Degenerative Scoliosis
Symptoms | Tests for Diagnosis | Treatment | Prognosis
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.
Symptoms
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).
Tests for Diagnosis
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.
Treatment
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.
Prognosis
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.