Because so many adults have contacted the NSF, we asked Nancy
Schommer, author of Stopping Scoliosis,
to provide us with an update about adult scoliosis. In the course
of her research, she interviewed Dr. David B. Levine, Clinical Professor
of Orthopedic Surgery at Cornell University Medical College and
Director of Orthopedic Surgery at the Hospital for Special Surgery
in New York City. Following are excerpts from their conversation.
Q: Dr. Levine, is it possible for an adult, a person 21
years of age or older, to suddenly "get" scoliosis?
Q: Will untreated adult scoliosis get worse year after year?
A: It's possible but extremely rare. When it happens, it is usually
because the patient has experienced some sort of trauma, such as
a fractured spine, or because the person develops a neuromuscular
condition like muscular dystrophy, or a metabolic condition like
osteoporosis that softens the bones. Most often, however, adult
scoliosis develops in adolescence, and is the "idiopathic"
variety, which means it occurs for no apparent reason.
A: I've followed patients for over twenty years, and have found that
probably 60% of adult patients do not get worse. Of the remaining
40% about 10% show a very significant progression, while the other
30% will show a very mild progression, maybe less than one degree
Q: Are there any factors that can decrease or increase
one's risk of progression?
A: Yes, there are. The person who is sedentary and overweight is
Q: What treatments are available for adults with scoliosis?
A: First, one has to understand that many adults who have scoliosis
never require treatment; they do not have obvious deformities or
breathing problems, and they have no pain. But when an adult has
a curvature that is approximately 50 degrees or more, then we begin
to consider the possibility of spinal fusion surgery.
Q: How do you decide on who's a proper candidate for spine
A: We look at four factors; pain, progression, appearance, and pulmonary.
Pain must be significant, and must be related to the scoliosis.
Regarding progression, anything under 5 degrees within a year is
questionable. A 5 degree change can be the result of any number
of variables. For example an x-ray taken of a 40-year-old woman
early in the morning might show a 50 degree curve, but an x-ray
of the same woman taken at 5 p.m. when she's tired and slumping
could show a curve that's 5-10 degrees greater.
Q: And what about appearance and pulmonary?
A: While we cannot document appearance with x-rays, simple photographs
can be helpful in revealing whether one's vertebral rotation has
gotten worse over time, whether ribs are sticking out more, or whether
one has lost height due to an increased curvature. Regarding pulmonary,
patients who are at risk for restrictive lung disease are usually
those individuals who have a scoliotic curvature of more than 75
degrees in the thoracic (upper back) area. Patients who have lumbar
(lower back) or thoraco-lumbar (mid back) curves will usually have
pulmonary functions that are normal.
Q: What factors increase the complication of surgery?
A: If surgery involves correction of two curves instead of just
one, the patient may have to undergo two surgeries, which of course
increases the odds for complications. The patient's general health
is a factor that can affect complication rates, as is the experience
and skill level of the surgeon performing the operation.
Q: We know that healing time will vary depending upon the
type of surgery performed, and the age and health of the patient.
But in general, when can adult surgical patients expect to return
A: You're right, it is quite variable. But a motivated person, living
a reasonable distance from an office location, could return to work
in six weeks. Of course, a patient should follow the advice of his
or her orthopedist.
Q: Any suggestions for helping patients heal properly?
A: In addition to proper rest, and whatever exercise is recommended
by their orthopedist, surgical patients should consume foods that
are high in calcium and vitamin D skim milk, for example as well
as foods such as yogurt, cheese, bony fish, vegetables such as broccoli,
even Japanese seaweed. Avoid excess alcohol, coffee, and tobacco;
these will decrease the rate and quality of bone formation
Q: Any other guidelines for adult surgical patients?
A: Each patient's surgeon will make his or her own recommendations,
but during convalescence, one should avoid strenuous physical activities
and heavy lifting. Six weeks after surgery, it's all right to have
sex, but actual details of positions should be discussed with one's
surgeon. In my opinion, women who've had scoliosis surgery should
not consider delivering a child until at least two years after the
surgery; it takes that long for fusion to become as hard as it should.
Q: One last question. Will you set the record straight
for us about exercise and what it can do for scoliosis?
A: Exercise can help pain that may be associated with scoliosis;
the best you can do is swimming the sidestroke and the backstroke.
But exercise is not a treatment for scoliosis it cannot stop a cuve
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