Scoliosis is a condition when the spine has one or more curves, measuring at least 10 (see SCOLIOSIS). The causes of both conditions can be congenital or be acquired, and the forms can be mild or severe as to how they affect stability and comfortable movement of the lumbar spine. Scoliosis occurs for different medical reasons, but all of them result in the spine acquiring a deviation from its normal vertical line and some degree of rotation. Degenerative scoliosis is caused by degenerative changes in the spinal discs and facet joints. The spine loses some amount of mechanical competence, which allows the deforming curves to develop.
Signs and symptoms include back pain, and sometimes leg pain and limping (claudication), due to nerve root irritation (radiculopathy) and spinal stenosis. There is also disc space narrowing, osteophyte formation and other signs of degenerative spine disease, or spondylosis. A spondylolisthesis, or forward slippage of a vertebra, may also be present (see above).
While many of the characteristics of degenerative scoliosis can be detected on X-ray, myelography and post-myelogram CT images can offer better anatomic detail, which may be important when spinal stenosis is also suspected. Evaluation of the spinal canal with MRI is of limited use with advanced scoliosis.
Nonoperative treatment consists of anti-inflammatory medications for pain, activity modification, and a prescribed regimen of therapy. A brace may be tried for relief of pain and if significant instability or deformity is present.
If these measures fail to improve the patientÍs condition or level of comfort and activity or back or leg pain becomes intractable over a prolonged period of time, surgical intervention is indicated. Surgery usually includes both decompression of compressed nerve elements and spinal fusion, with partial correction of the scoliosis using metallic implants.
Some of the risk factors for progression of degenerative scoliosis are an existing scoliotic curve of greater than 30 degrees, significant rotation of the spine, and severe osteoporosis.