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Pain Management

The Many Factors That Can Cause Scoliosis in Adults

Serena S. Hu, M.D., is a professor and the chief of spine surgery service in the Department of Orthopaedic Surgery and (by courtesy) Neurosurgery at Stanford University, School of Medicine. She shared her insights on scoliosis in adults, and how all people can improve their spine health.


Serena S. Hu, M.D.

Professor and Chief of Spine Surgery Service, Department of Orthopaedic Surgery at Stanford University School of Medicine

What types of scoliosis are there in adults and what are the common symptoms?

Adults may have scoliosis that developed when they were young, like teen or preteen years, called idiopathic, or develop scoliosis from degeneration of the spine, which we call degenerative. Although people like to know which type they have, it can sometimes be difficult to make a definitive diagnosis. Fortunately, the principles for treatment are the same for both.   

Common symptoms are pain in the back; asymmetry of the back, waist, or shoulders; and pain, tingling, or numbness in the legs. The symptoms may increase later in the day with fatigue, or with long periods of being upright or walking. 

What are some common nonoperative treatments and therapies for adult scoliosis?

Physical therapy is usually the first treatment. Improving core strength and cardiovascular fitness also helps. Walking, cycling, pool therapy, and swimming can all be used for the latter, as can other aerobic exercise. Anti-inflammatories (e.g., ibuprofen, naproxen) can help reduce symptoms. 

If the patient has nerve compression and pain or tingling down the legs from this, epidural injections may be helpful. Some patients benefit from the use of gabapentin or pregabalin to make the nerves less irritable. 

Assessing the person’s bone health is important, regardless of age. Poor bone density is a risk factor for progression and should be part of general health maintenance of all adults. Post-menopausal women (especially those with a family history), people who have taken medication that may decrease bone density (e.g., steroids, anti-seizure meds), and people with lactose intolerance or nutritional problems (e.g., anorexia, malabsorption, gastric bypass surgery), should ask their primary care physician or orthopedic surgeon about bone density testing. 

What additional options should patients discuss with their doctor?

Many patients ask about bracing. Bracing only works when the spine is still growing. If used by an adult, their own muscles will lose strength, so the opposite of what physical therapy is intended to do. 

Acupuncture and other complementary medicine options can be considered, but there is no data on how effective they may or may not be. 

What advice do you have for patients who are still looking for the best way to manage their chronic pain?

The most fit people I see are the ones who seem to do best at keeping their symptoms under control.  

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