De novo scoliosis

De novo

Elderly scoliosis (also called degenerative or de novo scoliosis) is a type of scoliosis that has always existed, but only recently been identified as a distinct form.
Typical of the elderly, it appears from the age of 50-60 years onwards and is associated with often marked clinical symptoms.
Albeit of only mild-moderate severity, this form causes pronounced forward and/or lateral bending of the back.
This happens because the general stiffness associated with aging means that affected subjects fail to develop the compensatory curves that would have the effect of straightening their back.

De novo scoliosis is the most frequent type of scoliosis: according to some studies it affects up to 30% of all people aged over 70 and with no previous history of vertebral abnormalities, and it typically appears at the lumbar level.

It is only in recent years that this form has been identified and studied, as it used to be thought that these curves represented a worsening, over time, of a condition that had been present from a young age.

Indeed, in the absence of previous X-rays of the spine, it is not easy to distinguish elderly scoliosis from adolescent idiopathic scoliosis that has persisted into adulthood.
The onset of elderly scoliosis seems to be triggered by rotation and lateral translation (rotatory subluxation is the technical term) caused by degeneration and aging of the intervertebral discs and joints.

This results in the sudden and rapid formation of a curve in a previously perfectly straight back, and it upsets the older adult’s balance.
This pattern of events is borne out by the accounts given by affected individuals, who report feeling their spine suddenly and unexpectedly giving way, leaving them centimetres shorter and needing to hold on to something to stay upright.

This type of scoliosis has become a particular focus of interest because, unfortunately, it tends to lead to disability, functional impairment and reduced quality of life.

Young people are physically flexible and therefore usually able to compensate adequately for scoliosis curves, even severe ones; accordingly, youngsters retain a normal-looking posture even in the presence of asymmetries at the level of the hips, trunk and shoulders.

Elderly people, on the other hand, no longer have this strength and flexibility, therefore even a relatively mild curve (degenerative scoliosis curves rarely exceed 25°) will cause them to assume a laterally flexed and forward bent posture.

This is sufficient to compromise their functionality, making both standing and walking tiring, difficult and painful.

What can be done to improve the condition?

As always, the first step is prevention: adults who make sure they do regular physical activity are more likely to preserve, for longer, the elasticity that can help them compensate for any changes that occur.

Once the condition has been diagnosed by a specialist physician, and if it is causing pain and disability, the next step is immediately to consult a physiotherapist with specific expertise in this field.

However, it is necessary to draw some distinctions: if the problem is the pain, and your posture is not affected, then once the pain has been reduced or eliminated, you will not necessarily have to follow a maintenance therapy; it may well be sufficient just to resume your regular physical activity.
If, instead, your posture is significantly altered by the scoliosis (forward and/or lateral bending of the trunk), then you should not delude yourself that a “course of treatment” will work wonders: in this case, you will need to do several specific exercises every day for the rest of your life.

Another type of alteration observed in elderly scoliosis is the lateral collapse of the spine caused by an increase in the scoliotic curve that, once again, the patient is unable to counter; this results in a lateral imbalance.

Further to these aspects, pain is a common factor in all these situations and it is one of the main reasons why affected individuals decide to do something in order to improve their back and, as a result, their overall health.

To slow down the problem and try to improve the situation, it is necessary to undertake a course of rehabilitation involving specific exercises for the spine.

The importance of specific exercises

These exercises have several purposes; the main one is to reduce pain.
The therapist will  “explore” the patient’s back, performing assessments and seeking to identify pain-free positions that can be taken as a starting point both for providing some relief and for starting to plan a programme of work designed to help the patient’s back cope with more active exercises.

As with youngsters, with elderly people, too, it is crucial to teach self-correction, even though in this case the objectives will be different.

An elderly person with scoliosis, by definition, has a stiff back and can therefore have mobility problems; obviously in these circumstances self-correction should not be seen as a means of obtaining the best possible correction of the back, but rather as a  way of supporting it and reducing, as far as possible, the abnormalities that have developed.

In the presence of lateral bending, the aim will be to support the back as much as possible against the direction of the curve. In contrast, forward bending will be tackled by attempting to restore lordosis and mobility of the lumbar spine, so as to move the patient’s back into an upright position.
A key element in both these cases is an axial extension of the spine, which serves to reduce dorsal kyphosis and open, as much as possible, the scoliotic curve.

However, when embarking on a rehabilitation pathway, patience is always the key, because exercises, unlike drugs, cannot eliminate or reduce pain in the space of a few hours.

The very term “pathway” implies the need to allow a certain amount of time for the desired results to appear.
The treatment demands not only patience but also constancy over time, as patients have to do much of the work on their own, having first been taught the exercises and instructed to do them independently at home.

This is the only way of obtaining the kind of results that, over time, will lead to improvements in different areas of the patient’s life.

It is also important not to make the mistake of becoming complacent as soon as there is some improvement; indeed, it is crucial to continue following the programme consistently to consolidate the results achieved.

The first positive result will be perceived by the patient as a reduction of the pain experienced, and this reduction will be proportional to the improvement obtained; subsequently, he/she will become aware, both in the course of the day but also when standing in front of a mirror, that his/her posture has also improved.

An equally important development will be better general physical conditions and a better quality of life as the patient, starting to feel better and happier about his/her appearance, will start resuming his/her previous activities.

The specific exercises prescribed are very important for preventing/limiting possible deterioration over the years, and patients will therefore need to go on doing them for the rest of their lives: since these are patients who have difficulty supporting their backs, it is essential to work on strengthening all the relevant physical abilities.
And this can be achieved solely and exclusively through specific exercises.
All the other treatments that exist for scoliosis have different objectives, e.g. to provide pain relief (drugs) or to replace lost function (bracing or surgery), and they are, in any case, more invasive.