Degenerative Scoliosis of the Lumbar Spine

Degenerative Scoliosis of the Lumbar Spine Overview

Normal spinal alignment and balance are very important to energy consumption with standing and walking. Scoliosis is an abnormal curvature of the spine. 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, degenerative scoliosis of the lumbar spine 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 or a similar spine deformity are a different story. The curvature of the spine can silently advance in a child and treatment for scoliosis is commonly necessary.

In the adult, skeletal disorders such as scoliosis lead to accelerated degenerative changes of the discs and vertebra, causing spine pain and other symptoms. 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 of Degenerative Scoliosis of the Lumbar Spine

Degenerative scoliosis of the lumbar spine, as well as any other curvature of the spine deformity 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 and spine pain are common complaints as when the discs wear out and start to subluxate (lateral lysthesis or bone on bone pain).

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(Please keep reading below for more information on this condition.)

Treatment of Degenerative Scoliosis of the Lumbar Spine

Non-Surgical

Treatment for most skeletal disorders, including degenerative scoliosis of the lumbar spine, usually begins with conservative measures. There are standard treatments such as with medications, physical therapy and spinal injections. These also help with the spine pain that may result from the spine deformity. 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

Surgery for scoliosis will be considered after conservative measures have failed. If surgery for a curvature of the spine 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 more involved surgery for scoliosis may be necessary and the experience of the surgeon in these matters can be quite helpful.

If you live in the Vail, Aspen, Denver and Grand Junction, Colorado area and are experiencing symptoms associated with degenerative scoliosis of the lumbar spine, please contact spine specialist and back surgeon Dr. Donald Corenman.

Related Content

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

(Click to Enlarge Image) 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.

(Click to Enlarge Image) 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.

(Click to Enlarge) Before and after degenerative scoliosis surgery. This was a 42 degree curve that straightened out to 12 degrees and is well balanced.

Donald Corenman, MD, DC

Average rating:

81 reviews

Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

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Degenerative Scoliosis of the Lumbar Spine