Deformity of the adult spine includes patients with curvature of the spine (scoliosis) of varying degrees caused or impacted by degenerative disc and joint disease. Adult scoliosis may be the result of persistent or progressive deformity since adolescence or a new, de novo, onset of deformity resulting from degeneration or aging of the spine. Degenerative scoliosis accounts for the majority of scoliosis cases in older populations aged 65 years and older, as reflected in the low proportion of older patients with a diagnosis of primary idiopathic scoliosis.

Degenerative scoliosis is one of the most challenging spine conditions to treat because of the variability of the condition. Generally, it is thought to originate with the degeneration of the intervertebral discs, which leads to misalignment of the vertebral column. Degenerative scoliosis, particularly in the very elderly, is often associated with other conditions, such as osteoporosis. Treatment outcomes for both nonsurgical and surgical procedures are not well documented; hence, recognition and earlier intervention are important to ward off the more complex problems of adult scoliosis. The role played by undiagnosed, mild idiopathic adolescent scoliosis on the development of degenerative scoliosis in later life is unknown.

While scoliosis is the primary form of spinal curvature, two other spine curvature disorders are included in the data cited here. These are lordosis, also known as swayback, where the spine curves significantly inward at the lower back, and kyphosis, characterized by an abnormally rounded upper back with a curvature of more than 50º.

The clinical presentation and management of adults with scoliosis is characterized by a great deal of variability. There is a poor correlation between the magnitude of deformity and the impact of scoliosis on health status, as patients with large spinal curvatures may have limited pain and disability with and patients with relatively mild deformity may be severely impaired. Deformity in the sagittal plane (lateral) is most closely associated with disability.1 Patients with adult scoliosis seek medical care for symptoms including back pain, neural symptoms, and progression of deformity.

• 1. Glassman SD, Berven S, Bridwell K, Horton W, Dinar JR: Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine 2005;30:682-688.