Our spines curve naturally in an “S” shape from front to back. This curving gives our spines a springiness that helps absorb shocks as we walk and run.
However, our spines are not supposed to curve from side to side. If you look at a person’s spine from the back it should look straight. People who have an abnormal side to side curve in their spines have a condition called scoliosis. There are a few different kinds of scoliosis. The most common type is called idiopathic scoliosis. Idiopathic means “no known cause”; we don’t know why some people’s spines curve this way. It happens overwhelmingly to girls over boys, and usually it starts at about age 12. In most kids the curvature stops before it gets too large, but in some children the curvature gets bigger and bigger and must be treated. This treatment consists of braces, and if they fail, then surgery is necessary. By the time a child’s growth is over, the curvature will almost always stop getting bigger. Adults who acquired this condition as children will have the abnormal curvature their whole lives, but it fortunately causes pain only rarely. Things are different during the golden years, however. Eventually the abnormal stresses of the curvature cause arthritis in the lower back, and this can lead to low back pain. Occasionally it can cause nerve pinching as well and lead to pains traveling down one or both legs.
Another common scoliosis is the degenerative type. In this condition, people live most of their lives with straight spines. However, as they get older their spines slowly collapse in an uneven fashion, and this leads to curvature; it’s like a house tilting on sandy soil. This can also lead to low back pain and, in the truly unlucky, nerve pinching.
If scoliosis causes pain in the elderly years, usually the treatments are conservative. They consist of light bracing, physical therapy for back strengthening, medication, and adjustment of lifestyle. In a small number of people, usually those with nerve pinching and sciatica, the pain is too excruciating for conservative treatment, and then surgery is required. It usually consists of freeing up any pinched nerves and then stabilizing the spine with a procedure called a fusion.
The results of any treatment for scoliosis in the elderly, whether conservative or surgical, are rarely superb. Usually the best we can do is help alleviate some of the pain. What these patients really need is a new spine