When dealing with scoliosis as an adult whether you had the condition from childhood or developed it later in life it seems the major concern is progression. Most adult patients especially the ‘baby boomers” are very concerned about their scoliosis getting worse. I think we have to consider the prevalence of scoliosis differs between the adolescent populations at a 3% incidence level versus the adult population having a 20% incidence level (3). In addition to the older populations of >60 being 40% and >70 year old population at 68%. So there definitely needs to be a distinction between adolescent scoliosis patients that are now adults versus later onset scoliosis induced almost entirely via environmental interaction with an effect on the lumbar spine primarily.
There is a very detailed and respectable study that was recently done regarding progression rates with scoliosis in the adult population (2). The truth is that scoliosis does progress in adulthood. Not only does it progress but it has a somewhat predictable nature to it based on where the curve is located or type of scoliosis. Lumbar and thoracolumbar single curves progress with the highest rate approximately 1.64 degrees per year, so a 10 year span would result in a 16 degree progression, WOW! whereas double major curves have the lowest rate of progression at .82 degrees per year or 8 degrees per decade. These progression statistics were based on very specific parameters. The patients observed in this study were separated into two very distinct groups, Type a double major curves and Type B single lumbar or thoracolumbar curves.
The double major group (type A) was often diagnosed in adolescence and in this particular study started being monitored at a mean age of 24 with a mean cobb angle measurement of 37 degrees (range 22° to 52° ). The single lumbar/thoracolumbar group (type B) began initial monitoring much later at a mean age of 46 with a mean cobb angle of only 20° (range 3° to 35°). The most significant difference between the two different scoliosis types was menopause. Type B single lumbar curves had a significant deterioration and progressed at a faster rate following menopause.
So when discussing whether or not scoliosis progresses in adulthood we have to make an initial distinction between the type of scoliosis that a patient has either adolescent scoliosis generally double major curves or adult onset scoliosis of the lumbar spine. If it is adult onset scoliosis of the lumbar spine then there are certain characteristics to look for and to monitor. If you are female then obviously menopause is a big component of the progression and all proactive steps available should be taken to prevent a big swing of the scoliosis in the wrong direction causing more dysfunction and pain in later years. Considering the progression is correlated and often caused by the rotation in the lumbar spine with adult onset scoliosis this needs to be a major component of the monitoring and scoliosis treatment process.
The adolescent double major has a lower progression rate and is not linked to menopausal deterioration but certainly should not be neglected based on a “ it’s not as bad” mentality, it still will worsen without any intervention and cause undo spinal dysfunction and pain. Interestingly the rotation in this scoliosis type appears to be secondary and a direct result of progression.
The progression of adult scoliosis is linear and therefore can be used to establish an individual prognosis and potentially generate treatment plan to accommodate each type and level of scoliosis.
Spine (Phila Pa 1976). 2005 May 1;30(9):1082-5.
Adult scoliosis: prevalence, SF-36, and nutritional parameters in an elderly volunteer population.
Natural history of progressive adult scoliosis.
Marty-Poumarat C, Scattin L, Marpeau M, Garreau de Loubresse C, Aegerter P.
Spine 2007 May 15;32(11):1227-34; discussion 1235.
Adult Lumbar Scoliosis: Underreported on Lumbar MR Scans
Z. Anwara, E. Zana, S.K. Gujara, D.M. Sciubbaa, L.H. Riley IIIa, Z.L. Gokaslana and D.M. Yousema
Published online before print January 6, 2010, doi: 10.3174/ajnr.A1962 AJNR 2010 31: 832-837