What to Know About Adult Scoliosis

Curvature of the spine can happen in adults, even if they never had this in childhood.

Scoliosis, an abnormal curving of the spine, is usually associated with childhood. But adults can develop this problem, too, for a number of reasons.

Byron Stephens M.D., is a spine specialist who cares for people with scoliosis at the Vanderbilt Spine Centre in the United States. Strategies for treatment depend on how severe someone’s curve is, among other factors. Here, Stephens answers questions about this problem, which becomes more common as people age.

Is adult scoliosis a continuation of childhood scoliosis, or something that develops in adulthood?

There are two types of adult scoliosis. One, called idiopathic adult scoliosis, results from the progression of scoliosis that was present in childhood.

The other type, degenerative scoliosis, does not happen until adulthood. Adult scoliosis usually stems from a problem in the lumbar spine (lower back). Childhood scoliosis usually affects the thoracic spine (the spine running up the mid- to upper back).

What causes adult scoliosis?

Sometimes a fracture or injury can lead to an imbalance in the spine that results in scoliosis. Scoliosis that begins in adulthood can also happen because of arthritis, damage to discs, a complication from a surgery, or having legs of different lengths. Any of these problems can cause the spine to slowly curve more than it’s supposed to.

A common culprit is asymmetrical disc collapse, Stephens said. Most people with degenerative disc problems have spinal discs – the circular cushions of cartilage between vertebrae – that collapse, or get compressed, the same way throughout the disc. But if the disc sinks more to one side than the other, that can lead to a curve.

Is it obvious when someone has scoliosis in adulthood? Do they look like they’re standing crooked?

If someone has a side-to-side curve, that causes relatively few symptoms in adulthood, and it may not be noticeable by looking at someone. They may lose some height due to their curve.

However, a severe curve in the spine from front to back will cause more discomfort. This can prevent someone from standing up straight, which can be quite debilitating.

What are the symptoms of adult scoliosis?

People with this condition often have back pain or pain in one or both legs, though not everyone does. Family members may notice that the affected person’s waist or shoulders are not symmetrical – one hip or shoulder may be higher than the other.

Scoliosis is actually diagnosed and evaluated with special X-rays or MRI imaging.

Can adult scoliosis be fixed?

Many people associate scoliosis with wearing a back brace, but bracing can do more harm than good for adults with scoliosis, Stephens said.

The non-operative (non-surgical) treatment of adult scoliosis centers around core stabilization exercises — physical therapy aimed at strengthening our abdomen and our extensor muscles in our back,” he said. “A brace actually can weaken those muscles because it takes a lot of the stress and strain off them.” A brace might be helpful on occasion when someone is doing a strenuous activity, or for someone with an extreme curve who is too ill to tolerate corrective surgery. Otherwise, the most important treatment for adult scoliosis is physical therapy with a therapist who specializes in spine health.

The point of physical therapy is to ultimately teach the patient the exercises so they can do them on their own,” Stephens said. Over time, doing daily physical therapy work will strengthen the shape and function of the spine.

Usually, adult scoliosis does not lead to surgery. However, if surgery is necessary, a patient should choose a surgeon specifically trained to treat spine deformities. “It can be a complicated problem to treat surgically,” Stephens said. “The good news is technology is advancing all the time. We’re improving outcomes for these patients and really advancing the science of the field every day.”

How can someone prevent a spinal curve from getting worse?

The two best strategies are maintaining a healthy weight – because excess weight seems to worsen a spinal curve – and keeping bones strong and healthy, Stephens said.

Avoiding osteoporosis is really one of the biggest things” for prevention, he said. “Because the weaker bones are, the faster the curve can progress.” Also, more fragile bones can be a barrier to corrective spinal surgery.

Regular, weight-bearing exercise (for example, walking or lifting weights), getting outside for some moderate sun exposure every day and taking a vitamin D supplement (if your doctor approves) help keep bones strong. These are particularly important strategies for post-menopausal women, whose bones are more at risk than men’s of losing density and therefore strength. Older women should ask their primary care doctor or gynaecologist about getting a bone density check.

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Source Material and Acknowledgements:

The author of this article is Maura Ammenheuser, from the Vanderbilt University Press Office. It was first published on 10th December, 2018 in My Southern Health, a Vanderbilt publication. The article is reproduced here, with minor editorial adjustments, under CCL copyright provisions. The original article, which includes active links to all references, may be found here.

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Rethinking how we see anorexia

Teenagers with anorexia nervosa, the most serious of all eating disorders, don’t have to be ‘skinny’ – it’s possible to be diagnosed at any weight

By Melissa Whitelaw, University of Melbourne

Rake thin, visible ribs, emaciated bodies. The stereotypical ‘look’ of people with anorexia nervosa is well known.

But our research at the Royal Children’s Hospital Melbourne and the University of Melbourne has found that anorexia is actually possible at any weight.

Anorexia’s many guises

We worked with 171 adolescents over a period of nine years between 2005 and 2013, who were hospitalised for the first time with a restrictive eating disorder. Our results are published in the Journal of Adolescent Health.

We found around a third had ‘atypical anorexia nervosa’, where they met all the diagnostic criteria for anorexia nervosa apart from being severely underweight. Over the study period, there was a five-fold increase in hospital admissions for this condition.

These patients still experienced the same life threatening complications usually associated with anorexia, including a low pulse rate, low systolic blood pressure and low phosphate levels.

But they didn’t present with the highly visible, severe emaciation that has long been considered the core diagnostic criterion for anorexia nervosa.

We also found the total and recent weight loss were stronger predictors than weight itself for a number of clinical complications, with the strongest predictor overall total weight loss. A striking finding was that no outcome was independently associated with low admission weight.

In other words, it seems anorexia’s symptoms are associated with weight loss, not necessarily emaciation.

We need to rethink how we conceive restrictive eating disorders; in actual fact, they can emerge at any weight, and adolescents who have lost large amounts of weight should be assessed for a possible eating disorder – no matter their size.

None of the adolescents participating in our study were being monitored by a health professional, despite being advised to lose weight in some cases.

Balancing healthy eating messages

Adolescents who receive positive reinforcement about their weight loss can end up on increasingly restrictive diets.

With overweight and obesity a major health issue in Australia, we have seen a proliferation of information about its prevalence and complications throughout society.

Appropriately, healthy eating and lifestyle programs are taught in schools. But elsewhere, adolescents are inundated with messages about dieting, often with inappropriate recommendations for quick fixes promising fast weight loss, advice on how to change body shape and images of ‘beautiful’ thin bodies.

And while adopting a healthier approach or dieting for weight loss can be done in a way that is healthy and safe, for some adolescents it can trigger eating disorder cognitions and lead to them adopting increasingly restrictive diets.

For some, this can become a vicious cycle as they receive positive reinforcement about their weight loss from friends and family. For those with previously higher weights, positive affirmations for their weight loss are common and, in some cases, they are even encouraged to continue losing weight.

We don’t yet know why some adolescents are susceptible to this while others are not, but it isn’t surprising this is the most common age for eating disorders to develop – they are the third most common adolescent chronic illness after obesity and asthma.

Adolescence is a highly dynamic period of development as we acquire the physical, cognitive and emotional characteristics of adults. By the end of adolescence, we are sexually and reproductively developed, our bodies are grown and our brains have matured.

Although adolescence is generally considered a time of robust physical health, it is often the age when mental health disorders emerge. Psychiatric illness is considered common at this age, with 50 per cent of adult mental disorders reported to have started by the age of 14 years.

Body image concerns are also common, as is a heightened susceptibility to dieting. And for some, this can become dangerous.

It’s important to be conscious of how food is discussed around adolescents; stigmatising discussions that relate food to body weight can encourage them to adopt restrictive diets.

It’s much more effective to offer positive healthy eating advice, like eating more fruit and vegetables.

A new way of diagnosing anorexia

In the future, weight loss in higher weight adolescents, even those who have been assessed as overweight or obese, should be closely monitored by health professionals so that if an eating disorder emerges, it can be picked up early.

This should include a review of the patient’s weight loss strategies to ensure they are sustainable and safe, as well as an assessment of their cardiovascular health.

And we need to rethink the diagnostic criteria for anorexia nervosa, the most serious of all eating disorders.

Our findings suggest that weight loss, as well as weight, should be included in future revisions of the diagnostic criteria for anorexia nervosa.

It’s not just about being underweight.

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About The Author and Source material:

This material for this article was provided by the University of Melbourne press office, and is reproduced here under CCL copyright provisions. The article also featured on 2nd December, 2018 in Pursuit, which is the university’s online magazine.  The original article, which includes active links to all references, may be found here

Melissa Whitelaw’, who is the author of this piece is a PhD candidate at thr University of Melbourne. Her supervisors are Professor Susan Sawyer who leads the Population Health research group at the Murdoch Children’s Research Institute and is Chair of Adolescent Health at the University of Melbourne and Director of the Royal Children’s Hospital Centre for Adolescent Health; Associate Professor Katherine Lee, Senior Biostatistician at the Murdoch Children’s Research Institute; and Dr Heather Gilbertson, Manager, Nutrition and Food Services at the Royal Children’s Hospital.

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