FAQ’s on Adult Degenerative Scoliosis Treatment in Las Vegas

Scoliosis is any deviation (lateral bending) of the spine. A normal spine appears straight when viewed from the back of the patient. Adult degenerative scoliosis is lateral bending that occurs from aging, wear-and-tear, and chronic spinal conditions.

What spine structures are involved with scoliosis?

The spine is made of 24 moveable, irregular-shaped bones called vertebrae. Every vertebra (single bone) is separated from the one below and above it with an intervertebral disc. These cushioning discs are fluid-filled structures that act as shock absorbers. The spinal cord travels through a canal created by the posterior structures of the vertebra, and spinal nerves branch off the cord. Distorting normal spinal curvature, adult degenerative scoliosis can affect any of these spinal structures.

What symptoms are associated with adult scoliosis?

Most patients with mild adult degenerative scoliosis do not have symptoms. However, when the curvature is greater than 10 degrees, many patients report back pain. If nerve compression is involved, the patient can experience leg weakness, numbness, and pain. With severe scoliosis, breathing problems can occur, as can problems with ambulation.

What conditions are associated with adult degenerative scoliosis?

Aging of the spine is the main cause of adult scoliosis. However, certain conditions can contribute to spinal curvature, including:

  • Osteoporosis
  • Degenerative disc disease
  • Spinal stenosis
  • Vertebral compression fractures

How does the doctor diagnose adult degenerative scoliosis?

The pain specialist will examine the spine and conduct a neurological examination. Adult scoliosis is confirmed by x-ray, which will reveal a curvature of 10 degrees or greater. When nerve symptoms occur, the doctor may conduct a magnetic resonance imaging (MRI) scan or other tests.

What are the treatment options of adult degenerative scoliosis?

To treat adult degenerative scoliosis, the doctor will assess the severity of the condition, the extent of the pain, and the associated symptoms. Treatment options include:

  • Physical therapy – To improve muscle strength and spinal flexibility, the doctor may recommend a course of physical therapy. The strengthening program helps improve posture, strengthen muscles, support the spine, and provide pain relief.
  • Spinal brace/orthotics – A back brace is often used to provide support and alleviate tension. Orthotics, such as shoe inserts, are designed for leg length abnormality issues. These devices help with leg discomfort, walking, and balance.
  • Medications – The pain specialist often prescribes prescription strength nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen and ketoprofen. In addition, anti-depressants and anticonvulsants are used for nerve pain. Severe pain can be treated with narcotic analgesics.
  • Epidural steroid injection (ESI) – With this procedure, the doctor inserts a needle into the epidural space, which lies outside the spinal cord. X-ray guidance is used to assure correct needle placement. A long-acting corticosteroid is instilled into the space to decrease pain. An anesthetic can be added as well. Clinical research studies show ESI to have a 90% efficacy rate. The pain specialist may recommend a series of three ESIs for maximum results.
  • Facet joint injection (FJI) – The facet joints like along the back portion of the spine. The doctor can injection one or more of these joints with a long-acting anesthetic and corticosteroid drug using x-ray guidance. A recent research study found that FJI had an 85% efficacy rate.
  • Radiofrequency facet denervation (RFD) – If FJI proves an effective therapy, the doctor can destroy a portion of the nerve root in the facet joint using radiofrequency energy. The procedure is done similar to the FJI, using x-ray guidance to assure correct probe placement. According to a recent clinical study, RFD has a 76% success rate, and numerous patients report more than 50% pain relief lasting for several months.

Resources

McLain RF, Kapural L, & Mekhail NA (2005). Epidural steroid therapy for back and leg pain: mechanism of action and efficacy. Spine Journal, 5, 191-201.

Riew KD, Park JB, Cho YS, et al. (2006). Nerve root blocks in the treatment of lumbar radicular pain. A minimum five-year follow-up. Journal of Bone Joint Surgery, 88(8), 1722-1725.

Streitberger, K, Muller, T, Eichenberger, U, Trelle, S., & Curatolo, M (2011). Factors determining the success of radiofrequency denervation in lumbar facet joint pain: a prospective study. European Spine, 20(12), 2160-2165. doi:  10.1007/s00586-011-1891-6