How Does Adolescent Idiopathic Scoliosis Progress Into Adult Scoliosis?

There are multiple different kinds of scoliosis, which is a term that refers to abnormal twisting and curvature of the spine. With regards to the different kinds of scoliosis, there are those that occur in childhood and those that occur in adults.

Scoliosis that occurs prior to adulthood can be subclassified into juvenile, adolescent, congenital, and neuromuscular. The most common type is referred to as adolescent idiopathic scoliosis. The term "idiopathic" means there is no known cause. The good thing about scoliosis in adolescents is that the spine has the following characteristics:

1. Until skeletal maturity is reached, the spine can potentially respond to bracing as it may be flexible.


2. Only a minority of kids with adolescent scoliosis experience pain. It's noted to be less than 25%.


3. If an adolescent does need surgery for scoliosis, the physiologic reserve is tremendous and the complication profile is reasonable.

Bracing for adolescent scoliosis can help prevent the progression of curvature, but not reversal. If skeletal maturity is reached and the curvature is under 40 degrees, the scolisosis may not progress according to various studies. However, if it's over 40 degrees studies show the natural progression after skeletal maturity to be approximately one degree per year. Might not seem like much, but after 30 years, the curve may be at 70 degrees!

Once skeletal maturity is reached and the curvature is over 30 to 40 degrees, surgery is not always indicated. The curve should be monitored every year or two along with the patient's symptoms.

As the patient settles into adulthood, additional factors come into play. Meaning adults who had adolescent sciolosis have spines that are typically loaded off-center and subjected more often to arthritis of the spinal joints and degenerative disc disease. The spinal discs can be loaded off-center and experience asymmetric degeneration leading to a worsened scoliosis.

As the scoliosis worsens, the biomechanics of the spine actually compound the situation, creating arthritis in the spinal facet joints and making the scoliosis painful. This is a major difference between adolescent and adult scoliosis - Pain! While adult scoliosis can be exceptionally painful, adolescent scoliosis is typically more of a cosmetic issue.

The increased facet joint arthritis and degenerative disc disease brought on by the asymmetric scoliosis leads to two problems:

1. Worsening scoliosis


2. More pain

So adolescent scoliosis can lead to adult degenerative scoliosis. Adult degenerative scoliosis can occur all on its own, but a significant amount of the time it is a continuation of what occurred in the person's early years. Unfortunately the gift that keeps on giving.