Adult scoliosis and spinal deformity.
Scoliosis in adults is either a curve carried since adolescence or one that develops later as the discs and joints wear unevenly. Many curves need nothing more than monitoring; when they progress or cause pain, leaning, or nerve symptoms, correction is a specialty of this practice.
What adult deformity looks like
Scoliosis is a side-to-side curve; kyphosis is an excessive forward bend; and many adults have a loss of the spine’s normal front-to-back balance that leaves them feeling pitched forward by the end of the day. Symptoms include back pain and fatigue that worsen with standing, a visible lean or shoulder or hip asymmetry, and — when the curve crowds the nerves — leg pain, numbness, or weakness similar to stenosis.
Why it develops
Adolescent idiopathic scoliosis can persist into adulthood and slowly progress. Degenerative (de novo) scoliosis begins in adulthood, usually after 50, when discs and facet joints wear asymmetrically and the spine settles into a curve. Prior spine surgery, osteoporosis, and certain neuromuscular conditions can also contribute.
Assessment
The key test is a set of full-length standing X-rays, which measure each curve in degrees and the overall alignment of the spine over the pelvis. MRI or CT evaluates the nerves and bone where surgery may be needed. Bone density is often checked, because it affects how any correction is planned.
Managing deformity without surgery
Milder or stable curves are managed with physical therapy focused on core strength and posture, activity modification, pain management, and periodic X-rays to watch for progression. Bracing rarely changes an adult curve but can ease pain for some. Injections can treat a specific pinched nerve within the curve.
Deformity correction
Surgery is considered for curves that are progressing, for pain or imbalance that significantly limits life, or for nerve compression. The operation — deformity correction — realigns and stabilizes the spine with instrumentation and fusion, sometimes combined with a lateral lumbar interbody fusion to restore disc height from the side. Complex and adult deformity is a particular focus of Dr. Mushlin’s fellowship training and research, and his biomechanics work informs how the instrumentation is planned.
Where to be seen
Dr. Mushlin sees patients at the Stony Brook Spine Institute offices in Riverhead, Lake Grove, and Commack, across Suffolk County. Full-length standing X-rays are the key study; earlier films, even from years ago, are worth bringing to show how a curve has changed.
Ready to have it looked at? Request an appointment or call 631-444-1213.
Does adult scoliosis get worse?
Curves can progress slowly — often a degree or so per year — particularly degenerative curves and larger adolescent curves. Periodic standing X-rays are how progression is tracked; most curves are watched rather than operated on.
Can adult scoliosis be treated without surgery?
Yes, in most cases. Therapy, activity modification, pain management, and monitoring are the standard approach. Surgery is reserved for progression, disabling pain or imbalance, or nerve compression.
What does scoliosis surgery involve in adults?
It is a significant operation: the curve is realigned and held with screws and rods, and the corrected segments are fused. Planning is individualized to the curve, bone quality, and overall alignment, and recovery is measured in months.
Where is deformity evaluated?
Dr. Mushlin evaluates adult deformity at the Stony Brook Spine Institute offices in Riverhead, Lake Grove, and Commack, NY.