Scoliosis and Aging: A Curved Path - Managing Challenges as We Get Older

Scoliosis, a sideways curvature of the spine, often affects children and adolescents. But what happens when you reach adulthood and discover you have it or when a previously mild case worsens with age? For many adults over 50, scoliosis can become a concern, impacting mobility, daily activities, and overall well-being.

Understanding Scoliosis in Adults

Scoliosis is a curvature of the spine of at least 10 degrees. 

In adults, scoliosis may stem from a curvature of the spine that began in their teenage years and worsened over time. Initially, doctors might have considered the curvature too minor to warrant treatment, or the condition might have gone undiagnosed, or previous treatments may not have had a lasting effect. Alternatively, scoliosis might be a new development, commonly known as degenerative scoliosis, frequently occurring as part of aging.

In such cases, the facet joints — which link the vertebrae and enable movements like bending over to tie your shoes — gradually deteriorate with age. This deterioration can cause the joints to push the spine sideways, leading to a curvature.

According to Richard Fessler, MD, PhD, a neurosurgeon and researcher who specializes in treating degenerative scoliosis at Rush University in Chicago, the source of the pain is not the curved spine itself, but rather, similar to spinal osteoarthritis, it is caused by the vertebrae bones jabbing and irritating the joints and nerves.

While this may not be problematic for everyone, in some cases, it can cause incapacitating pain in the back or pain that shoots down the legs. It can also cause stiffness and numbness.

Adults can also develop scoliosis due to:

• Degenerative changes in the spine: As we age, the discs and joints between vertebrae can wear down, leading to spinal misalignment.
• Progression of undiagnosed childhood scoliosis:  A mild curvature in childhood might become more noticeable as an adult.

Diagnosis and the Impact of Age

Diagnosing scoliosis in adults typically involves a physical exam, X-rays, and potentially an MRI scan. However, age can influence how the condition manifests. 

Spine surgeon Dean Chou, MD, vice chair of neurological surgery at Columbia University Vagelos College of Physicians and Surgeons, explains that adult-onset scoliosis can manifest differently from childhood scoliosis. The frequency of scoliosis developing in adults isn't precisely known, but a recent study suggested that about one in every three adults aged 40 to 90 might be affected. The curvature typically appears in the lower back. Currently, there is no known method to prevent the onset of scoliosis.

Adult scoliosis can be different from the scoliosis that occurs in children and teenagers, especially if it develops later on in life.

Treatment of Scoliosis

Seek out healthcare providers who are experts in scoliosis management for reliable guidance. By scheduling appointments with these specialists, you can ensure a thorough assessment of the curvature's extent and discuss potential treatment options. Based on the severity of the condition, these professionals will determine whether noninvasive methods or surgical interventions are more appropriate.

Bracing is often considered one of the primary options for treating scoliosis, particularly effective in cases of moderate curvature. For example, specialists commonly recommend this method if an adolescent or a young child develops a misalignment during their growth spurts. 

A modern center for treating scoliosis will also have comprehensive approaches to managing the condition, from scoliosis exercises to nutrient therapies. If conventional treatments prove unsuitable, these centers are well-equipped to perform surgery.

Treatment Not Always Required

According to Dr. Chou, scoliosis does not always require treatment. Many patients remain asymptomatic and may not even be aware they have the condition. 

"Unlike in children, we generally don't treat adult scoliosis until it causes symptoms," explains Dr. Chou. Even those with significant curvatures may not need treatment if they are symptom-free and continue to lead active, normal lives.

However, some patients experience scoliosis symptoms, including back, buttock, or leg pain or difficulties with walking and standing. In such cases, the shifting spine may compress nerves, making treatment a reasonable consideration if symptoms severely impact daily life. 

Surgery, however, is considered a last resort. For symptomatic patients, the initial treatments typically include physical therapy, medications, and injections.

Surgery is only indicated when the pain is severe and significantly impairs the patient's quality of life.

Dr. Chou notes that scoliosis surgery can be performed using traditional open or minimally invasive techniques. The choice of surgery depends on the patient's specific condition, the nature of the problem, and personal preferences. While minimally invasive surgery can be an excellent option for some, open surgery may be the definitive solution for others. Dr. Chou emphasizes that each patient must be evaluated individually to determine the most appropriate treatment option.

Bracing in Older Adults?

Bracing can be an appropriate treatment option for scoliosis in older adults but with some key considerations. 

• Pain Management:  Bracing can provide support and help alleviate pain caused by scoliosis, improving overall comfort and mobility.
• Curve Control:  In some cases, bracing can help slow down or even halt the progression of the spinal curvature, particularly for mild or moderate curves.
• Improved Posture:  Bracing can promote better posture, reduce strain on the spine, and potentially improve lung function.

However, there are factors to consider for older adults:

• Severity of Curve: Bracing is typically the most effective for mild to moderate scoliosis curves. Surgery might be a more suitable option for severe curves.
• Bone Mineral Density:  Weakened bones due to osteoporosis can make bracing less effective and potentially uncomfortable.
• Overall Health: Other treatment approaches might be preferred if an older adult has significant health issues or difficulty tolerating the brace.

Consulting a Healthcare Professional is Crucial

Ultimately, the decision of whether bracing is appropriate for an older adult with scoliosis should be made by a healthcare professional. They will consider the individual's specific case, including factors like:

• Curve severity
• Location of the curve
• Overall health status
• Bone density
• Pain level
• Activity limitations

Coexisting Conditions and the Importance of Management

Scoliosis often coexists with other age-related health issues like arthritis or osteoporosis, further complicating its impact. Effective management becomes crucial to maintain mobility and independence. 

"Early intervention and treatment can significantly improve a patient's quality of life," emphasizes Dr. Choi. Treatment options for adults with scoliosis include:

• Exercise:  Specific exercises can strengthen core muscles and improve posture, potentially reducing pain and slowing curve progression.
• Physical Therapy:  A physical therapist can design a personalized exercise program and provide manual therapy techniques to manage pain and improve flexibility.
• Pain Management:  Over-the-counter pain relievers or prescription medications can help manage discomfort caused by scoliosis.
• Bracing:  In some cases, bracing may be recommended to provide support and prevent further curvature progression.
• Surgery:  For severe cases causing significant pain or impacting lung function, surgery might be an option to correct the spinal curvature.

Maintaining Independence and Daily Activities

Left unmanaged, scoliosis can significantly impact an individual's ability to perform daily activities and maintain independence.  

Scoliosis can lead to pain, stiffness, and difficulty with activities like walking, standing, and bending.

With proper treatment and lifestyle modifications, most adults with scoliosis can continue to live active and fulfilling lives. Here are some tips:

• Maintain good posture:  Being mindful of posture while sitting, standing, and sleeping can help reduce strain on the spine.
• Choose supportive footwear:  Properly fitted shoes can improve balance and stability.
• Stay active:  Regular exercise, tailored to your specific condition, can strengthen core muscles and improve flexibility.
• Listen to your body:  Take breaks when needed and avoid activities that aggravate pain.

Living Well with Scoliosis

Scoliosis doesn't have to dictate your life after 50. By working with a healthcare professional and implementing a personalized management plan, you can minimize the condition's impact and maintain a high quality of life. Remember, early diagnosis and intervention are crucial to success. Talk to your doctor if you experience any symptoms of scoliosis, such as back pain, uneven shoulders, or a noticeable tilt of your body. With the right approach, you can manage scoliosis and continue living a vibrant and active life well into your golden years.

Impact on Independence - Scoliosis and Long-Term Care

Scoliosis is a growing concern for older adults in long-term care settings, whether at home or in a facility. As scoliosis curves progress with age, it can impact mobility, daily activities, and overall independence. Caregivers and facilities must adapt their approach to support these care recipients effectively.

For caregivers managing scoliosis at home, prioritizing comfort and safety becomes paramount. Modifications like raised toilet seats, grab bars in bathrooms, and ergonomic furniture can significantly improve daily living. Pain management becomes crucial, with options like over-the-counter pain relievers, topical creams, or physical therapy to manage discomfort.

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In long-term care facilities, a multi-pronged approach is essential. Physical therapists can design exercise programs to strengthen core muscles and improve flexibility, potentially reducing pain and slowing curve progression. Additionally, occupational therapists can help care recipients adapt to their daily activities and accommodate their limitations. Assistive devices like walkers or canes can be crucial for maintaining mobility and preventing falls. 

Facilities may need specialized equipment for residents with severe scoliosis impacting breathing or causing significant pain. Specific beds or seating arrangements can offer improved comfort and support for the spine. 

Open communication and collaboration between healthcare professionals, caregivers, and the resident themself are vital in creating a safe and supportive environment that maximizes independence and quality of life for those living with scoliosis in long-term care facilities or with caregivers at home.