Scoliosis, characterized by an abnormal lateral curvature of the spine, is frequently identified during childhood or adolescence. However, scoliosis can also be diagnosed in adulthood. Understanding how scoliosis is diagnosed in adults is crucial for effective management and care. This article delves into the diagnosis of scoliosis in adults, drawing upon expert insights to provide a comprehensive overview.
Understanding Scoliosis
Scoliosis is not simply a curve in the spine; it is a complex, three-dimensional condition. While often measured in the coronal plane (frontal view), scoliosis involves deviations in all three planes:
- Coronal Plane: This vertical plane divides the body into front and back sections. Scoliosis is traditionally measured as a lateral curvature in this plane.
- Sagittal Plane: Dividing the body into right and left halves, the sagittal plane is where the spine’s natural curves (cervical, thoracic, and lumbar) are located. These curves are essential for balance and shock absorption.
- Axial Plane: This horizontal plane is parallel to the ground, intersecting the coronal and sagittal planes at right angles. Scoliosis also involves rotational abnormalities in this plane.
Illustration of spinal planes: coronal, sagittal, and axial, demonstrating the three-dimensional nature of scoliosis.
Scoliosis in Adults: Distinct Considerations
Scoliosis in adults presents unique characteristics compared to cases diagnosed in children. Adult scoliosis can be broadly categorized into three groups:
- Adults with Untreated Adolescent Scoliosis: These individuals had scoliosis that developed during adolescence but was either undiagnosed or unaddressed until adulthood.
- Adults with Surgically Treated Adolescent Scoliosis: This group includes adults who underwent surgical correction for scoliosis during their younger years.
- Adults with Degenerative Scoliosis: This type develops in adulthood, often due to the degeneration of spinal discs and joints associated with aging. Degenerative scoliosis is most common in the lower back (lumbar spine) and frequently affects individuals aged 65 and older.
Studies indicate that scoliosis progression can occur in adults. A 20-year study revealed that approximately 40% of adult scoliosis patients experienced curve progression, with 10% showing significant progression and 30% experiencing mild progression, typically less than one degree per year.
Symptoms of Scoliosis in Adults
While some adults with scoliosis may experience no noticeable symptoms, others may develop various signs, prompting the need for diagnosis. Common symptoms in adults include:
- Visible Spinal Curvature: An unevenness in the shoulders, waist, or hips can be a visual indicator. One shoulder may appear higher than the other, or one hip may be more prominent.
- Back Pain: Back pain is a common complaint among adults with scoliosis, especially degenerative scoliosis. The pain can be activity-related and may gradually worsen over time.
- Uneven Shoulders or Hips: Asymmetry in the body’s alignment is a key symptom. Clothes may not hang properly, and one side of the rib cage might protrude more than the other.
- Fatigue: Muscle imbalance due to scoliosis can lead to increased fatigue, as the body works harder to maintain balance and posture.
- Nerve Issues (in severe cases): In more severe cases, scoliosis can compress nerves, leading to symptoms like numbness, weakness, or pain radiating into the legs. Degenerative scoliosis, often associated with spinal stenosis (narrowing of the spinal canal), can also cause nerve compression.
- Breathing Difficulties (in severe cases): Severe thoracic scoliosis can restrict the rib cage, potentially impacting lung function and causing breathing problems.
It’s important to note that back pain in adults with scoliosis should be thoroughly evaluated to rule out other underlying conditions, as a study showed that a percentage of scoliosis patients with back pain had associated conditions like herniated discs or spinal tumors.
Adult undergoing Adam’s Forward Bend Test for scoliosis screening.
The Diagnostic Process for Adult Scoliosis
Diagnosing scoliosis in adults involves a comprehensive approach, combining physical examination and imaging techniques.
1. Physical Examination
A physical exam is the initial step in diagnosing scoliosis. Doctors will look for visible signs of spinal curvature and assess posture and alignment. Key components of the physical exam include:
- Visual Inspection: Observing the patient from the front, back, and side to identify any asymmetry in shoulders, hips, waist, and rib cage.
- Adam’s Forward Bend Test: While primarily used in children and adolescents, this test can also be informative in adults. The patient bends forward at the waist with feet together and arms hanging freely. From this position, the doctor can observe any rib hump or trunk asymmetry indicative of scoliosis.
- Neurological Examination: Assessing nerve function is important, particularly in adults with pain or suspected nerve compression. This may involve testing reflexes, muscle strength, and sensation.
2. Imaging Tests
If scoliosis is suspected based on physical examination, imaging tests are crucial to confirm the diagnosis, determine the curve’s severity, and identify any underlying causes or associated conditions. Common imaging techniques include:
-
X-ray: Spinal X-rays are the primary imaging tool for scoliosis diagnosis. A posterior-anterior (PA) X-ray, taken from the back to front, allows for measurement of the Cobb angle, the standard method for quantifying spinal curvature. A Cobb angle greater than 10 degrees on an X-ray confirms a scoliosis diagnosis. X-rays also help rule out other potential causes of pain or spinal abnormalities.
X-ray image showing scoliosis curvature measurement using the Cobb method.
-
Computed Tomography (CT) Scan: CT scans provide detailed cross-sectional images of the spine, offering excellent visualization of bony structures. CT scans are helpful in evaluating complex scoliosis cases, assessing spinal canal dimensions (important in degenerative scoliosis and spinal stenosis), and planning surgical interventions if needed.
-
Magnetic Resonance Imaging (MRI): MRI uses magnetic fields and radio waves to create detailed images of soft tissues, including the spinal cord, nerves, and discs. MRI is particularly valuable in adults with scoliosis to evaluate for nerve compression, spinal cord abnormalities, disc degeneration, spinal tumors, or other conditions that may contribute to or mimic scoliosis symptoms.
Degrees of Scoliosis Severity in Adults
The severity of scoliosis is classified based on the Cobb angle measured on X-rays:
- Mild Scoliosis: Cobb angle of 10 to 25 degrees.
- Moderate Scoliosis: Cobb angle of 25 to 40 degrees.
- Severe Scoliosis: Cobb angle greater than 40 degrees. Curves exceeding 45 to 50 degrees are often considered to require more aggressive treatment.
In adults, the degree of curvature, along with symptoms and the presence of progression, guides treatment decisions.
Seeking Expert Diagnosis
If you suspect you may have scoliosis as an adult, or if you are experiencing back pain or postural changes, it is essential to consult a healthcare professional experienced in spinal disorders. A neurosurgeon or orthopedic spine specialist can provide accurate diagnosis, assess the specifics of your condition, and recommend the most appropriate management plan tailored to your needs. Early and accurate diagnosis is the first step towards effective management and maintaining quality of life with adult scoliosis.
Note from AANS
The AANS does not endorse any treatments, procedures, products or physicians referenced in these patient fact sheets. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific neurosurgical advice or assistance should consult his or her neurosurgeon, or locate one in your area through the AANS’ Find a Board-certified Neurosurgeon online tool.
