Lumbar Scoliosis
A Guide to the Causes & Treatment of Lumbar Scoliosis
There are two types of scoliosis, idiopathic scoliosis, which most often presents itself in adolescents, and lumbar scoliosis, which is usually the name given to the adult degenerative scoliosis. Both forms involve a curving of the spine. While for children and adolescents, no cause is known, it is most often thought to be a genetic condition. Many times, spinal fusion surgery is needed to correct the condition.
Degenerative lumbar scoliosis, on the other hand, is caused by aging, and is the result of degeneration of disk space and paired facet joints at the back of the spine. The wearing down of the joints can cause a spinal curve to develop, much like the S-curve that is present in idiopathic scoliosis. Degenerative lumbar scoliosis can be very painful while adolescent scoliosis often goes undetected because of the lack of pain.
Idiopathic scoliosis most often affects the thoracic spine, or middle of the back and degenerative affects the lower or lumbar region of the back. Lumbar scoliosis is a problem mainly for people over the age of 65. Recent statistics show that almost one-half of the people over the age of 65 will experience lumbar scoliosis to some extent.
Some of the symptoms of lumbar scoliosis are pain first thing in the morning, which gradually improves with increased activity. The pain returns later in the day and is the worst when standing and walking. The pain can be relieved by sitting or bending over. This takes pressure off of the facet joints.
As the degeneration of discs and joints increases, arthritis is apt to develop. This swelling can actually lead to another problem, which is known as lumbar stenosis, a narrowing of the spinal canal. When this happens, there will leg pain when walking. Blood collects at the root of the nerve and can only flow out when you are in a sitting position. While this is very similar to osteoarthritis, the difference is that in this condition there is a definite curve occurring in the spine.
Many types of treatments are tried with lumbar scoliosis before surgery will be performed. Surgery is always the last option, and because so many patients with this condition are over 65 years of age, many times surgery is not a viable option given the other medical problems the patient may have.
Some of the first treatments of lumbar scoliosis will be to try NSAIDS, or non-steroidal anti-inflammatory drugs, such as ibuprofen to relieve the pain and swelling, or an epidural injection into the area to reduce the inflammation. Patients often are sent to physical therapy or to pools for water therapy to improve their strength and conditioning, which can lead to less pain and improve mobility.
Other treatments for lumbar scoliosis can include going to a chiropractor for manipulation of the facet joints to relieve pain, a weight-loss program, or use of a brace. The approach is designed to help the patient deal with chronic pain and be able to continue to be functional for daily activities.
The risks are much greater for surgery with degenerative lumbar scoliosis than with idiopathic lumbar scoliosis. Usually the goal is decompression of the spinal nerves to decrease pain and allow better movement. However, because this can make the joint unstable, the curvature of the spine is apt to worsen. Thus, a spinal fusion is usually performed at the same time.
Older patients have a greatly increased risk of complications such as loss of blood, and the spinal fusion will take much longer to heal. In fact, the spine may not fuse and heal at all; there can be a spinal fluid leak, injury to nerves, and an increased possibility of infection. It will take a year to heal after the surgery. Because of all of these possibilities, you can see why a surgery for degenerative lumbar scoliosis is the last treatment option.
If the patient is in his or her 50s, the risks are fewer and the percentage of complete recovery is much higher. In all cases, however, the possibility exists that the surgery can make the condition worse or do nothing at all to help the situation.