Adult Progression of Scoliosis

Q.I have had scoliosis for a long time now. My spine has had a 13-degree curve in it for two years. I went to see my orthopedic doctor last week. It has now progressed to a 20-degree curve. I am 32 years old. Why is it progressing? I thought it only got worse in growing children and that when you became an adult it wouldn’t worsen. Could it get even worse than it is now, or could it stay at 20 degrees?


A.Scoliosis involves a curvature of the spine that can be seen from either the front or back. Doctors measure the degree of curvature on X-rays using a method called the Cobb technique. This involves drawing transverse (crosswise) lines through certain of the vertebrae on the X-ray. Then a line is drawn perpendicular to these lines, and the doctor measures the angle formed by the intersection of these lines. That angle is what we call the degree of curvature. This technique is fairly complex, and there definitely can be some variation in the results. If you took a set of spinal X-rays to multiple orthopedists, they would give you somewhat different measurements of the curvature.

A.You say you had a 13-degree curvature that was stable for two years. In general, an adult with 13 degrees of curvature has very mild scoliosis, and the chance of this progressing is extremely small. In fact, if a child finishes growth and has only 13 degrees of curvature, I don’t feel any significant need to follow that patient with continuing X-rays. Posture can certainly play a role in accentuating the curvature of the spine. In fact, some patients with acute back injuries will exhibit some degree of curvature.

In general, you are correct that curves typically worsen in children but not in adults. Several good studies have shown that if the curve is less than 30 degrees at maturity, the chance is minimal that the curve will progress. On the other hand, if the curve is over 50 degrees, then these curves need to be followed closely during adulthood for progression. As patients who have scoliosis become older, they can develop a degenerative type of scoliosis, but at age 32, I think that is unlikely.

A.My recommendation is that your X-ray be repeated before you become overly concerned that you have had progression. If your curvature has indeed progressed, and the doctor can compare it to the prior films, it may be best to get a magnetic resonance imaging (MRI) scan to rule out another cause of an increase in your curvature. If no cause can be found, I think any developments should be watched over time with sequential X-rays.

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March 27th, 2012 - Posted in Bone Diseases | | Comments Off

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