Adult degenerative scoliosis – A literature review

Abstract

Adult scoliosis is an umbrella term referring to all forms of scoliosis occurring in skeletally mature individuals, irrespective of whether the deformity began before or after skeletal maturity. Adult degenerative scoliosis is a specific type of adult scoliosis that refers to a structural curve that develops after skeletal maturity in a previously normal spine. The pathogenesis of adult degenerative scoliosis has at its foundation the same starting point of degenerative spine disease namely age related desiccation of the intervertebral disc. The crucial pathophysiological concept to appreciate in adult degenerative scoliosis is the asymmetry of disc and facet joint degeneration which leads to progressive coronal imbalance on axial loading. Further abnormalities in the pathophysiology of adult degenerative scoliosis include hypertrophy of the ligamentum flavum, laxity of the interspinous ligament and eventual spinal instability. The clinical course of patients with adult degenerative scoliosis is usually a progressively increasing deformity with worsening axial backache over many years. Superimposed leg pain and eventually gradual leg weakness occurs in the advanced stages of the disease. Conservative measures commonly employed by primary care physicians include out-patient medication, lumbo-sacral and thoraco-lumbo-sacral braces, and physical therapy. Degenerative scoliosis is a however best regarded a surgical disease and the conservative measures should be regarded as palliative in non-surgical candidates secondary to significant medical co-morbidities. This review aims to provide a comprehensive overview of adult degenerative scoliosis considering the clinical, pathophysiological, and surgical management of this increasingly prevalent problem. The problem is best managed by Neurosurgeons and Orthopedic surgeons in a multi-disciplinary team familiar with the complexity of this disease in a patient specific manner.