There are two main types of adult scoliosis- Pre-existing (usually adolescent scoliosis), which in adulthood becomes known as adolescent scoliosis in Adult (ASA) ; and the second known as development of scoliosis in adults, usually a result of spinal degeneration which is also known as degeneration De-Novo Scoliosis (DDS). Adults with ASA may not have been previously diagnosed with adolescent scoliosis. ASA may be progressive or stable, depending on the individual case. Those with previous diagnosis, monitoring progress is easy with comparison of current x-rays to adolescent x-rays.
In those where scoliosis is discovered in adulthood, determining whether the scoliosis is pre-existing or a new onset of degeneration scoliosis can be difficult.
De-Novo scoliosis usually develops in middle aged and older adults and is typically seen starting around 45 years onwards. In most circumstances DDS is a result of degenerative instability, it is almost always progressive over time. The main complaint associated with degenerative instability is lower back pain.
Pain & Adult Scoliosis
Although some forms of adult scoliosis can be progressive, the main complaint is lower back pain. Often this pain is severe and little relief has been found from usual medical and complimentary care. A common misunderstanding still perpetuated by most health professionals is that scoliosis does not cause pain. This is not true. This notion has come about because the majority of children suffering from adolescent idiopathic scoliosis do not present with a primary complaint of pain and quite often even large deformities in children do not cause pain. However, in adult between the ages of 50 to 80 who suffer from chronic lower back pain, research shows that up to 40% will have an adult scoliosis.
This misconception has led to a diagnostic and treatment approach that argely ignores the role of scoliosis in chronic lower back in adults and, as a result less than satisfactory outcome for many of these patients.
The pain seen in adulat scoliosis is not related to the size of the curve. Several good studies show there is little to no relationship between the size of the curve and pain. For example a 20 degree and 50 degree curve have the same chance of causing pain in adults. There are 2 key factors related to the pain.
1. Location of the curve. Almost all complaints of pain in adult scoliosis is related to the lower back. The majority are degenerative curve are lower back curves. It is rare for a single curve in the upper spine to cause lower back pain. However some patients present an “S” shaped curve; this curve in the bottom half of the lower back can cause pain as an adult
2. Balance of the spine. What is meant by ‘balance’ is the forward/backwards, left/right shift of the spine that does not necessarily relate to the size of the curve. More importantly adults with scoliosis who have forward shifted posture, or those that are bent forward, will develop more pain than those in neutral or backward shifted posture.