What is degenerative scoliosis in adults?
Basically, scoliosis is a deformity of the spine that produces an imbalance, a rotation, of the vertebral bodies, of the vertebrae of the spine. The best known is adolescent scoliosis, which we have all known at one time or another from a child, a family member, a friend’s child who has a deviation of the back. Unlike the adolescent, in the adult, there are a series of characteristics that greatly aggravate this pathology, which are basically the appearance of neurological symptoms, compressions, stenosis of the canal, compressions of the nerves or of the spinal cord. And also the presence of important degeneration of the intervertebral discs, what people usually call arthrosis of the vertebral discs. This makes the treatments we have to apply to these patients more complex and, above all, there is an added factor that basically affects female patients more, which is the presence of osteoporosis, which also forces us to apply more complex treatments to ensure the stability of the assemblies we make in these patients.
What are the symptoms?
The most important symptoms that our patients present are of 2 types. One, neurological symptoms, that is, the patient begins to notice the appearance of sciatica, pain radiating to the lower extremities, the inability to walk as much as he would like, what we call claudication, that is, the patient wants to walk but the legs do not follow him, and the presence of pain in the spine, this would be the initial group of symptoms. But then there is also a group of very important symptoms related to stability, to the balance of our patients, patients realize that in a very short period of time they are starting to present imbalances, they go to one side, they try to stay upright but they fall either forward or to one side and these two symptoms, the neurological and the balance symptoms are the most important in patients with adult degenerative scoliosis.
How can it be treated?
Treatment is directed primarily at the two groups of symptoms we have discussed: symptoms related to loss of balance and symptoms related to neurological problems. For the loss of balance, unlike in the child, we cannot use rigid corsets, we cannot use orthoses because they atrophy the musculature too much and are not useful. What we must do is to lose weight if we have a problem of obesity, improve the capacity of the muscles that support the spine, the abdominal muscles, the paravertebral muscles, what we must do is a physical activity adapted to our age and our situation. And for the neurological symptoms what we should do is in addition to using some type of rehabilitative treatments, electrotherapy, etc… we may end up needing medication by way of infiltrations sometimes in the epidural area, in the spinal column, in the spinal cord, to relieve pain and neurological symptoms or what is called rhizolysis, facet blocks to relieve pain in the spinal column.
When should one opt for surgery?
Surgery is always the last resort and we should only use surgical treatments when all other possible treatments have failed. Basically, the surgery is aimed at solving the 2 basic problems presented by the patient. On the one hand the neurological problem, what we want is to decompress the nerves that are compressed so that the pain in the lower extremities subsides and so that the patient can recover the ability to walk without limit. And speaking of the second group of symptoms, what we want is to restore the balance that our patients have lost, either because they have fallen forward or because they have become unbalanced to one side, and we achieve this through the use of titanium anchors, often reinforced with cement inside the body of the vertebrae in order to recover the statics, to recover a good balance both in the frontal plane and in the sagittal plane.