Treatment for Adult Scoliosis:

Adults who were treated with surgery for scoliosis in their youth are at risk for disk degeneration and spinal fusion failure.

In most adults with previous scoliosis, moderate exercise is not harmful and is extremely important for maintaining healthy, supportive muscles, and preventing disk degeneration. However, people who have only one or two mobile lumbar vertebrae below the area that was fused during surgery should avoid activity or exercise that causes excessive twisting on the spine. Some experts believe this may accelerate spinal degeneration.

Nonsurgical Treatment of Adult Scoliosis

In most cases of adult scoliosis, nonsurgical care is preferred, if possible. This can include patient education, exercises, and medical treatments. Braces are not useful.

One center reported that epidural steroid injections were a beneficial alternative to surgery in patients with degenerative lumbar scoliosis.

Surgical Treatment in Adult Scoliosis

Candidates for Surgery. In general, pain is the most common reason for surgery in adult scoliosis. Surgery may be recommended in the following cases:

• Curvatures over 50 degrees with persistent pain
• Curvatures over 60 degrees (surgery is almost always recommended in this case)
• Progressive mid and low back curve or low back curve with persistent pain
• Reduced heart and lung function; most surgeons, however, will not operate on adults with severely impaired lung function and heart failure. Once this has occurred, surgery will not help improve lung capacity, and may cause the condition to worsen, at least temporarily.
• Significant deformity is present; adults should not expect to achieve a completely straight spine, however. There is a high risk for nerve damage if the spine is over-corrected, and an adult spine is less flexible than a child's. Nevertheless, the correction usually achieves an acceptable cosmetic improvement.

Surgeons prefer to operate on adults under 50 years old, although surgery may be appropriate in some older people.

Standard Scoliosis Procedures in Adult Scoliosis. The procedures involve the following, depending on whether the patient had been previously treated or not:

• In patients who have not had previous treatment, and who have degenerative lumbar scoliosis, the procedure is often a diskectomy (removal of the diseased disks) followed by scoliosis procedures (instrumentation and fusion).
• In patients with previously treated scoliosis, the only remedy is removal of the old instrumentation, extension of the fusion, and implementation of new instrumentation and bone grafts.

Surgical procedures in adult scoliosis are complex, and are undertaken only after careful consideration and all nonsurgical methods have been exhausted. Adults have a much higher risk than children for complications including pneumonia, infection, poor wound healing, and persistent pain. In addition, procedures in adults often involve fusion in lumbar and sacral areas (the low back), which can cause several complications. Some experts believe that the risks of operations in this area nearly always outweigh any benefits in adults. Most studies on adults have also reported low success rates.

Others argue that without an operation, the back will become unstable and painful. In addition, most studies on adults report on procedures using the old Harrington instrumentation techniques. Advances in instrumentation are increasing success rates in adults. In a recent study, for example, adults who underwent anterior fusion and instrumentation had excellent results. In another study of newer generation instrumentation, 87% of adult patients reported satisfaction.

Wedge Osteotomy. Researchers are investigating wedge osteotomy in patients with mature spines, as corrective surgery and as an alternative to braces. In this procedure, a surgeon cuts wedges of bone from the concave side of the curve. The surgeon then straightens the spine by inserting a temporary rod and closing the cut sections. The patient needs to wear a brace and restrict activity for about 12 weeks or until the bone has healed. The patient can resume normal activities when a surgeon removes the rod, and the spine is mobile.