When most people hear the word scoliosis, they think of adolescents being screened in middle school. But adult degenerative scoliosis — which develops or worsens as the spine ages — is actually more common in our practice than adolescent scoliosis. It is also, for many patients, more painful and more limiting.
What Is Adult Degenerative Scoliosis?
Adult degenerative scoliosis is a lateral (sideways) curvature of the spine that develops in adulthood as a result of asymmetric disc and facet joint degeneration. Unlike adolescent idiopathic scoliosis — which develops during growth spurts for reasons that aren't fully understood — adult degenerative scoliosis is a direct consequence of the wear-and-tear changes that affect everyone's spine over time, but unevenly.
As discs degenerate asymmetrically — collapsing more on one side than the other — the spine gradually tilts. Over years, this can produce a measurable curvature as well as accompanying problems: spinal stenosis, nerve root compression, loss of normal lumbar lordosis (the inward curve of the low back), and problems maintaining upright posture.
How Is It Different from Adolescent Scoliosis?
Several important differences distinguish adult degenerative scoliosis from adolescent idiopathic scoliosis:
- Pain is the primary complaint in adult degenerative scoliosis. Adolescent scoliosis is typically painless — the main concern is curve progression. Adults come to us because they hurt.
- Neurological symptoms are common in adults — leg pain, numbness, and weakness from associated stenosis affect a significant proportion of adult degenerative scoliosis patients.
- Posture changes are often apparent — patients frequently describe leaning to one side or needing to use their hands to push themselves upright after sitting.
- Curve magnitude alone doesn't drive treatment decisions in adults the way it does in adolescents. A 30-degree curve causing significant pain and functional limitation may warrant treatment; a larger curve in an older patient with few symptoms may not.
Who Gets Adult Degenerative Scoliosis?
The condition becomes increasingly common after age 50, though we see patients across a wide age range. Risk factors include advanced disc degeneration, osteoporosis, prior lumbar surgery, and a history of mild adolescent scoliosis that has progressed with age.
How Is It Treated?
Not everyone with adult degenerative scoliosis needs surgery. For patients with mild curves and manageable pain, physical therapy, core strengthening, and targeted injections can provide meaningful relief. The goals of non-surgical care are pain management and functional improvement — not curve correction.
Surgery is considered when pain is severe and not adequately controlled with conservative measures, when neurological symptoms (leg pain, weakness, numbness) are limiting function, or when the curve is progressing significantly. Adult deformity surgery combines decompression of compressed nerves with spinal fusion to correct alignment and stabilize the spine.
The goal of surgery in adult scoliosis is not to achieve a perfectly straight spine — it is to restore comfortable upright posture, decompress the nerves, and relieve pain in a way that is durable long term.
When to Seek Evaluation
If you have been told you have scoliosis and you are experiencing significant back pain, leg pain, or difficulty maintaining upright posture, a neurosurgical evaluation is appropriate. We will review your imaging, assess your neurological function, and discuss all options — non-surgical and surgical — based on your individual situation and goals.