What is degenerative adult scoliosis?
A healthy spine is straight when viewed from behind. As discs and facet joints wear, they can wear unevenly, one side losing more height than the other, and the spine gradually tilts into a curve. Unlike the scoliosis found in adolescents, this develops in an already-mature spine, and the problems it causes usually come from narrowing and alignment rather than from the curve's appearance.
Symptoms
- Low back pain and stiffness, often worse through the day
- Fatigue with standing or walking, improving on sitting
- Leg pain, numbness, or heaviness when the curve narrows the canal
- A sense of leaning forward or to one side, or clothes hanging unevenly
- Gradual loss of height
Urgent
Seek urgent care for new loss of bowel or bladder control, numbness in the saddle area, or rapidly worsening leg weakness.
How it is diagnosed
Full-length standing X-rays are central: they show the curve, the balance of the spine over the pelvis, and how the body is compensating. MRI shows where nerves are crowded. Comparison with any older imaging matters, because whether a curve has changed is often more informative than its current size.
Non-surgical treatment
Most people are managed without surgery. Physical therapy directed at core and hip strength, posture, and walking tolerance is the foundation. Anti-inflammatory medication and targeted injections can settle nerve-related leg symptoms enough to keep therapy productive. Treatment is aimed at function rather than at correcting the curve.
When surgery is considered
Surgery is discussed when leg symptoms or walking tolerance are limiting despite appropriate care, when weakness is progressing, or when spinal alignment has deteriorated enough to affect standing. Procedures range from targeted decompression to alignment correction, and the extent is matched to the problem, the smallest operation that addresses what is actually causing symptoms.