Adult Degenerative Scoliosis

Adult degenerative scoliosis is a side-to-side curve — usually in the lower back — that develops later in life as discs and facet joints wear asymmetrically. One side of a disc collapses more than the other, the spine tilts and rotates to compensate, and over years a curve appears where there never was one.

This is a different condition from the scoliosis of teenagers, and the goals of treatment are different too. In adults, the curve itself is rarely the enemy. The problems that matter are the ones the curve creates: nerves pinched in the concavity of the curve, stenosis at the degenerated levels, and the exhausting forward- or sideways-leaning imbalance that makes standing upright a workout.

The evaluation is built on standing full-length X-rays — how your whole spine balances over your pelvis when gravity is involved — plus an MRI for the nerves and a careful history: what stops you, how far you can walk, what a day actually looks like.

Most adults with degenerative scoliosis are managed without surgery, often for years: therapy focused on core strength and posture, judicious injections for flares of nerve pain, bone-density treatment, and activity that keeps you moving. A curve on an X-ray, by itself, is not an indication for anything.

What we watch for is trajectory — a curve that is measurably progressing on serial imaging, walking distance that is steadily shrinking, or imbalance that is taking over. Those trends, not any single number, are what move the conversation.

Surgery becomes the right discussion when the disability is real and conservative care is exhausted: leg pain or weakness from nerves compressed in the curve, an inability to stand upright without bracing yourself, or documented progression. The operation is matched to the problem — sometimes a focused decompression at the worst level, sometimes a longer correction that restores balance.

This is among the largest surgery decisions in the spine, and it deserves an unhurried, honest conversation about trade-offs, recovery, and what the operation can and cannot give back. It is also a decision where preparation — bone density, nutrition, medical fitness — measurably changes outcomes, so we start that work before any date is set.