This is a front to back (AP) diagram of a degenerative scoliosis.

This diagram shows the angular collapse that can occur with asymmetric wear of the spine. The foramen that the nerve exits from is substantially narrowed by this collapse and nerve pain can occur with walking.

This is an x-ray of a patient with degenerative scoliosis of the lumbar spine. In this front to back (AP) view, the spine should be straight up and down.

Scoliosis is an abnormal curve of the normally straight spine in the frontal plane. A curve in the front to back plane (coronal plane) of greater than 10 degrees is called a scoliosis. If the curve is less than 10 degrees, it is not considered scoliosis.  Normally, lumbar degenerative scoliosis should not be painful until the degenerative process advances and causes local problems. The only time the actual non-symptomatic curve needs to be addressed in a mature individual is when the curve becomes significantly larger or the patient is out of balance when standing. Children with scoliosis are a different story. The curve can silently advance in a child and treatment commonly is necessary.

In the adult, scoliosis leads to accelerated degenerative changes of the discs and vertebra. The load on the spinal column is concentrated on a small portion of the total available surface area of the disc and facet. This increased pressure will wear out the segments faster than an evenly loaded spine. A comparison is a car tire knocked out of alignment. Normally, unless you drive like me, you can expect 20-30,000 miles out of a set of tires. However, the if camber is off, the tire will wear in less than 5,000 miles as the pressure is increased only on one side of the total potential contact area.

Symptoms

Degenerative scoliosis of the lumbar spine can cause most of the symptoms of any of the single disorders listed in the low back category such as herniated disc or spinal stenosis. In addition, low back pain is a common complaint as when the discs wear out and start to subluxate (lateral lysthesis or bone on bone pain).

Treatment

Non-surgical

Treatments for this disorder are standard with medications, physical therapy and spinal injections. Some individuals gain benefit from traction or antigravity machines. Impact activities need to be restrained. Chiropractic can be helpful but mobilization of the segments may increase the abnormal curve of the back.

Surgical

If surgery is necessary, surgical treatment may only need to involve the localized individual painful problem such as a herniated disc or a degenerative spondylolysthesis with stenosis. There are occasions that a degenerative scoliosis can be like a house of cards and a simple operation can destabilize the spine. A larger scoliosis procedure may be necessary and the experience of the surgeon in these matters can be quite helpful.

For additional research information on degenerative scoliosis of the lumbar spine or for additional resources on scoliosis and other spinal conditions, please contact Dr. Donald Corenman at 970-479-5895.