Adult degenerative scoliosis

In one minute

Adult degenerative scoliosis is a sideways curve of the lower spine that appears after the age of 50 in someone who had a straight spine before. It comes from uneven wear of the discs and facet joints, and it is very common: in one study of volunteers over 60, 68% had a curve. Most curves cause little trouble. The ones that do produce leg pain, numbness and a walking distance that shrinks year by year, because the tilted, worn segments pinch the nerves. Standing X-rays and an MRI (magnetic resonance imaging) make the diagnosis. Treatment starts with exercise, weight, pain control and injections; surgery is for nerve symptoms that do not settle, and for many people a decompression of the pinched nerve, sometimes endoscopic, is enough without a fusion to straighten the spine.

What it is

Scoliosis means a curve to the side, measured on a standing X-ray as the Cobb angle between the most tilted vertebrae; 10 degrees or more counts. Adolescent scoliosis is a growth problem. Degenerative scoliosis, also called de novo scoliosis, is a wear problem: it starts in a spine that was straight and it affects the lumbar region, typically between T12 and L5 with its apex at L2 or L3. In a series of 200 patients over 50, 71% were women, no curve exceeded 60 degrees, and every patient had worn discs and facet joints and a loss of the normal lumbar hollow.

How common it is depends on who is examined. Among 75 healthy volunteers with an average age of 70 who had never been told they had scoliosis, 68% had a Cobb angle over 10 degrees, and the volunteers as a group had no marked physical or social impairment. Earlier reports had found up to 32%. The curve, in other words, is the norm rather than the disease; the disease is what it does to the nerves.

Causes and risk factors

The disc and the two facet joints behind it wear at different rates on the two sides. The vertebra tilts toward the more worn side, the segment above compensates, and a curve forms. The ordinary risk factors for disc degeneration, age, heavy physical work, smoking and family history, are assumed to apply, and osteoporosis and earlier spine surgery are often blamed, though the evidence for each is thin. Women made up 71% of the symptomatic 1993 series, although the volunteer study found no difference in prevalence between men and women, and one long-term study found that late-onset curves often began or worsened around the menopause. The 1993 series identified what predicts progression: a Cobb angle of 30 degrees or more, a sideways slip of one vertebra on another of 6 mm or more, marked rotation of the apex, and the position of L5 relative to the line between the hip crests.

How it develops

As the curve forms, the vertebrae rotate as well as tilt, and one may slip sideways on its neighbour (lateral listhesis). On the inner side of the curve the foramen, the opening through which each nerve root leaves, is squeezed between tilted bone and bulging disc; on the outer side the nerves are stretched. The central canal narrows from thickened ligaments and enlarged joints, which is lumbar spinal stenosis. In the 1993 series the narrowing on myelography was worst at the apex of the curve. The lumbar hollow flattens and the trunk pitches forward, so the back muscles work hard just to hold the body upright, which is the source of the aching, tiring back pain of a long day.

Progression is slow but real. In the 1993 series, 73% of curves progressed, at about 3 degrees a year over five years. A 2007 study that followed 51 adults for an average of 27 years found that late-onset curves progressed faster than adolescent curves that continued into adulthood, at about 1.6 versus 0.8 degrees a year in lumbar and thoracolumbar curves.

Symptoms

Most people come with the symptoms of the pinched nerves rather than the curve. The typical story is pain, numbness or tingling running into one buttock and leg, often on the inner side of the curve, and a walking distance that has shrunk to a few hundred metres before the legs ache and the person has to sit or lean forward, which is neurogenic claudication. Back pain that builds through the day and eases lying down is the second complaint. Some people notice that they lean to one side or forward, that clothes fit differently, or that they have lost height. All 200 patients in the 1993 series had back pain, and the 45 who were studied with myelography had severe pain with neurological deficits.

Diagnosis

The examination looks at how you stand and walk, whether you lean forward or to one side, the strength and sensation of the legs, and the reflexes. The first test is a standing X-ray of the whole spine from the front and the side, because the curve, the slips and the forward pitch of the trunk only show when the spine is loaded. The report gives the Cobb angle in degrees, describes any lateral listhesis or spondylolisthesis, and may give the sagittal balance, meaning how far the head sits in front of the pelvis.

An MRI shows what the curve has done to the nerves: central stenosis, foraminal stenosis (narrowing of the exit opening), and which root is pinched at which level. Matching the level of stenosis on the MRI to the leg symptoms is what decides treatment, more than the size of the curve. A CT scan (computed tomography) is added to plan screws. For our opinion, send the standing X-rays, the MRI images, the reports and a description of which leg hurts and how far you can walk.

Treatment without surgery

The curve itself cannot be reversed without surgery, and no brace or exercise programme straightens an adult spine. Treatment aims at the symptoms, and for most people it is enough. Walking and cycling within tolerance, a physiotherapy programme for trunk strength and hip flexibility, weight loss where relevant and stopping smoking are the base. Pain is treated with simple analgesics and short courses of anti-inflammatory drugs (NSAIDs; the doctor chooses the drug and the dose), with nerve pain medication for radicular symptoms. An epidural or nerve root injection under X-ray guidance can settle a flare of leg pain for weeks to months and confirms which root is responsible. A brace may ease back pain for short periods. What is not supported: prolonged rest, manipulation of the curve, and any promise of correction without an operation.

When surgery is considered

Surgery is considered when leg pain, numbness or claudication remains disabling after several months of proper conservative care and the MRI shows the stenosis that explains it; when there is a progressive neurological deficit; and, less often, when a curve is progressing with pain and imbalance that make standing and walking impossible. The question is then not whether to operate but how much to do.

The evidence points to matching the operation to the problem. A 2023 meta-analysis of 15 studies and 586 patients treated with decompression alone, in curves averaging about 18 degrees, found that the curve increased by 1.8 degrees on average, that 9.7% needed a further operation (range 3 to 33%), that disability scores improved from 56 to 27 out of 100, and that 71% of patients were satisfied. A 2026 systematic review concluded that decompression alone is reasonable when the curve is generally below 20 degrees, the stenosis is localised, the sagittal balance is preserved and there is no significant slip or rotation, and that fusion becomes more favourable with larger curves, instability, lateral listhesis, disc wedging or a forward-pitched trunk. The Cobb angle is an aid to the decision, not the decision. None of the studies above compared early with delayed surgery, so there is no evidence that operating sooner gives a better result, and there is time to decide.

Surgical options

Decompression alone frees the pinched nerve root or the narrowed canal at the symptomatic level and leaves the curve as it is. It can be done through the endoscope, through a 7 mm incision, when the segment is stable; see the endoscopic lumbar decompression page. In a 2025 comparison of 53 patients, endoscopic decompression alone in curves averaging 24 degrees matched a limited fusion in curves averaging 40 degrees for pain relief and satisfaction, with a curve progression of 1.5 degrees and fewer complications and reoperations over an average of about 16 months.

Short-segment fusion decompresses and fixes one or two unstable levels with a cage and screws, which can be done fully endoscopically; see the endoscopic lumbar fusion page. A propensity-matched comparison of 31 pairs found that minimally invasive decompression alone had a shorter operation (91 versus 204 minutes), less blood loss (22 versus 116 mL) and a shorter stay (2.6 versus 5.1 days), while the short fusion gave larger improvements in back pain and disability at one year; complication and reoperation rates were similar, as was the proportion reaching a meaningful improvement.

Long fusion with deformity correction realigns the spine over many levels with screws, rods and sometimes bone cuts, and is described on the spinal fusion page. It is the right operation for a large, progressing, unbalanced curve with mechanical back pain, and it carries more risk and a longer recovery than the smaller operations.

How we treat it at spine.uz

We are Tashkent's first endoscopic spine team, five surgeons operating as one, and we treat the full range of surgical spine pathology, including endoscopic decompression, endoscopic fusion and open deformity surgery. The decision follows the evidence above: treat the symptom that brought you, and decompress or fuse only as much as that requires.

Send your standing X-rays and MRI through Telegram or WhatsApp and a doctor from the team replies by voice within 48 hours. When the problem is a pinched nerve in a mechanically quiet curve, we decompress it endoscopically through a 7 mm incision, usually under local anaesthesia with sedation, without screws or implants, and most patients walk the same day and go home within 24 hours. When a segment is unstable, the team performs fusion fully endoscopically with an interbody cage and percutaneous screws. When the curve itself is the problem, we say so and plan open deformity surgery. After the consultation you receive a written conclusion from the team. Across the team's 27,600+ endoscopic and spine operations, our complication rate is well below 1%.

Recovery and outcomes

After decompression alone, leg pain and walking distance usually improve quickly, and in the meta-analysis disability fell by about half. The curve remains and may progress slowly, by about 2 degrees on average in the pooled data, and about 1 in 10 patients needs a further operation over the years of follow-up. After a short fusion, recovery takes longer but back pain improves more. After a long deformity correction, recovery is measured in months, and the outcome depends on restoring balance as much as on straightening the curve.

Realistic expectations matter here: the operation relieves nerve pain and lengthens walking distance; it does not give back a young spine.

Living with it and prevention

Keep walking, keep the trunk and hip muscles strong, keep your weight down and do not smoke. Treat osteoporosis if you have it. Have a standing X-ray repeated if your posture changes or new leg symptoms appear, and treat new nerve symptoms early rather than waiting for the curve to grow.