There are two ways that an adult can develop scoliosis. One is simply a progression of curvature from having adolescent idiopathic scoliosis. Studies show that if a person’s curvature is over 40° at the end of adolescents, the curve typically gets worse by 1° every year during adulthood.
The other way that adult scoliosis develops is degeneration of the intervertebral disc with subsequent arthritis of the spinal joints. This degeneration does not occur in a completely symmetric fashion, therefore, the individual may end up with a curve as a result of this asymmetric arthritis and scoliosis with resulting pain.
The pain that results from having scoliosis as an adult can be located in the back and buttock as well as having pain into one or both legs due to pinched nerves. This pinching of nerves is due to spinal stenosis, where the overgrown tissue from arthritis pinches on nerve roots as they try to get out from the spinal canal.
Undergoing surgery for adult scoliosis is a last resort decision and considerable nonoperative treatment should be undertaken first. Initial treatment for adult scoliosis should consist of over-the-counter medications such as Tylenol and anti-inflammatories. These should always be taken according to manufacturer’s recommended dosing. Spinal bracing does not help for adult scoliosis as the curve is not flexible as it is during adolescence.
For periods of painful exacerbations, short-term narcotics may be very helpful. They also involve significant muscle spasms, so a muscle relaxer may also be added in with effectiveness with spasm relief. If an individual is having leg pain due to the spinal stenosis, a neurogenic medication such as Neurontin or Lyrica may be very helpful to reduce this pain.
Physical therapy can help considerably as strengthening up the muscles around the scoliotic spine can help reduce pressure on the arthritic areas. Modalities such as electrical stimulation, ultrasound and ice and heat can help on a regular basis. Acupuncture and massage can also relieve pain nicely and they have a very low risk profile. Chiropractic manipulation may have some benefit, but there is no considerable research to back up its utility with adult scoliosis.
When it comes to interventional pain management procedures, there are multiple that can provide months of pain relief at a time. The first are epidural steroid injections. These injections can help soothe inflamed nerve roots that are being pinched and causing the leg pain with spinal stenosis.
Medial Branch Block
It may take a series of three injections to obtain a few months of pain relief, and then those injections may be repeated on a regular basis. For the back pain that occurs as a result of adult scoliosis, medial branch blocks over the arthritic facet joints can tell which joints are symptomatic and provide months of pain relief at the same time. The pain doctor may also place injections into the arthritic facet joint, whereas, the medial branch block simply places the medicine around the joint.
If these injections work for a while and then wear off, the next step is typically a radiofrequency ablation, which is also called a radiofrequency neurotomy. This has been a revolutionary procedure in the world of pain management, as ablating the medial branches around the facet joints can provide 12 to 18 months of considerable pain relief. If the injection then wears off, a repeat procedure has been shown to typically provide the same amount of relief as the first one.
Considering how many joints are often involved with an adult scoliosis deformity, nonoperative treatment is definitely preferred to operative intervention. While surgery for adult scoliosis may provide a lot of pain relief, there is a high risk of complications and a very lengthy rehabilitation involved. Therefore, the prudent course of action is to exhaust all attempts at conservative pain management prior to taking that last resort staff.
The Award Winning, Board Certified Arizona pain doctors and chiropractors at Arizona Pain Specialists provide comprehensive Phoenix pain management at 4 locations throughout the Valley. Both traditional and alternative methods of pain treatments are provided such as Phoenix chiropractor, acupuncture, medication management, spinal decompression therapy and interventional pain management.
Over 50 insurances are accepted including major medical, Medicare, Medicaid, Workers Compensation and Personal Injury. Self pay patients are accepted as well.
Call (602) 507-6550 for more information and scheduling.