The Health Problem of Our Time: Adult Scoliosis

A Modern Health Challenge: Adult Scoliosis Excess weight, sedentary lifestyle, poor posture and sitting habits, and even wearing excessively high heels or flat shoes can all be causes. Today, adult scoliosis is becoming increasingly common due to both unhealthy lifestyles and advancing age. Acıbadem Maslak Hospital Spine Health Center Orthopedics and Traumatology Specialist Prof. Dr. Ahmet Alanay stated that adult scoliosis affects quality of life as much as other chronic diseases; "Research shows that adult degenerative scoliosis is a new public health issue of our time, with increasing frequency as the population ages," he said. Prof. Dr. Ahmet Alanay, in a statement made during June – Scoliosis Awareness Month, answered the 6 most frequently asked questions about adult scoliosis, listed 4 mistakes to avoid, and provided important warnings and recommendations.

How does it develop?

Adult spinal disorders can be a continuation of conditions that emerged in childhood and adolescence, or they can also begin during adulthood. Scoliosis that begins during adolescence but is not noticed at that time, or is noticed but not treated, and whose symptoms progress, is called 'adult idiopathic scoliosis'. In this type of scoliosis, symptoms such as pain and postural deformity appear over time. Adult degenerative scoliosis, on the other hand, is caused by wear and tear of the spinal structure and osteoporosis (bone loss) that accompany aging. While studies show that the prevalence of this type of scoliosis in those over 60 years of age exceeds 60 percent, Prof. Dr. Ahmet Alanay says that adult degenerative scoliosis is a new public health issue of our time.  

What problems does it cause?

In individuals with advanced adult scoliosis, the spine and torso lean sideways or forward, and there can be restricted movement capacity, back and lower back pain, muscle weakness, numbness in the legs, cramps, and shortened walking distance. If the commonly known term 'slipped disc' – the displacement of one vertebra over another forward, backward, or sideways – is added to the picture, complaints can increase. In adult idiopathic scoliosis, there can be severe pain due to spinal joint deformities, while chest cage compression can cause rapid fatigue and respiratory difficulties. All these complaints significantly reduce patients' quality of life.

How is treatment method determined?

The patient's complaints and the degree of scoliosis curvature determine the direction of treatment. The doctor, evaluating the patient's complaints, may request radiography, magnetic resonance imaging (MRI), computed tomography (CT), or electro-diagnostic tests. The treatment method to be selected in adult scoliosis treatment is planned according to pain and the degree of scoliosis curvature, and whether the curvature is progressive. Generally, non-surgical treatment methods are applied to the patient first.  

How effective are non-surgical treatments?

Prof. Dr. Ahmet Alanay states: "For patients with adult scoliosis, methods such as physical therapy and exercises under the supervision of a physiotherapist, medications and injections, and bracing can be applied individually or together. Depending on the type of scoliosis and the person's physical condition, doctors will select the most appropriate method for each patient. However, prolonged bracing treatment can cause more harm than benefit, just as physical therapy and exercises may be insufficient in preventing progressive scoliosis." he explains.  

How effective is surgical treatment?

Prof. Dr. Ahmet Alanay, noting that in adult scoliosis surgery, the operation time and number of surgical procedures can be greater than in younger patients, states: "Especially if the patient has conditions such as heart and lung disease, diabetes, and osteoporosis, surgical treatment can be even more challenging. However, with proper patient preparation and necessary precautions, surgical treatment results can be extremely satisfactory."

What is the current surgical approach?

The goal in scoliosis surgery is to correct the curvature enough to provide balance and fuse the vertebrae (fusion) and eliminate nerve compression. Prof. Dr. Ahmet Alanay states: "In adult scoliosis and spinal deformities, minimally invasive surgeries are generally the first choice. We aim to achieve maximum benefit with minimal intervention. However, in some cases, more aggressive surgeries such as fusion may be necessary. In fusion surgeries using screws and rods, planning and especially achieving the patient-specific shape of the spine's normal lumbar and thoracic curves is very important. Otherwise, new surgeries may be required." he explained. Prof. Dr. Ahmet Alanay, noting that they achieve the ideal spinal profile for these types of surgeries through patient-specific analysis and simulations performed on computers, states: "This minimizes mechanical complications after surgery. In deciding how aggressive the surgery will be, the patient's deformity analysis and general health status play a role. Today, using artificial intelligence-generated risk calculators, we try to select the most appropriate surgical method for the patient," he said. Post-operative recovery and rehabilitation process patients are discharged 7-10 days after surgery. The goal is to help the patient return to normal life as soon as possible through exercises and regular follow-ups.

Avoid these 4 mistakes!

Prof. Dr. Ahmet Alanay, noting that spinal deformities are found in 60 out of every 100 people over 60 years of age and that this number is expected to increase significantly in the coming years, said: "To prevent the increase in adult scoliosis and spinal deformities, some erroneous behaviors that have become habitual in our daily lives must be changed."

Prof. Dr. Ahmet Alanay explained the 4 mistakes that can lead to adult scoliosis and spinal deformities as follows:

• Excess weight increases the load on the spine and causes movement restrictions. Maintain your fitness through healthy eating and give your spine relief. Additionally, a balanced diet rich in calcium strengthens your bones. • Strong muscles are essential for a healthy spine structure. A sedentary lifestyle away from exercise weakens muscles and leads to spinal problems. Therefore, add movement to your life. Spend at least half an hour every day on exercise. • Maintain good posture. The first rule of a healthy spine is good posture. With good posture, the spine uses minimal energy and does not wear down. Therefore, the risk of spinal problems in later years decreases. • Excessively high heels or flat shoes negatively affect knee, hip, and spinal health. Therefore, your shoe heel height should be 3-4 centimeters.