成人脊柱侧弯主要有两种形态：
1. 由青少年脊柱侧弯（Adolescent Idiopathic Scoliosis，缩写为AIS）演化而来，称为成人期青少年脊柱侧弯（Adolescent Scoliosis in Adults，缩写为ASA）。对于既往已经诊断出AIS 的成人患者，监测侧弯进展相对简单，可以将当前的X光片与青少年时期的X光片进行对比。ASA 可能是渐进的，也可能是稳定的，具体因人而异。
2. 由于脊柱退化造成的。这被称为退行性新发脊柱侧弯（Degenerative De-nono Scoliosis，缩写为DDS）。DDS 通常发生于中老年人，通常从 45 岁左右开始发病。由于 DDS 是关节与组织退化形成的不稳定与代偿，其症状往往是进行性的，相关的主诉是疼痛。
疼痛和成人脊柱侧弯
尽管某些形式的成人脊柱侧弯可能是进行性的，但主要的症状通常是腰痛。通常，这种疼痛很严重，并且通过常规医疗和补充护理几乎无法缓解。大多数健康专业人士仍然存在一个常见的误解，即脊柱侧弯不会引起疼痛。这不是真的。之所以出现这种想法，是因为大多数患有青少年特发性脊柱侧凸的儿童并不以疼痛为主要主诉，而且通常情况下，即使儿童的较大畸形也不会引起疼痛。然而，研究表明，在 50 岁至 80 岁患有慢性腰痛的成年人中，高达 40% 的人会患有成人脊柱侧弯。
这种误解导致诊断和治疗方法在很大程度上忽视了脊柱侧凸在成人慢性下肢疼痛中的作用，因此，许多患者的治疗结果不太令人满意。
成人脊柱侧凸的疼痛与弯曲的大小无关。几项良好的研究表明，曲线的大小与疼痛之间几乎没有关系。即 20 度和 55 度的曲线引起成人疼痛的几率相同。
有两个与成人疼痛相关的关键因素
曲线的位置。几乎所有成人脊柱侧弯疼痛的主诉都是腰痛。大多数新的 DDS 曲线都是下背部曲线。上脊柱的单一弯曲引起下背部疼痛的情况很少见。然而，在某些具有“S”形曲线的 ASA 患者中，下背部曲线的下半部分可能会导致成年后疼痛。
脊柱的平衡。所谓“平衡”是指脊柱的前/后、左/右/移动，与曲线的大小没有必然关系。最重要的是，患有脊柱侧弯的成年人，如果姿势前移或向前弯曲，会比处于中立或后移姿势的人产生更多的疼痛。
Pain and adult scoliosis
Although some forms of adult scoliosis can be progressive, the main complaint is usually lower back pain. Often this pain is severe and little relief has been found from usual medical and complementary care. A common misunderstanding still perpetuated by most health professionals is that scoliosis does not cause pain. This is not true. This notion has come about because the majority of children suffering from adolescent idiopathic scoliosis do not present with a primary complaint of pain and quite often even large deformities in children do not cause pain. However, in adults between the ages of 50 and 80 who suffer from chronic lower back pain, research shows that up 40% will have an adult scoliosis.
This misconception has led to a diagnostic and treatment approach that largely ignores the role of scoliosis in chronic lower pain in adults and, as a result, less than satisfactory outcomes for many of these patients.
The pain seen in adult scoliosis is not related to the size of the curve. Several good studies show there is little to no relationship between the size of the curve and pain. i.e a 20 degree and a 55 degree curve have the same chance of causing pain in an adult.
There are two key factors related to pain in adults
- Location of the curve. Almost all complaints of pain in adult scoliosis are of lower back pain. The majority of new DDS curve are lower back curves. It is rare for a single curve in the upper spine to cause lower back pain. However in some cases patients with ASA who have an “S” shaped curve, the bottom half of the curve in the lower back may cause pain as an adult.
- Balance of the spine. What is meant by “balance” is the forward/backwards, left right/shift of the spine that does not necessarily related to the size of the curve. Most importantly adults with scoliosis who have a forward shifted posture, or those that are bent forward, will develop more pain than those in a neutral or backwards shifted posture.
The usual care recommended for patients suffering back pain with adult scoliosis is pain killers, anti-inflammatory or other drug treatments, back strengthening exercises, surgical decompression and the whole range of other medical and complementary treatments used to treat common lower back pain. On the whole these treatments do not manage the pain over the medium to long term as they generally do not help to treat the underlying condition causing the pain, which is the scoliosis.
Specialised conservative scoliosis treatments and specialised surgical treatments have been developed to treat adult scoliosis. Unfortunately as adult spines have finished growing, the potential to make correction is limited to the inherent flexibility of the scoliosis and is usually very limited. However in many cases, the scoliosis need not be corrected to reduce pain. As the majority of adult scoliosis patients suffering pain do so because of the altered spinal balance and not because of the size of the curve, both conservative and surgical treatments that specialise in treating adult scoliosis can be beneficial.
In some cases, pain relief and stabilisation can be achieved with intensive specialist physiotherapy which works on spinal balance, not just strengthening core muscles. The goal of these programs is to teach the patient to overcorrect the abnormal position the scoliosis causes in their posture. Once the patient can make these correction movements, there a series of exercises can be used to re-enforce the correction and assist the body to maintain the correction itself.
Specialised scoliosis specific exercise programs play an important role in the treatment of scoliosis in adults. Traditionally there has been the opinion that “exercise does not work for scoliosis”. While this is true for general exercise (eg. core stabilisation, pilates) there are now specialised scoliosis specific exercise programs that are supported by published evidence and are regarded as effective when delivered by certified providers.
ScoliBalance is a specialised scoliosis specific exercise program that is tailored to each individual patient according to their curve type, symptoms and treatment goals.
By focusing on improvements in spinal balance, ScoliBalance is effective at reducing back pain in the majority of scoliosis cases. If the curve is flexible, it may also be possible to achieve improvement to body appearance. ScoliBalance may also improve standing balance and reduce fall risk in older adults. While ScoliBalance is very helpful in pain management, it may also aid in slowing the progression of a degenerative curve. However where degenerative progression is present, an adult custom 3D brace should be recommended.
Performing surgery on adults can be challenging and carries higher risks. This is particularly true when the patient has osteoporosis, which weakens the bones and makes it harder to attach rods and bone grafts. Although surgery may not always provide pain relief, it may be the only viable option when conventional and conservative treatments have been unsuccessful.