Degenerative = relating to wear-and-tear over time
Scoliosis = side-to-side curve in the spine. From the Greek word “skoliosis,” meaning “bending” or “crooked”
Scoliosis is a side-to-side curve in the spine. Degenerative scoliosis is a result of wear and tear on the discs and joints of the spine. It is the most common type of scoliosis in adults, and usually happens in the lumbar (lower) spine.
Patients with degenerative scoliosis may experience no symptoms, have only mild complaints, or be severely disabled. Degenerative scoliosis may cause the following symptoms:
- back pain that is worse with standing
- back pain that is relieved by lying down
- electric shock-like pain in one or both legs
- numbness in one or both legs
- weakness in one or both legs
Symptoms usually come on gradually. They may be worse first thing in the morning, better once the day’s activity begins, and then worsen again over the course of the day.
The spinal curves of degenerative scoliosis are usually not the cause of the symptoms. Instead, the curve and the symptoms are both caused by the spinal degeneration. Treatment therefore generally focuses on the degeneration. The curves are usually slow to progress, and don’t always need to be “corrected” in order to relieve the symptoms.
A complete medical history and physical examination are the first steps in diagnosing degenerative scoliosis. The doctor performing the diagnosis will ask questions about the specifics of any pain: where it is located, what it is like, whether anything makes it better or worse. Then the doctor may observe the patient’s backbone, shoulders, and hips as the patient stands straight, bends forward, or bends to either side.
The following procedures may also aid in diagnosis and, if necessary, surgical planning:
- X-ray: test that uses invisible beams of electromagnetic radiation to project images of bones onto film. X-ray will reveal the degree of spinal curvature and overall alignment of the spine.
- Magnetic resonance (MR) imaging: test that uses a magnet and radio waves to produce images of bones and soft tissues. MR imaging can reveal information about the discs of the spine, the spinal cord, and spinal nerves.
- Computed tomography with myelogram (myelo-CT): test that uses a special dye and several X-rays to reveal detailed information about the spinal cord
The treatment of degenerative scoliosis will depend on a variety of factors. The surgeon will determine the best treatment for each patient and each situation.
Nonoperative treatment, including physical therapy, strengthening and stretching exercises, or pain management, may be an option for some patients.
If degenerative scoliosis has resulted in spinal stenosis, surgery may be required. Spinal stenosis is the narrowing of the spinal canal, which can result in pressure on the spinal cord. In this case, spinal stenosis is usually caused by the development of bone spurs (overgrowth of the bone). To make room for the nerve roots, the surgeon may perform a laminectomy to remove the laminae, which is the bone that covers the spinal canal. As a result, the nerve roots will have enough room to function properly. In some cases, the surgeon may perform a spinal fusion to ensure the spinal column is stable after surgery. During a spinal fusion, the surgeon places a bone graft and allows it to fuse (grow together) with existing bone.