The Aging Spine: Managing and Preventing Adult Degenerative Scoliosis

Adult Degenerative Scoliosis is a form of scoliosis that affects adults who’ve had a normally shaped spine most of their lives but develop postural changes due to degenerative processes. This post discusses ways to reduce your risks and limit progression.
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Degeneration is a natural process of aging. Dramatic changes in posture are not. Why do some people experience normal degenerative changes in their spine, while others face dramatic (and sometimes debilitating) changes?

Adult Degenerative Scoliosis (ADS) affects over 35% of Americans, mostly females, over the age of 60. Several factors are involved. Understanding your risk for developing postural changes over time may be all the motivation you need to prioritize spinal health.

What causes ADS?

ADS is a form of scoliosis that affects adults who’ve had a normally shaped spine most of their lives but develop postural changes due to degenerative processes. It is believed to result from a combination of factors, including genetics and dessication(drying out)of the vertebral disc .

In a healthy spine, the disc acts as a shock absorber, distributing weight-bearing forces evenly and contributing to stability during movement. When discs start to degenerate, they lose height, increasing loads on your facet joints, or the posterior portion of your vertebral complex. The facet joints provide further stability during movement, especially bending forward and backward. More importantly, they protect the discs from torsional forces that can occur with asymmetrical weight-bearing. Eventually, with uneven wear and tear across these structures, there will be segmental shifts in the vertebrae resulting in instability and collapse.

Factors, such as osteoporosis, fractures, diabetes, muscle weakness, imbalances in gait, and chronic inflammation can perpetuate disc degeneration, asymmetrical loading on the spine and contribute to the process of ADS.

Limiting Your Risks and Enhancing Spinal Health

Following are research-backed strategies to improve spinal health and limit your risks of acquiring ADS. Or if you have signs of it, maximize your spinal health:

Maintaining Disc Health: Intervertebral discs play a crucial role in the integrity of your spine. Discs don’t have a direct blood supply and rely on diffusion through their endplates for nutrients and waste removal. Any damage to the cartilage, bone, or the disc itself can hinder these processes. 

Things like osteoporosis, a history of spinal trauma, a job or profession that puts repetitive strain on your back, or an inflammatory condition, put you at a higher risk for disc strain through metabolic stress or mechanical stress.

The best conservative measures you can take are to exercise, stay active, maintain a healthy weight, and reduce unnecessary strain to your discs and spine through proper body mechanics. Some research supports spinal mobility exercises, but if you have advanced stages of ADS, this type of activity could be contraindicated.  Seeking appropriate care soon after you sustain an injury is a good idea and will help mitigate the risk of disc degeneration and related spinal conditions down the road. Research continues to explore ways to reverse disc pathology using supplements, regenerative medicine, and even disc replacement surgeries but these options are still in the early stages.

Postural Awareness: Good posture is a balanced alignment which varies based on the way your spine is shaped. Indications of poor posture may include difficulty maintaining a straight, upright position. Targeting specific muscle groups can be particularly beneficial for strengthening the muscles that support your spine and posture. 

While exercise has positive effects on posture, it has its limitations in correcting postural deformities. If you have ADS, I highly recommend seeking the expertise of professionals, such as physical therapists or chiropractors, who possess specialized knowledge in managing scoliosis, to maximize the benefits. Otherwise, emphasis should be placed on exercises that promote strength, flexibility, symmetry, and balance.

Photo by Mikhail Nilov on Pexels

Prioritizing Bone Health: Taking care of your bones can decrease your risk of osteoporosis and its potential contribution to disc degeneration and spinal deformities. Fractures associated with reduced bone density can result in progressive deformity. There are many reasons you could lose bone density outside of aging including genetics, medications and overall health. Weight-bearing exercises, such as resistance training, helps build bone density and prevent muscle loss at any stage, and eating a balanced diet helps too, possibly supplemented with calcium and vitamin D.

Lifestyle Choices for Overall Health: Sensible lifestyle choices, including exercise, getting enough sleep, maintaining healthy relationships, not smoking etc., can have a profound impact on overall health and potentially decrease the risk of developing ADS. Research suggests that lifestyle choices and environmental factors play a role in gene expression related to disc pathology. Lifestyle choices can reduce the severity of most conditions.

Taking care of your body, includes mental health as well. Mind, body, and spiritual health are undervalued in our medical system, yet they play a crucial role in overall well-being.

If you have pain or feel afraid to do things you used to because of your back, it may affect your mood and spirits. Surrounding yourself with the right people and resources can have far reaching effects on your mental health.

Photo by Ella Olsson on pexels

Braces or assistive devices: If you have spinal weakness or pain, you may benefit from short-term use of a customized brace to limit postural strain during the day. Assistive devices such as a walker or a cane may also help unweight your spine or reduce balance deficits associated with postural asymmetries.

Surgical consideration: Correcting ADS through surgery is a complex process and requires careful consideration. Some advanced surgical techniques now take postural balance into account, utilizing computational modeling to remodel the spine and minimize long-term complications. Do your research to understand the potential risks and benefits before undergoing such an involved surgery. For some, surgery has resulted in significant improvement in quality of life, but it’s not a guarantee. If you have pain, sometimes less invasive alternatives such as spinal injections and nerve blocks can be helpful. 

Less complex surgeries may be beneficial in the early stages of the disease or deformity to address a specific and localized concern and limit further progression. But conservative management should always be the initial approach, prioritizing non-surgical options.

Conclusion

ADS is a challenging condition influenced by multiple factors. It also has a wide range of both severity and symptoms from mild deformity  to severe.  If you or someone you love struggles with ADS, know you can effectively manage it and stay active and healthy in body and mind through the process. Engaging in regular discussions with healthcare professionals, staying updated on the latest research and treatment options, and staying strong and active can greatly contribute to your overall well-being. 

If you do not have any spinal concerns, do your best to keep it that way. 

Featured photo credit: Lucien Monfils on Wikimedia

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