Scoliosis is a condition that causes an irregular side to side curvature of the spine. Adult scoliosis is the term used for this condition when it affects persons later in life beyond the age of skeletal maturity.
How does adult scoliosis occur?
There are 2 reasons adult scoliosis occurs. The first is completely new scoliosis, where nothing existed in adolescence. The initial degeneration occurs in the intervertebral disc, with subsequent arthritis in the facet joints of the spine. Interestingly, the degeneration often does not occur symmetrically, leading to scoliosis. Osteoporosis has been associated with adult scoliosis, but that association has not clearly been delineated.
When an individual has scoliosis as an adolescent, it often does not progress in adulthood. However, if the curve was over 40 degrees when skeletal maturity occurs, several studies have shown an average progression of the scoliotic cuve of one degree per year.
While one degree per year may not sound like a lot, it can really add up over a few decades. And along with it the individual may experience back pain and leg pain as well.
Scoliosis affects as many as nine million persons in the United States alone. Most of these cases are idiopathic scoliosis that occurs in children ages 10-15 years, but still, many adults are treated for secondary, or adult, scoliosis.
What are the symptoms of adult scoliosis?
Irregular curvature of the spine is the characteristic symptom of scoliosis, but this often causes other symptoms to arise. These symptoms include:
- Uneven shoulders and/or hips
- The head is not centered over the body
- Shoulder blades are uneven and one may protrude more
- Arms hang at different lengths
- Development of a so called “rib hump” where the body contorts to the point that the ribcage protrudes abnormally
- Back pain, buttock pain and leg pain
- Spinal stenosis may occur due to the spinal arthritis and asymmetric degeneration. Nerve roots may get pinched due to this.
- Difficulty breathing
- Stresses organs
How is scoliosis diagnosed?
X-rays will be taken from multiple angles and will show abnormalities of the curvature of the spine. The patient’s progress will be monitored over time to determine if further steps (like surgery) are needed to prevent a severe or debilitating condition or if it is progressing to potentially have a negative effect on the organs.
A complete physical exam will be performed and testing of motor function is used in diagnosis to determine if the condition is affecting the functioning of the muscles. If the scoliosis begins to affect the nerves it may impair motor skills and function. Previous back surgery or other conditions such as osteoporosis can be good indicators of scoliosis occurring when other symptoms are present.
The Chicago pain management doctor may also use MRI (magnetic resonance imaging) and CT scans (computerized tomography) in order to get a realistic image of the spine as well as the soft tissue surrounding your spine to look for nerve impingement that could be causing pain as well.
For chronic pain, often a diagnostic injection (either facet or medial blocks) will be administered to measure effectiveness. If the injections are effective, a subsequent RA (radiofrequency ablation) may be in order for chronic pain relief.
What treatments are available for patients with adult scoliosis?
Conservative treatment methods are always preferred and surgery is saved as a last resort. If osteoporosis is present, medications may be used to treat the osteoporosis in an attempt to slow or stop the progression of the scoliosis.
Treatments may include:
- Anti-inflammatory medications
- Non-opioid analgesics
- Physical Therapy
- TENS Units
What interventional treatments are available?
- Facet Injections
- Medial Branch Blocks
- Radiofrequency Ablation
- Epidural Injections
- Trigger Point Injections
What are expectations when a patient gets nerve block injections?
For patients experiencing chronic, debilitating pain associated with their scoliosis, often injections are the primary means of relief as these injections are very effective in relieving pain. The majority of patients who undergo the procedures will experience some level of relief, often significant.
For patients experiencing multiple symptoms, we recommend a combination of injections. Facet injections and or medial branch blocks will address the back pain and epidurals can be administered for stenosis.
How is the procedure performed?
Nerve block injections are performed on an outpatient basis, the patient is placed face down on an exam table and the area(s) to be injected are cleaned with anti-septic solution then numbed with a topical anesthetic. A thin needle is inserted using fluoroscope guidance for accurate needle placement, (a fluoroscope is a type of real time x-ray machine that allows the doctor to see the needle being inserted).
A contrast dye is usually injected to confirm the nerves are contacted with the medications and then a mixture of local anesthetic and corticosteroids are injected.
How long can the effects of the injections last?
The patient will often experience immediate but temporary relief from the local anesthetic; this wears off in about 24 hours. The steroid medication may take 2 or 3 days to work but then provides longer lasting relief, often for several days to weeks after the first set of injections and for months after repeated procedures.
What risk or side effects are possible?
Risks are fairly minimal and include slight bruising, swelling, or bleeding at the injection site, allergic reaction to the medications used, (although this is rare) and infection.
How successful are nerve adult scoliosis treatments for the relief of pain?
Conservative methods are very successful with mild scoliosis. In more complex cases, nerve block injections are very effective in stopping pain as the medications used numb the nerve and stop pain signals to the brain. Minimally invasive surgery may be needed if the pain doesn’t respond to initial conservative treatments, but has limited results.
Premier Pain & Spine offers comprehensive nonoperative adult scoliosis treatments including both medical and interventional therapies. There are seven metro Chicago pain clinics accepting most insurance with the Board Certified pain doctors.
Call (847) 519 4701 today for pain management Chicago trusts!