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Adult Scoliosis
Usually diagnosed during childhood and adolescence, scoliosis can also develop in adults. Most cases are mild, but the degree of the curve in the spine determines how much treatment is needed. Learn from Dr. Daniel Cavanaugh, a spine expert and member of the UM Spine Network, what causes adult scoliosis, what treatments are available, if it can be prevented and more.
Featured Speaker:
Prior to coming to Maryland, Dr. Cavanaugh served as a clinical assistant professor in the Department of Orthopaedics at UNC School of Medicine. Dr. Cavanaugh’s areas of clinical interest and expertise include disorders of the cervical and lumbar spine and minimally invasive spinal techniques. Dr. Cavanaugh is seeing patients at UM Upper Chesapeake Medical Center.
Daniel Cavanaugh, MD
Dr. Cavanaugh is part of the University of Maryland Orthopaedic Associates. He completed his undergraduate work at North Carolina State University and received his medical degree from University of North Carolina (UNC) at Chapel Hill. Dr. Cavanaugh served an orthopaedic surgery residency at UNC, followed by an orthopaedic spine fellowship at University of Maryland Medical System in Baltimore. Dr. Cavanaugh has received multiple honors including the UNC Orthopaedics Chief Resident Research Award, WakeMed Resident of the Year and the William C. Patton Resident Teaching Award. He is the author of numerous original articles and book chapters.Prior to coming to Maryland, Dr. Cavanaugh served as a clinical assistant professor in the Department of Orthopaedics at UNC School of Medicine. Dr. Cavanaugh’s areas of clinical interest and expertise include disorders of the cervical and lumbar spine and minimally invasive spinal techniques. Dr. Cavanaugh is seeing patients at UM Upper Chesapeake Medical Center.
Transcription:
Adult Scoliosis
Caitlin Whyte: Welcome to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We put knowledge and care within reach, so you have everything you need to live your life to the fullest. This podcast is sponsored by the UM Spine Network.
Usually diagnosed during childhood or adolescence, scoliosis can also develop in adults. Most cases are mild, but the degree of the curve in the spine determines how much treatment is needed. We'll talk to Dr. Daniel Cavanaugh today, he is a spine expert and member of the UM Spine Network, about what causes adult scoliosis, what treatments are available, if it can be prevented and more.
So to begin our episode today, doctor, what is adult scoliosis and how is it different from the scoliosis that's diagnosed in childhood?
Daniel Cavanaugh, MD: So adult scoliosis is a type of spinal deformity that occurs as folks get older. There are several different types of scoliosis. The most common one is what we call idiopathic scoliosis. It typically presents as a teenager and there is some genetic predisposition for this. There's also other types of scoliosis that can be congenital because of a deformity in the spine. But adult scoliosis typically presents in adulthood and it's related to degenerative changes of the spine.
Caitlin Whyte: So what symptoms would cause this diagnosis and how exactly is it diagnosed?
Daniel Cavanaugh, MD: So many patients that I see have some scoliosis, but may not have many symptoms at all. The symptoms from adult scoliosis can be variable. Some patients present with back pain, some patients present with difficulty walking, difficulty standing upright, pain or numbness down the legs. Adult scoliosis could present many different ways.
Usually scoliosis is diagnosed on x-rays. Occasionally, we can diagnose it based on an MRI scan or a CT scan, but the most common presentation is on x-rays as the initial workup.
Caitlin Whyte: Gotcha. Now, can you dig in more to what causes adult scoliosis to develop so late?
Daniel Cavanaugh, MD: So we don't really have one particular cause for scoliosis. The way adult degenerative scoliosis typically presents is because people develop back pain, they develop neurologic symptoms related to the degenerative changes of the spine. Usually, there's some type of collapse at the disc or a slipped disc called a spondylolisthesis, and this sets off a cascade where it presents a little bit of asymmetry for the spine and then the spine begins to curve and rotate as you get older.
Caitlin Whyte: Is there a specific part of the back that's usually affected or can it be anywhere?
Daniel Cavanaugh, MD: It's typically in the lower part of the lumbar spine. Although when the spine begins to curve, the remainder of the spine can compensate to maintain a neutral balance, so that patients usually stand upright.
Caitlin Whyte: So let's talk about treatment. What treatment options are available?
Daniel Cavanaugh, MD: Well, this is a problem that in all honesty, rarely require surgery. With most spine pathology, you know, the initial treatment is non-operative, usually with physical therapy, anti-inflammatory medications, sometimes prescription medications, such as muscle relaxers, and even other modalities such as acupuncture, yoga and even chiropractic treatment can be helpful.
Caitlin Whyte: And what is the outlook for people diagnosed with adult scoliosis? How much does it impact a daily life?
Daniel Cavanaugh, MD: I think the presentation of this condition can be fairly variable for some people they're able to function quite well with their spinal deformity or their spinal deformity is quite mild. For some patients, it can be extremely debilitating. The main problem with the adult degenerative scoliosis is neurological symptoms that begin where the spinal canal and nerves become pinched as a result of the deformity. When nerves or the spinal canal becomes narrowed, or you have nerve pinching, you can start to develop numbness down the legs, weakness down the legs, difficulty walking, and these symptoms tend to be the ones that require surgery.
Caitlin Whyte: So is there anything that we can do to prevent adult scoliosis from onset? I know you mentioned some of it could just be genetic, but is there anything we can do?
Daniel Cavanaugh, MD: There's no good answer for this question, to be honest with you. We don't really understand the cause of adult scoliosis. Obviously, you can't change genetics. There's some evidence that shows that use of nicotine can accelerate disc wear, which may present with scoliosis. So I usually caution my patients to avoid tobacco use.
Anytime there's a structural abnormality to the spine, weight loss can sometimes be helpful for patients that are overweight. It helps their spine cope with a physiologic load of maintaining an upright posture. But there's no good preventative treatment for this. Bracing is not usually effective and can in fact sometimes make the supporting muscles around the spine weaker and dependent on a brace.
Caitlin Whyte: Well, doctor, an interesting topic covered today. Is there anything else you would like our listeners to know?
Daniel Cavanaugh, MD: When it comes to surgical treatment of adult degenerative scoliosis, the outcomes can be favorable and can be good in well-selected patients. Because of the unique pathology with this condition, everybody's curve or everybody's spine is different. One surgery does not fit all if surgery is required. Sometimes people just require a decompression to alleviate their neurological problems. Sometimes there's significant instability, which requires a fusion. Sometimes people have a significant global deformity where they can't stand upright or their whole spine is off balance requiring a multilevel fusion. So the presentation can be quite variable and the treatment for each person should be individualized.
Caitlin Whyte: Well, doctor, we covered a lot today. I really appreciate your time. Thank you so much for joining us. This episode is sponsored by the University of Maryland Spine Network. Connected by the renowned University of Maryland School of Medicine, the UM Spine Network is home to the state's leading spine experts. With convenient locations throughout the state, UM spine network physicians collaborate to create comprehensive care plans for patients across the full spectrum of care. When you work with a UM Spine Network physician, you can expect to receive the high quality evidence-based care that you deserve.
Find more shows just like this one at umms.org/podcast. And thank you for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again.
Adult Scoliosis
Caitlin Whyte: Welcome to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We put knowledge and care within reach, so you have everything you need to live your life to the fullest. This podcast is sponsored by the UM Spine Network.
Usually diagnosed during childhood or adolescence, scoliosis can also develop in adults. Most cases are mild, but the degree of the curve in the spine determines how much treatment is needed. We'll talk to Dr. Daniel Cavanaugh today, he is a spine expert and member of the UM Spine Network, about what causes adult scoliosis, what treatments are available, if it can be prevented and more.
So to begin our episode today, doctor, what is adult scoliosis and how is it different from the scoliosis that's diagnosed in childhood?
Daniel Cavanaugh, MD: So adult scoliosis is a type of spinal deformity that occurs as folks get older. There are several different types of scoliosis. The most common one is what we call idiopathic scoliosis. It typically presents as a teenager and there is some genetic predisposition for this. There's also other types of scoliosis that can be congenital because of a deformity in the spine. But adult scoliosis typically presents in adulthood and it's related to degenerative changes of the spine.
Caitlin Whyte: So what symptoms would cause this diagnosis and how exactly is it diagnosed?
Daniel Cavanaugh, MD: So many patients that I see have some scoliosis, but may not have many symptoms at all. The symptoms from adult scoliosis can be variable. Some patients present with back pain, some patients present with difficulty walking, difficulty standing upright, pain or numbness down the legs. Adult scoliosis could present many different ways.
Usually scoliosis is diagnosed on x-rays. Occasionally, we can diagnose it based on an MRI scan or a CT scan, but the most common presentation is on x-rays as the initial workup.
Caitlin Whyte: Gotcha. Now, can you dig in more to what causes adult scoliosis to develop so late?
Daniel Cavanaugh, MD: So we don't really have one particular cause for scoliosis. The way adult degenerative scoliosis typically presents is because people develop back pain, they develop neurologic symptoms related to the degenerative changes of the spine. Usually, there's some type of collapse at the disc or a slipped disc called a spondylolisthesis, and this sets off a cascade where it presents a little bit of asymmetry for the spine and then the spine begins to curve and rotate as you get older.
Caitlin Whyte: Is there a specific part of the back that's usually affected or can it be anywhere?
Daniel Cavanaugh, MD: It's typically in the lower part of the lumbar spine. Although when the spine begins to curve, the remainder of the spine can compensate to maintain a neutral balance, so that patients usually stand upright.
Caitlin Whyte: So let's talk about treatment. What treatment options are available?
Daniel Cavanaugh, MD: Well, this is a problem that in all honesty, rarely require surgery. With most spine pathology, you know, the initial treatment is non-operative, usually with physical therapy, anti-inflammatory medications, sometimes prescription medications, such as muscle relaxers, and even other modalities such as acupuncture, yoga and even chiropractic treatment can be helpful.
Caitlin Whyte: And what is the outlook for people diagnosed with adult scoliosis? How much does it impact a daily life?
Daniel Cavanaugh, MD: I think the presentation of this condition can be fairly variable for some people they're able to function quite well with their spinal deformity or their spinal deformity is quite mild. For some patients, it can be extremely debilitating. The main problem with the adult degenerative scoliosis is neurological symptoms that begin where the spinal canal and nerves become pinched as a result of the deformity. When nerves or the spinal canal becomes narrowed, or you have nerve pinching, you can start to develop numbness down the legs, weakness down the legs, difficulty walking, and these symptoms tend to be the ones that require surgery.
Caitlin Whyte: So is there anything that we can do to prevent adult scoliosis from onset? I know you mentioned some of it could just be genetic, but is there anything we can do?
Daniel Cavanaugh, MD: There's no good answer for this question, to be honest with you. We don't really understand the cause of adult scoliosis. Obviously, you can't change genetics. There's some evidence that shows that use of nicotine can accelerate disc wear, which may present with scoliosis. So I usually caution my patients to avoid tobacco use.
Anytime there's a structural abnormality to the spine, weight loss can sometimes be helpful for patients that are overweight. It helps their spine cope with a physiologic load of maintaining an upright posture. But there's no good preventative treatment for this. Bracing is not usually effective and can in fact sometimes make the supporting muscles around the spine weaker and dependent on a brace.
Caitlin Whyte: Well, doctor, an interesting topic covered today. Is there anything else you would like our listeners to know?
Daniel Cavanaugh, MD: When it comes to surgical treatment of adult degenerative scoliosis, the outcomes can be favorable and can be good in well-selected patients. Because of the unique pathology with this condition, everybody's curve or everybody's spine is different. One surgery does not fit all if surgery is required. Sometimes people just require a decompression to alleviate their neurological problems. Sometimes there's significant instability, which requires a fusion. Sometimes people have a significant global deformity where they can't stand upright or their whole spine is off balance requiring a multilevel fusion. So the presentation can be quite variable and the treatment for each person should be individualized.
Caitlin Whyte: Well, doctor, we covered a lot today. I really appreciate your time. Thank you so much for joining us. This episode is sponsored by the University of Maryland Spine Network. Connected by the renowned University of Maryland School of Medicine, the UM Spine Network is home to the state's leading spine experts. With convenient locations throughout the state, UM spine network physicians collaborate to create comprehensive care plans for patients across the full spectrum of care. When you work with a UM Spine Network physician, you can expect to receive the high quality evidence-based care that you deserve.
Find more shows just like this one at umms.org/podcast. And thank you for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again.