Adult Degenerative Scoliosis

Adult degenerative scoliosis is a side-to-side curvature of the spine that develops in adulthood due to the progressive wear and tear of aging discs and joints. Unlike childhood scoliosis, it is often accompanied by spinal stenosis and significant nerve compression, making it a complex condition that requires comprehensive evaluation and tailored treatment.

What Is Adult Degenerative Scoliosis?

Adult degenerative scoliosis (ADS), or de novo scoliosis, typically begins after age 50. As the intervertebral discs and facet joints degenerate asymmetrically, the spine begins to curve and rotate. This can lead to severe back pain, nerve root compression (radiculopathy) and a forward-leaning posture (sagittal imbalance).

At a Glance

Develops in adulthood (usually >50 years) due to asymmetric spinal degeneration
Causes a side-to-side curve, often primarily in the lumbar (lower) spine
Frequently accompanied by spinal stenosis and neurogenic claudication
Initial treatment is conservative (physical therapy, injections, medications)
Surgical intervention ranges from focused decompression to complex spinal realignment and fusion

Symptoms

Diagnosis

Types

De novo degenerative scoliosis — develops in adulthood from asymmetric disc/facet degeneration; curves usually lumbar, Cobb 20-40°, strongly associated with stenosis and leg symptoms
Progressive idiopathic scoliosis — childhood curve progressing into adulthood; larger (>40-50°), longer, thoracic involvement
SRS-Schwab Classification — groups by curve type and three sagittal modifiers (PI-LL, SVA, PT), each scored 0/+/++

Treatment

Conservative Management (first-line)

Physical therapy to strengthen core muscles and improve posture
NSAIDs and nerve-pain medications (e.g., gabapentin)
Epidural steroid injections or facet joint injections for targeted pain relief

Surgical Intervention

Decompression without fusion — for patients with leg pain from stenosis but a stable, mild curve.
Short-segment fusion — decompression and stabilization of a few severely degenerated segments causing the most symptoms.
Complex spinal reconstruction and fusion — for severe, progressive curves with significant imbalance; involves releasing rigid segments (osteotomies) and using rods and screws to realign the spine.

Outcomes

Treatment Approach	Leg Pain Relief	Deformity Correction	Notes
Conservative care	Variable	None	Best for mild symptoms; does not stop curve progression
Decompression only	~70-80%	None	Risk of curve progression post-surgery
Short-segment fusion	~80%	Localized	Good balance of symptom relief and recovery time
Complex reconstruction	~80-90%	Significant	Longest recovery; restores overall sagittal and coronal balance

References

Our Specialists

Timothy Witham, MD

Neurosurgery

Mohamad Bydon, MD

Neurosurgery

Martin Herman, MD, PhD

Neurosurgery

Request an Appointment

We are currently experiencing a high volume of inquiries, leading to delayed response times. For faster assistance, please call 1-773-702-2123 to schedule your appointment.

If you have symptoms of an urgent nature, please call your doctor or go to the emergency room immediately.

By submitting this form you acknowledge the risk of sending this information by email and agree not to hold the University of Chicago or University of Chicago Medical Center liable for any damages you may incur as a result of the transfer or use of this information. The use or transmittal of this form does not create a physician-contact relationship. More information regarding the confidentiality of this request can be found in our Privacy Policy.

* Indicates required field