Adult Scoliosis

by Nancy Schommer, author of Stopping Scoliosis

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?
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.

Q: Will untreated adult scoliosis get worse year after year?
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 per year.

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 inviting problems.

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 surgery?
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 to work?
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 from progressing.

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