Adults with scoliosis are often told the curve is the problem. They hear that only major surgery will change it. In most cases neither half of that is true.
Two different conditions share one name
Adolescent idiopathic scoliosis starts during growth and is usually painless. Doctors watch it, brace it or operate, depending on the curve. Adults who had it as teens often carry a stable curve for decades with no symptoms.
Adult degenerative scoliosis is different. It starts later in life from uneven disc and facet degeneration (the discs and joints breaking down more on one side). The spine sinks unevenly, and a curve forms as a result. This one usually does hurt. The pain comes from the degeneration, not from the curve itself.
The upshot: the Cobb angle (the measured bend of the curve) tells you fairly little about why someone hurts.
Why does scoliosis cause back pain in adults?
Inside a curve there are several separate pain sources. Each one can be treated on its own, even though the curve is not going anywhere:
- Facet joints on the concave side, which get squeezed and carry uneven load. See facet joint pain.
- Foraminal narrowing on the concavity, where the exit tunnels close down and pinch a nerve root. This causes leg pain that follows one root. See foraminal narrowing.
- The sacroiliac joints, loaded unevenly by a pelvis that is no longer level. See sacroiliac joint pain.
- Muscular fatigue on the convex side, where muscles work nonstop against gravity to hold the trunk up.
- Central canal stenosis, where degeneration has narrowed the spinal canal as well as bending it. See spinal stenosis.
Each of those causes a pattern we can spot. Each can be confirmed by targeted diagnostic injection. That is the whole basis of treating a painful curve without surgery.
What is the most important symptom in adult scoliosis?
Walking distance. Adults with degenerative scoliosis usually name a distance past which the back and legs give out and they must sit. This is the same neurogenic claudication (leg pain from pinched nerves when walking) seen in spinal stenosis, because the cause underneath overlaps.
Tracking that distance tells you more than tracking a pain score. It is what treatment should aim to improve.
What we do not do
We do not correct curves. Straightening a curve is major spine rebuilding surgery with a long recovery. It is the right answer for a minority of patients. These are usually people with curves that keep growing, significant sagittal imbalance (leaning forward), or neurological compromise (nerve function affected).
What we do is find which part inside the curve is causing the pain. Then we treat that part. For a great many adults, that is the difference between doing well and being told only an operation they do not want will help.
How is adult scoliosis pain treated?
- Diagnostic blocks to find which part is to blame, because a curve has several candidates
- Medial branch blocks and radiofrequency ablation where the facet joints are confirmed
- Transforaminal epidural injection for a specific compressed nerve root on the concavity
- Sacroiliac joint injection where pelvic obliquity has loaded the joint
- Physical therapy aimed at trunk muscle endurance, not at straightening the curve
- Surgical referral where there is progression, imbalance or neurological deficit
Does an adult curve get worse?
Degenerative curves do tend to grow slowly, usually by a few degrees per year. They grow faster when there is significant rotation or a large curve to start with. But growth on a scan and worse symptoms are not the same thing. Many people stay steady in daily life for years.
So watching it is worth doing, and panic is not. What changes the plan is a change in function, not a change in the angle. That means walking distance, balance, or new weakness.
To get checked, call or text us. We are at 12174 Natural Bridge Rd, Suite 110, St. Louis, MO 63044.
What usually gets missed
The most common mistake in adult scoliosis is treating the curve instead of the pain. The size of the curve matches symptoms poorly. Many large curves cause no pain at all.
What usually causes the pain comes second. Facet joints on the inner side of the curve take uneven load. The nerve exits narrow on that side. A pelvis that is no longer level strains the sacroiliac joint. We can find and treat each of those without touching the curve at all.
What to expect over time
Adult degenerative curves grow slowly, usually a degree or two a year. Most never reach the point where surgery is needed.
Teen idiopathic curves and adult degenerative curves are truly different conditions. They follow different courses. That is why advice for one is often wrong for the other.
When this becomes urgent
New or worsening leg weakness, numbness in the saddle area, or any change in bladder or bowel control needs emergency assessment. A curve growing fast or new severe pain in a teen needs a prompt specialist visit. Shortness of breath with a large curve in the upper back needs a lung check.
Common questions
Can the curve be corrected without surgery?
No. Exercise, therapy and injections do not change the angle in an adult. They can greatly change the pain and the function. That is usually what the patient really wants.
Is my scoliosis why my leg hurts?
Possibly, but not directly. Leg pain in a curve usually comes from a nerve root pinched where the foramen (the nerve’s exit hole) has closed on the inner side. That can be treated on its own.
Should I avoid exercise?
No. Trunk endurance work is one of the more useful things you can do. What matters is building up what you can handle, not trying to straighten anything.
Will I end up needing surgery?
Most adults with degenerative scoliosis do not. Surgery is for curves that keep growing, significant imbalance, or neurological compromise.
Is this the same as the scoliosis I had as a teenager?
Often not. Adolescent idiopathic scoliosis and adult degenerative scoliosis are different conditions that share a name. They behave differently.
How do you keep adult scoliosis from getting worse?
Exercise, therapy and injections do not change the angle of an adult curve. Degenerative curves grow slowly, usually a degree or two a year. Most never reach the point where surgery is needed. What you can change is function. Trunk endurance work builds what you can handle. Treating the exact pain source keeps you walking. Checkups should track walking distance, balance and new weakness, not the angle.
What makes scoliosis pain worse?
Walking and staying upright. Many adults describe a distance beyond which the back and legs give out and they need to sit. Inside the curve, facet joints on the inner side carry uneven load. Nerve roots get pinched where the exit tunnels narrow. Muscles on the outer side tire from holding the trunk up. And a pelvis that is no longer level strains the sacroiliac joints.
How do you live with scoliosis pain?
Find out which part inside the curve is causing the pain, then treat that one. A targeted diagnostic injection can confirm the facet joints, a pinched nerve root or the sacroiliac joint. Keep exercising with trunk endurance work, not attempts to straighten anything. And track how far you can walk. That distance tells you more than a pain score does.
Sources
- Diebo BG et al. Adult spinal deformity. Lancet (London, England), 2019. PubMed 31305254
- Petrosyan E et al. Biological principles of adult degenerative scoliosis. Trends in molecular medicine, 2023. PubMed 37349248
- Gupta M. Fundamental principle of adult spinal deformity. The Keio journal of medicine, 2024. PubMed 38925944
- Özyemişci Taşkıran Ö. Rehabilitation in adult spinal deformity. Turkish journal of physical medicine and rehabilitation, 2020. PubMed 33089079
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