About Degenerative Lumbar Scoliosis
Degenerative Lumbar Scoliosis is a lateral curvature of the spine that occurs in adults. The condition typically occurs in people over the age of 65. Although the cause of this type of scoliosis is not fully known, it is thought that asymmetrical degeneration of the discs and joints in the spine cause shifting of the bones and discs, leading to a sideways curvature. The sideways curve creates greater stress on the more severe degenerated joints leading to progression of the degenerated process. The result is a perpetuation and progression of the deformity. Some people with lumbar scoliosis have no symptoms; others experience pain, sciatica, or impaired mobility.
Common Symptoms of Degenerative Lumbar Scoliosis
When the facet joints and discs in the spine start to deteriorate pain usually results. The deterioration causes the joints to become irritated and inflamed which leads to pain. This pain may gradually increase and worsen over time. The pain seems to be worse first thing in the morning and later in the day. Sitting generally takes some of the pressure off of the spine, making it more comfortable than standing. Sometimes leg pain will occur in one or both legs, especially when standing or walking.
Diagnosis of Degenerative Lumbar Scoliosis
Once a neurosurgeon determines the severity and location of your pain, a treatment plan can be developed. Typically surgery is not needed, and pain can be reduced through conservative maneuvers. The goal of these nonsurgical options is to reduce pain, increase strength, range of motion, and flexibility. These conservative maneuvers are intended to reduce the stress on the spine and decrease inflammation and irritation, leading to less pain. The degenerative curvature of the spine is not corrected through conservative care.
Treatment Options for Degenerative Lumbar Scoliosis
Medication used to treat degenerative lumbar scoliosis is similar to medication used for osteoarthritis of the spine. Pain medications include over the counter non-steroidal anti-inflammatory agents, such as ibuprofen, as well as prescription medications. Injections may be considered for pain that is unresponsive to oral medications. These are commonly referred to epidural steroid injections or facet joint blocks. These injections deliver anti-inflammatory medication directly to the inflamed spine to decrease pain.
Another nonsurgical option to treat degenerative lumbar scoliosis is physical therapy (PT). PT is intended to strengthen the core and take stress off the spine, improve flexibility, and educate patients regarding maneuvers to avoid that may elicit pain. If these nonsurgical options don’t help reduce pain, surgery may be considered.
The goal of surgery for degenerative lumbar scoliosis is to address the spinal instability and deformity that may be causing pain. In addition, areas of nerve compression are addressed by removing degenerated spine segments that cause narrowing of the nerve channel. Since there is a certain degree of underlying spinal instability, the surgery will often involve a fusion with the insertion of metallic implants, such as screws and rods, to stabilize the spine. The goal of surgery is to reduce pain so that a patient’s quality of life is restored.
These are relatively involved procedures that require a longer recovery time than more routine spinal procedures. The healing of the bone and reduction of pain can take anywhere from three months to one year. Due to the significant recovery time only patients with severe symptoms should consider this procedure. Since adult degenerative lumbar scoliosis surgery is more difficult to perform than adolescent surgery, it is extremely important that the benefits of the procedure outweigh the risks.