When there is a C- or S-shaped curve in the spine, it is diagnosed as scoliosis. About 3% of the population will be diagnosed with scoliosis in youth. However, in adulthood the frequency is much higher, with an increase of occurrence relative to advancing age. Adolescent idiopathic scoliosis is the most familiar type, but degenerative scoliosis also can occur later in life.
They are the result of a slight pre-condition spinal curve that worsens in adulthood through degeneration of the vertebrae and discs due to aging. A variety of issues can put pressure on the spine, causing a long, slow onset. Degenerative lumbar scoliosis is typically associated with a number of painful conditions including back pain, spondylolisthesis, lumbar radiculopathy and lumbar spinal stenosis.Dr. Sandro LaRocca, director and founder, New Jersey Neck & Back Institute
Adult scoliosis is the result of disc degeneration and dysfunction of the normal stabilizing structures of the spine. This degenerative scoliosis can be superimposed on a pre-existing scoliosis, such as an adolescent idiopathic scoliosis or develop from the aging and pressure of a healthy adult spine.
When degenerative scoliosis appears in later adulthood, it’s called “De Novo scoliosis.” The degree of the C- or S-shaped curve is measured and monitored. Normally a diagnosis is made after someone experiences pain, neurological dysfunction and/or other symptoms that disrupt quality of life. Severe cases can create balance problems, neurological dysfunction posture problems and limited mobility all the way up to organ failure and major disability.
Juvenile scoliosis is detected through routine pediatric exams. When adult degenerative scoliosis is detected in adulthood, it has a different pathology. Sometimes, unlike other spinal conditions, adult scoliosis can be diagnosed through a simple office exam and various posturing observation. Radiological imaging will discern the cause of neurologic dysfunction or back pain when adult degenerative scoliosis is discovered.
The imaging used to diagnose most back problems — such as MRI, X-ray and CT scans — are used for more precise characterization of adult degenerative scoliosis and other associated diagnoses, including lumbar spinal stenosis, spondylolisthesis and instability.
Upon diagnosis, scoliosis is then monitored and observed to detect any progression and worsening, which will determine the treatment plan. The goal of the treatment is reduction of pain and discomfort and improvement in the quality of life and an increase in functional activity with minimization of complications.
Most pain and neurologic dysfunction associated with adult degenerative scoliosis will respond favorably to nonsurgical modalities such as oral nonsteroidal anti-inflammatory medication (acetaminophen, ibuprofen, aspirin), physical therapy, chiropractic treatment and possible interventional pain management. Lifestyle changes, such as incorporating activities such as yoga, may also have long-term benefit. When the more conservative approaches and lifestyle changes fail to relieve pain and dysfunction or fail to arrest progression of the curve, surgery may be beneficial to improve quality of life.
The goal of surgery includes decompression of the nerves that are being squeezed, with restoration and stabilization of spinal balance with a vertebral fusion. In select cases, these surgeries can be performed through minimally invasive techniques. There are a variety of approaches to achieve those goals, which generally involve the implantation of prosthetic devices to internally brace the spine.
The number of fusion levels and complexity of the reconstruction is directly related to how much of the spine is affected. As previously noted, lumbar stenosis and radiculopathy are frequently associated with the scoliosis and require concurrent decompression of the compromised areas of the spinal cord. Your surgeon will explain a surgical plan to you that aims to correct the scoliosis as effectively as possible and prevent worsening, while alleviating any pressure on internal vital organs or back pain from disc and nerve compression.
Yes. Dr. Sandro LaRocca is experienced in all the different related surgical techniques to treat adult degenerative scoliosis and will provide a referral for juvenile scoliosis. After many years as an orthopedic spinal surgeon, Dr. LaRocca has treated all types of moderate to advanced adult scoliosis.
Dr. LaRocca also is experienced at diagnosing scoliosis by evaluating the various imaging and diagnostics ordered for any patient. Repairing scoliosis through spinal fusion, reconstruction and decompressive procedures, and all solutions to treat scoliosis are offered by NJNBI. NJNBI also works with an allied network of pain management professionals and physical therapists that can help a patient manage pain and dysfunction before and after surgery.
To achieve excellent outcomes, half the battle is making sure the patient fits the criteria and getting the timing of surgery right; the other half is the operating room skills of your surgeon. Dr. LaRocca recommends surgery according to long-developed criteria that he has adhered to his entire surgical career. An intervention like a fusion/decompression surgery can prevent further degeneration of the spine and vastly improve quality of life.
When a patient fits that precise criteria and there is long-refined excellence in the actual surgery, many of the surgical protocols to stabilize and straighten the spine succeed in lessening pain and other symptoms. Dr. LaRocca and NJNBI have the surgical experience and patient outcomes demonstrating superb expertise in developing surgical treatment plans for patients.
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