Guide to Advanced Surgery for The Spine
Why Choose Cedars-Sinai Marina del Rey Hospital for Adult Scoliosis Treatment?
The highly skilled, professionally trained spinal surgeons at Cedars-Sinai Marina del Rey Hospital can assess patients with adult scoliosis and derive a treatment plan that suits their condition. We offer several conservative and surgical treatment methods to treat spinal disorders.
Adult scoliosis also referred to as adult-onset scoliosis or degenerative scoliosis, is a spine condition in which the alignment of the spine shifts abnormally to the left or the right side, resulting in a "C" or "S" shaped curve in the spine. This condition is frequently seen in people above the age of 65 with spinal osteoarthritis, due to the fact that their spinal facet joints have weakened and tend to break down easily.
Adult scoliosis commonly affects the lower back region (lumbar spine) because the vertebrae in this segment bear the entire weight of the body and as such are subjected to more wear and tear. Sometimes, adult scoliosis can also be the result of undiscovered or untreated childhood scoliosis. The pain associated with adult scoliosis is due to spine degeneration-related inflammation, and not the spinal curvature itself. The treatment of adult scoliosis is focused on the management of symptoms.
Surgical Procedures Performed at Cedars-Sinai Marina del Rey Hospital for Adult Scoliosis
Surgical treatment is considered in severe cases of adult scoliosis that do not respond to the use of conservative treatment methods, such as pain medications, physical therapy, and hot/cold compresses, for several weeks to months. The objectives of surgical treatment are the reduction of the patient’s pain and the facilitation of their return to routine activities. At Cedars-Sinai Marina del Rey Hospital, we advocate minimally invasive surgical techniques, rather than the traditional open surgical methods. Minimally invasive spinal surgery techniques use smaller incisions to gain access to the spine and tiny surgical tools to achieve spinal nerve decompression (laminotomy and foraminotomy). Our surgeons will then remove the damaged spinal disc (discectomy) and stabilize the spine using bone grafts secured with metal rods and screws (transforaminal lumbar interbody fusion and lateral lumbar interbody fusion).
The minimally invasive spinal surgery techniques used to treat scoliosis include:
- Lateral Lumbar Interbody Fusion: During this procedure, access to the spine is gained through a small cut made on the side of the body. This method does not require cutting through bone, disruption of muscles, and moving of blood vessels. Once the damaged disc is removed, the remaining vertebrae are realigned and an implant or bone graft is placed in the empty space in order to maintain spinal stability.
- Transforaminal Lumbar Interbody Fusion (TLIF): This procedure begins with one or two small incisions being made in the lower back region. Then, the disc that is causing problems is removed and the remaining vertebrae are realigned to the proper position by using implants.
Benefits of the minimally invasive approach:
- Minimally invasive techniques are usually performed as outpatient procedures and require a shorter hospital stay
- There is minimal risk of postoperative complications
- Faster recovery time
Drugs and Other Treatment Needed for Adult Scoliosis
Epidural Steroid Injection »
Physical Therapy »
The different types of adult-onset scoliosis are described below:
Idiopathic Scoliosis »
Paralytic Scoliosis »
Secondary Scoliosis »
Myopathic Scoliosis »
Symptoms of Adult Scoliosis
The most common symptom of adult scoliosis is back pain that becomes worse with activity over a period of time. The patient may feel pain in one or both of their legs while walking and standing. Pain tends to dissipate when the patient is in a seated position. Other physical signs that may develop depending on the severity of adult scoliosis include:
- Asymmetry: The shoulder or hip on one side may appear to be higher than the other
- Difficulty walking normally or disturbances in gait due to one leg being longer than the other
Diagnosis of Adult Scoliosis
Adult scoliosis is diagnosed based on a careful physical examination and additional diagnostic tests. During the physical examination, a doctor will examine the patient's back and note the spinal curvature. The patient is also observed while bending in different directions, which shows the flexibility of the spine. Additionally, a neurologic examination will be used to evaluate a patient's reflexes, sensation, and muscle strength.
Diagnostic Imaging Tests:
- X-rays: X-rays are taken from the front and sides to visualize and exactly measure the curvature of the spine.
- Magnetic Resonance Imaging (MRI) Scan: This type of imaging test helps visualize the nerves, as well as the spinal cord.
- Computed Tomography (CT) Scan: A CT scan of the spine helps detect any problems associated with the vertebrae.
Risk Factors for Adult Scoliosis
The risk factors that contribute to the onset of adult scoliosis include:
- Being obese or overweight: Excessive body weight increases the amount of stress placed on the spine, accelerating the wear on the cartilage lining of the spinal joints. Being overweight also places excessive force on the intervertebral discs, causing degenerative disc disease that leads to scoliosis in adults.
- Aging: Advancing age and continual stress on the spine may increase the risk of developing osteoarthritis and osteoporosis, which in turn leads to adult scoliosis.
- Other potential risk factors: Spinal damage during surgery, spinal cord injury that results in the loss of muscle function, and conditions such as multiple sclerosis or Parkinson's disease also increase a patient's chances of developing adult scoliosis.
Causes of Adult Scoliosis
The major cause of adult scoliosis seems to be the gradual age-related degeneration of the facet joints, found in between the vertebrae, which leads to the development of a lateral curvature of the spine. In most cases of adult scoliosis, the cause remains unknown. Degenerative disc disease, osteoporosis, and related compression fractures may result in changes in the shape and height of the vertebral bodies that can lead to an abnormal curve in the spine. Sometimes, adult scoliosis may occur if pre-existing scoliosis worsens, or if it is left untreated or undiscovered from childhood.
Alternative medicine treatments that are beneficial for patients with degenerative or adult scoliosis include acupuncture and chiropractic treatment. Acupuncture is a traditional Chinese method of achieving pain relief and it involves insertion of fine, hollow needles into specific points of the body. As per the recent research published in the Scoliosis Journal, acupuncture is effective in slowing down the progression of lateral spinal curvature. It is advisable to consult a doctor before beginning any acupuncture sessions.
Chiropractic treatment involves various spinal adjustments and osteopathic manipulations that are done by a chiropractor. These treatments help decrease pain by maintaining the mobility of the spinal facet joints.
Even though there are no established preventive methods to avoid scoliosis, you may proactively follow certain steps to avoid degeneration of your spine and development of scoliosis at a later stage in life. In most cases, adult scoliosis develops without any reason, which makes it even more difficult to prevent. Here are a few lifestyle modifications that can help improve spine health and reduce the risk of degenerative scoliosis.
- Maintaining a healthy weight: People who are overweight or obese tend to sustain more damage to their spine. Maintaining an ideal weight is important in reducing the stress on the spine.
- Getting regular exercise: Exercise strengthens the neck and back muscles and provides support to the spine. Stretching and strengthening exercises also reduce pain resulting from degenerative spinal disorders.
- Eating nutritious food: Consume a diet rich in nutrients essential for maintaining bone health, such as calcium and vitamin D. Avoiding osteoporosis can also prevent the development of degenerative scoliosis, as these conditions are interrelated.
- Avoiding high-impact/contact sports activities: Physical activity is important in maintaining overall health, but athletes engaging in high-impact and contact sports are at a higher risk of spinal trauma. Therefore, it is better to choose low-impact activities and to avoid sports activities such as hockey, football, and wrestling.
Do you have chronic lower back pain, or have you found asymmetry in your body? The specially trained spinal surgeons at Cedars-Sinai Marina del Rey Hospital can provide information and guidance about treating adult scoliosis.