve compression, or spinal stenosis

In some cases, dynamic (flexion-extension) X-rays are used to detect instability.

Non-Surgical Treatment Options

Most cases of degenerative scoliosis begin with * conservative treatment*. These options aim to reduce pain and improve function rather than correct the curve:

1. *Physical Therapy*
   - Focuses on core strengthening, flexibility, and posture correction.
2. *Anti-inflammatory medications*
   - NSAIDs can reduce pain and inflammation in the joints.
3. *Epidural Steroid Injections or Nerve Blocks*
   - Target inflamed nerve roots for temporary relief of radiating leg pain.
4. *Bracing* *(in select cases)*
   - Rarely used long-term in adults but may provide short-term relief in certain cases.
5. *Activity Modification & Weight Management*
   - Reducing strain on the spine can slow progression and improve comfort.

While conservative treatment doesn’t “fix” the curvature, it can offer meaningful relief and delay the need for surgery.

*When Surgery Becomes an Option*

Surgical treatment is considered when:

• Pain becomes *chronic or disabling
• Neurologic symptoms worsen (e.g., *leg weakness*, *numbness*, *bowel/bladder dysfunction*)
• Spinal imbalance or deformity leads to progressive loss of mobility
• Nonsurgical therapies have failed

Surgical Goals:

• Decompress *pinched nerves*
• Correct and stabilize spinal *alignment*
• Reduce pain and restore function

Common Surgical Options

1. *Decompression Alone*
   - Involves removing bone or tissue pressing on nerves (laminectomy, foraminotomy).
2. *Decompression with Spinal Fusion*
   - Most common approach for significant scoliosis or instability.
   - Involves realigning the spine and fusing affected segments to prevent further progression.
3. *Anterior or Lateral Fusion Techniques* (e.g., *TLIF*, *ALIF*)
   - Accesses the spine from the front or side to correct larger deformities with less muscle disruption.

Each surgical plan is customized based on curve severity, symptoms, overall health, and bone quality (especially important in older adults with osteoporosis).

Final Thoughts from Dr. Callewart

Degenerative scoliosis is a condition that evolves slowly—but for many patients, its impact on daily life becomes impossible to ignore. Fortunately, with accurate diagnosis and a tailored treatment approach, most people can find relief—without surgery in many cases.

If you're experiencing persistent lower back pain or leg symptoms and suspect spinal curvature could be involved, don’t wait. Early evaluation allows us to manage the condition before it becomes disabling.

Ready to Take the Next Step?

At *Craig C. Callewart, MD’s practice*, we specialize in diagnosing and treating adult spinal deformities using both conservative and advanced surgical techniques. Contact our office to schedule a consultation and start your path to recovery.