Idiopathic scoliosis is the most common type of scoliosis seen in children from age 7 to early teens, the time when children grow the fastest. However, it can be seen at any age and it presents in people of all ages. Therefore, idiopathic scoliosis is divided into three subgroups according to age:
- Infantile (0-3 years)
- Juvenile (4-10 years)
- Adolescent (11- maturity)
Once skeletal maturity is reached, a patient with adolescent idiopathic scoliosis is now said to have Adult Idiopathic Scoliosis. There would typically be a slow increase (about 0.5-2 degrees per year) in the curvature that began during teenage years in an otherwise healthy individual which is progressive during adult life. These curves can occur in the thoracic (upper) and lumbar (lower) spine and have the same basic appearance as those seen with teenage scoliosis. Physical symptoms can include: shoulder asymmetry, a rib hump or a prominence of the lower back on the side of the curvature.
Though a patient with adult idiopathic scoliosis will still benefit from scoliosis exercises to stop progression, pain is a much more common reason for treatment. Commonly, patients were diagnosed with idiopathic scoliosis earlier in life, but their curves were not prescribed treatment because their were not deemed severe enough to warrant treatment by the standard medical approach of bracing or surgery. These patients later find that by adulthood their curves have either progressed so that they now require treatment or are now causing pain. Other patients may have been braced during adolescence only to have their “corrected” curves revert or continue to progress as adults.
Adult scoliosis patients differs from the pediatric patients because the curve tends to cause back pain which is often the main complaint. The curve also tends to be more severe and is often progressive. Curves in adults tend to be rigid or stiff and therefore this treatment can be more challenging. Advanced stages of disc degeneration are also associated with adult scoliosis and may be the primary reason for back pain in many patients. Pinched nerves from herniated discs and arthritic changes may also be a challenge. In late middle age and after, it is common for patients to develop osteopenia (low bone density) or osteoporosis. All these are factors which affect treatment. Because normal degenerative changes of the spine may be accelerated by curvature, the patient may be at higher risk for skeletal pain or extremity pain due to nerve compression. That is why, though a curve in a child may appear insignificant or not be causing any symptoms, it is still important to treat it early before it has the chance to become a curve that is more difficult to treat. That being said, adult idiopathic scoliosis patients can receive adult scoliosis treatment that is almost identical to the treatment received by adolescent idiopathic patients.
It is important to have an adult scoliosis specialist monitor the curve over time because these curves can worsen due to the disc degeneration that occurs with older patients. This may also cause patients to lean progressively forward and cause sagittal imbalance. Also, arthritis in the spine facets can lead to bone spurs, pain and stiffness of the back and (in more severe cases) shooting pain and numbness down the legs from pinched nerves.