Adult Degenerative Scoliosis: Signs, Symptoms, Treatment

1. What is Adult Degenerative Scoliosis?

It is a condition in which the moving parts of the spine, the facet joints and the intervertebral discs, have lost their usual structure, usually because of wear and tear over a period of time,. This causes the vertebrae to no longer be in alignment, resulting in an abnormal curve in the spine. This is not to be confused with the physiological or normal curvatures in the spine that are designed to help distribute the body’s weight.

2. What are common symptoms and signs of Degenerative Scoliosis?

The symptoms can range from no symptoms to back pain from the bones of the spine and/or the spine’s supporting structures.

3. How does Degenerative Scoliosis differ from Idiopathic Scoliosis?

Idiopathic means that we do not know the cause. With degenerative scoliosis, we know the cause, degeneration of the facet joints and intervertebral discs. The facet joint is where the top, or superior vertebra joins the lower, or inferior vertebra.Each superior and inferior vertebra meet at bilateral facet joints.The intervertebral discs are positioned like cushions between the superior and inferior vertebra.With idiopathic scoliosis, there is often no evidence on imaging studies of disc or facet joint degeneration; however, there is abnormal curvature of the spine. Scoliosis in childhood would be an example of idiopathic scoliosis.

4. How can Degenerative Scoliosis be treated?

The health of our spine is determined by our lifestyle, i.e. the foods that we eat, the vitamins and minerals that we lack in our diet, the types/frequency of exercise that we do, how much excess weight we carry on our musculoskeletal system, reversible disease processes that we acquire (diabetes, heart disease, high blood pressure, obesity, metabolic syndrome, gout, etc. ), how we engage our bodies in our field of employment, the quantity/quality of our sleep, how we manage stress, our mental capacity to deal with change, etc. The best treatment plan is to start with examining your lifestyle and changing the habits that are hindering you from achieving optimal health. This can be done concurrently with an exercise program under the guidance of a Physical Therapist trained in the function of the spine.

Pain is the body’s way of signaling something is wrong. For degenerative scoliosis, you want to be evaluated by experts such as Physiatrists, also known as Physical Medicine and Rehabilitation Physicians who understand the pathophysiology of this disease process. Acute processes generating back pain will need to be ruled out first; this can be vertebral fractures, ruptured discs, nerve root compression, foraminal stenosis, and central canal stenosis, to name a few. Assuming an acute process is not present that would warrant immediate surgical evaluation/treatment, the next step would be an exercise program with a Physical Therapist as noted above. The focus of Physical Therapy in the treatment of degenerative scoliosis is to stretch/loosen tight muscles and strengthen the weak muscles to balance the forces being exerted on the abnormally curved spine.

Management is designed based on your preference, pre-existing medical conditions, the severity of pain, and whether pain limits the ability to be independent. Oral medication is often an initial approach; however, utilizing manual modalities such as acupuncture, heat/cold applications, myofascial release techniques, dry needling, trigger point injections, and/or topical analgesics should also be considered. Interventional Pain Management injections may also be utilized to offer pain relief for weeks to months at a time.

5. What lifestyle changes can help manage Degenerative Scoliosis?

Every structure in our bodies requires water and nutrients to maintain its function. As a Physician Acupuncturist, I align with the Eastern Medicine approach of using nature to explain diseases. Our bones have the same make up as rocks with calcium phosphate that is combined with collagen, a type of protein that provides the scaffolding for all our body’s structures. Our discs contain water, collagen and proteins that have carbohydrate molecules attached to them. The same way that rocks break down to form soil, our vertebrae and discs can break down as well. With this in mind, I often recommend a well-balanced diet that takes into consideration food preferences, food allergies/intolerances, daily schedules, weight loss goals, food access, and budgets. Supplementing with vitamins and minerals is important especially if you are not eating a variable diet.

And we cannot forget hydration. Drinking at least 1 oz. of water for every kg of body weight is a good rule to follow. If you don’t like using kg as a metric, take half your weight in lbs. to calculate how many oz of water you should drink. Example: A person weighing 160 lbs. should drink 80 oz of water in a day. If you work outside and sweat a lot, work heavy labor, exercise a lot, are a professional athlete, you will need more water. Hydration can be in the form of water, juices, smoothies, teas, coffee, and soups. Avoid carbonated and sugary beverages as they can prevent good blood flow to bones and vertebral discs.

Our bodies are designed to move, which is why I think exercise is the fountain of youth. Movement in the spine helps to lubricate the facet joints and keep them healthy. Regular exercise keeps the heart pumping optimally so that nutrients are distributed to the spine. Strong core muscles of the abdomen, back, pelvic floor and diaphragm support the spine and help to maintain its structure. An exercise program focusing on maintaining strength, balance, agility, flexibility and cardiovascular health is recommended.

Last but not least is sleep. Quality sleep, defined as being in a deep state of relaxation for 3-4 hours at a time combined with length of sleep (7-9 hours per day for adults; 8-12 hours per day for children) is what is needed to repair damaged cells. We incur damage to our cells on a daily basis; this cannot be avoided hence the importance of giving our bodies the opportunity to repair itself via sleep.

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