Adult Scoliosis and Spinal Deformity
Spinal deformity in adults is either a curve that has been present since adolescence and is now wearing, or a new curve created by uneven degeneration of the discs and joints. The most important question is not the size of the curve but whether the spine can still hold the head balanced over the pelvis without effort. When it can't, standing becomes work, and that is what brings people in.
Alignment, not just curvature
Adult deformity is evaluated with full-length standing X-rays that show the whole spine and pelvis. The measurements that matter most describe balance: whether the head sits over the hips when standing naturally, and whether the low back keeps its normal inward curve. A large curve that is well balanced may be entirely tolerable; a modest loss of low-back curve that forces a person to lean forward can be disabling. Dr. Michael's fellowship at Twin Cities Spine Center, one of the country's highest-volume deformity centers, focused heavily on this analysis.
Nonsurgical care
Most adults with deformity are managed without surgery. Conditioning of the core and hip muscles, physical therapy, weight management, and treatment of osteoporosis are the foundation. Injections help with leg symptoms from narrowing at the concave side of a curve. Rigid bracing, useful in adolescents, does not correct adult curves and can weaken the trunk if worn long term.
Surgical options
Surgery is matched to the problem. When leg symptoms come from a narrowed level within a stable, balanced curve, a limited decompression or a short fusion may be all that is needed. When the problem is imbalance, the operation is a reconstruction: realigning the spine over multiple levels with screws and rods, restoring the low-back curve, and fusing the corrected segments. These are significant operations with meaningful recovery, and the decision to proceed is made deliberately, with attention to bone quality, overall health, and realistic goals.
Dr. Michael uses navigation and robotic guidance for screw placement in deformity surgery and applies minimally invasive techniques when they achieve the same correction. He also treats deformity that has developed after prior spine surgery, including flatback and adjacent-level breakdown.
Common questions
Does adult scoliosis get worse?
Degenerative curves tend to progress slowly, often a degree or two a year, but the rate varies. Periodic standing X-rays track it. Symptoms, not the number alone, drive treatment decisions.
Am I too old for deformity surgery?
Age by itself is not the deciding factor; overall health, bone quality, and goals are. Many patients in their 70s do well with carefully planned reconstruction, and less extensive options exist when a full reconstruction is not appropriate.
Can my curve be corrected with a smaller operation?
Sometimes. If the main symptom is leg pain from one narrowed level and the spine is balanced, a limited decompression may be enough. A thorough alignment analysis is what tells us which situation you are in.