Scoliosis Degenerative

Degenerative scoliosis is a side‑to‑side curve of the spine that develops in adults as the discs and joints wear out unevenly, usually in the lower back. It often causes back and leg pain more than visible deformity, and tends to slowly worsen over time.​

1) What is this condition?

  • The spine, which was previously straight, gradually curves sideways (10 degrees or more) because age‑related wear affects one side more than the other.​

  • Worn discs and joints can also narrow the nerve tunnels, causing sciatica‑type leg pain, numbness, or heaviness when walking.​

2) How serious is it?

  • Many people have mild curves that mainly cause back pain and stiffness and can be managed without surgery.​

  • More advanced curves can progress 3–4 degrees per year, leading to increasing pain, nerve symptoms, stooped or leaning posture, and, rarely, breathing restriction.​

3) Non‑surgical treatments

  • Pain‑focused care:

    • Anti‑inflammatory medicines, other pain relievers, and activity modification.​

  • Physical therapy and exercise:

    • Core strengthening, stretching, posture training, balance work, and sometimes scoliosis‑specific programs (e.g., Schroth‑based therapy).​

  • Injections:

    • Epidural steroid injections and/or facet joint injections for leg pain and back pain from nerve or joint irritation.​

  • Bracing:

    • Short‑ or medium‑term bracing can reduce pain and has been shown to slow curve progression in some adults.​

4) What type of surgery may be necessary?

  • Decompression alone: removing bone and tissue pressing on nerves in carefully selected patients with smaller curves and good alignment.​

  • Decompression with fusion and deformity correction:

    • Multi‑level fusion with screws and rods to straighten the curve and stabilize the spine while also freeing pinched nerves.​

5) Goals of surgery vs non‑surgical care

  • Non‑surgical goals:

    • Decrease pain, improve walking tolerance and function, and slow curve progression while avoiding major surgery, especially in older or higher‑risk patients.​

  • Surgery goals:

    • Relieve nerve compression, straighten and rebalance the spine, and stabilize painful, unstable segments to improve quality of life.​

6) How surgery can “fix” the problem

  • Decompression removes overgrown bone and ligament that are squeezing spinal nerves, which can ease leg pain and heaviness.​

  • Fusion with rods and screws realigns the curve and holds the vertebrae until they grow together into a solid block, preventing further collapse and deformity.​

7) Risks of surgery (general and specific)

  • General risks: bleeding, infection, blood clots, lung or heart complications, and anesthesia risks—higher in older adults with other health issues.​

  • Spine‑specific:

    • Nerve injury or spinal fluid leak, which can cause new weakness, numbness, or headaches.​

    • Hardware failure, non‑fusion, or loss of correction, potentially needing revision surgery.​

8) Chances this surgery will work

  • Studies show many adults have significant improvement in pain, walking, and overall quality of life after well‑planned degenerative scoliosis surgery.​

  • However, complication rates for adult deformity surgery are substantial, commonly reported between about 13–40%, and re‑operation rates up to 25–40% in some series.​

9) Possible complications from the surgery

  • Early: wound infection, excessive blood loss, spinal fluid leak, temporary nerve irritation, and medical complications (pneumonia, clots).​

  • Late: implant breakage or loosening, non‑fusion, adjacent‑segment degeneration above or below the fusion, persistent pain, and need for further surgery.​

10) Typical recovery from the condition (without surgery)

  • Many people manage for years with cycles of flares and quiet periods using therapy, medications, injections, and activity adjustments.​

  • Over time, some experience increasing pain, reduced walking distance, and visible leaning or stooping if the curve and degeneration progress.​

11) Typical recovery after surgery

  • Hospital phase: several days of pain control, early walking with help, and instructions to limit bending, lifting, and twisting.​

  • First months: structured physical therapy, gradual return to daily activities, and continued healing of the fusion (often 6–12 months).​

  • Long term: many patients report better pain control and posture but live with a stiffer spine and some permanent activity limitations.​

12) How long in the hospital

  • Typical hospital stays for multi‑level adult deformity fusion are about 3–7 days if there are no major complications.​

  • Older or more fragile patients, or those with extensive surgery, may require longer stays and sometimes inpatient rehabilitation.​

13) Long‑term outlook

  • Many with mild to moderate degenerative scoliosis do reasonably well long term with non‑surgical care and ongoing exercise.​

  • For appropriately selected surgical patients, benefits (pain relief, better standing balance, improved walking) often outweigh risks, but complications and need for further surgery are not rare.​

14) Need for outpatient follow‑up

  • Non‑surgical: regular visits to monitor curve size, symptoms, and response to therapy, plus periodic imaging if symptoms change.​

  • Post‑surgery: scheduled follow‑ups with X‑rays to track fusion and hardware, manage complications, and adjust rehab and activity levels.​

  • Long‑term: ongoing spine, bone‑health, and rehab follow‑up to address adjacent‑level issues, balance changes, and pain flares over time.