Degenerative Scoliosis

What it is

Degenerative scoliosis is a curve that develops in adulthood — often called “de novo,” meaning new — in a spine that was straight earlier in life. It happens when the discs and joints of the lower back wear unevenly, so the spine gradually tilts to one side. It is a condition of the aging spine, most common after age 60.

What it feels like

The curve itself is often not the main complaint. Most people come in for back pain and, frequently, the leg symptoms of a narrowed canal — heaviness, aching, or cramping in the legs with standing and walking, eased by sitting or leaning forward. The uneven settling can also pinch a single nerve on one side.

How we follow it

Standing X-rays show the curve and how balanced you are overall, and an MRI shows where the nerves are crowded. I look at both the alignment and the nerve compression, because they often drive different parts of your symptoms.

How we treat it

Most people start with non-surgical care — physical therapy, medication, and epidural steroid injections for nerve symptoms — and many do well. When symptoms persist, surgery is tailored to the problem: sometimes a focused decompression to relieve the nerves, and sometimes a larger procedure to also rebalance the spine, which involves a fusion. I match the size of the operation to the problem and fuse only what is necessary, because every fused level adds load to its neighbors.

The science — for the curious

An important nuance: the curve and the symptoms do not always match. Plenty of people have a visible degenerative curve and feel fine, while the trouble — when it comes — is usually from the narrowed canal rather than the tilt itself. That is why I aim treatment at what is actually causing your symptoms, starting with the least invasive option that addresses it, and reserve bigger rebalancing surgery for genuine imbalance or progression.

Learn more

Scoliosis Research Society — Scoliosis: srs.org

Scoliosis Research Society — Patient Brochures: srs.org/patients

This handout is general education about a common condition and does not replace the personalized advice we discuss in clinic. If anything here does not match what we talked about, what we talked about wins — please ask me.