SCOLIOSIS OF AGING
Definition and cause
Degenerative scoliosis is a condition associated with progressive wear of the unions between the vertebrae (discs, ligaments, and joints). It most often starts from the lumbar region, but can sometimes go up to the upper part of the back. The vertebrae will tend to slip relative to one another, which will result in both an S-shaped deformity of the spine and difficulty standing fully upright. This condition is very often associated with Lumbar spinal stenosis.
Course of the disease
This is a disorder of aging of the spine, which starts in the second half of life and slowly and progressively worsens, and whose symptoms will become disabling in the elderly.
Maintenance of the abdominal wall muscles and the paravertebral muscles is essential both for the prevention of spinal deformities and the management of back pain. Once the pain appears, medical treatment will combine analgesic and anti-inflammatory drugs, and sometimes massages or infiltrations.
Principle of surgical treatment
As always, indications for surgical treatment must be made on a case-by-case basis. The aim of the surgery, in this case, is threefold:
- Neutralize the movement in the osteoarthritic areas (arthrodesis) to relieve the pain, often in the low back
- Straighten and rebalance the spine to reduce muscle tension, the source of pain and exhaustion during walking
- Release the compressed nerve roots in case of associated Lumbar spinal stenosis, to permanently treat sciatica and allow a recovery of the strength in the legs.
Average hospitalization time
7 to 15 days, depending on whether one or two procedures are required (these are the durations most often reported).
A 3-week stay at a rehabilitation center is often essential after discharge from the clinic. Transfer is by medical transport service. Management will be multidisciplinary (rehabilitation specialist, pain specialist, physical therapist, ergotherapist). The aim of the stay is to monitor the dressings, pain management, learn adapted actions for everyday life at “back school”, and recover sufficient autonomy to return home. The total recovery period is at least 3 to 6 months following the surgery. Based on the severity of symptoms before the procedure, this period may be longer. The back brace must be worn during the day for the first 3 months. Recovery is not synonymous with bed rest. Physical exertion, carrying loads, and car trips must be limited during this period. Walking is often beneficial. Recurrence of pain during recovery is often the result of too much activity and will tend to disappear with rest.