Degenerative Scoliosis (Adult Scoliosis)
Degenerative scoliosis is an abnormal lateral curvature of the lumbar spine that develops in adulthood as a consequence of asymmetric disc degeneration and facet joint arthritis.
What is Degenerative Scoliosis?
Degenerative scoliosis — also called adult-onset scoliosis or de novo scoliosis — is an abnormal lateral curvature of the lumbar spine that develops in adulthood as a consequence of asymmetric disc degeneration and facet joint arthritis. Unlike adolescent idiopathic scoliosis (which develops during growth and is typically managed by paediatric or orthopaedic spine surgeons), degenerative scoliosis develops in middle-aged and older adults, most commonly affecting the lumbar spine.
As disc degeneration occurs asymmetrically — affecting one side of a disc more than the other — the spine begins to tilt to one side. This lateral curvature is called a coronal deformity. Degenerative scoliosis is often associated with concurrent sagittal imbalance — forward tilting of the spine — and spinal stenosis, which causes leg pain and walking limitation.
At One Brain and Spine, our Melbourne neurosurgeons manage adult degenerative scoliosis across the full spectrum — from physiotherapy and injection therapies for mild disease through to complex spinal reconstruction surgery for severe, progressive deformity with neurological compromise.
What Causes Degenerative Scoliosis?
Degenerative scoliosis develops as a result of:
- Asymmetric disc degeneration — uneven wear of intervertebral discs causes one side of the disc to collapse more than the other, tilting the spine laterally
- Facet joint arthritis — asymmetric facet joint degeneration contributes to the curvature and instability
- Osteoporosis — reduced bone density can contribute to vertebral wedging and progressive curvature
- Pre-existing mild spinal asymmetry — patients with pre-existing minor spinal asymmetry from childhood may develop progressive curvature with degeneration
- Post-surgical — previous spinal surgery can alter spinal biomechanics and contribute to adjacent segment degeneration and progressive deformity
Symptoms of Degenerative Scoliosis
Back Pain
Chronic lower back pain is the most common presenting symptom, arising from disc degeneration, facet joint arthritis, and abnormal mechanical loading from the curvature. The pain is typically worse with prolonged standing and activity, and is often associated with paraspinal muscle fatigue.
Leg Pain and Neurogenic Claudication
The asymmetric curvature of degenerative scoliosis causes asymmetric compression of spinal nerve roots. Patients commonly experience sciatica (radiating leg pain), neurogenic claudication (leg pain with walking), and nerve-related numbness and weakness in the legs. These symptoms often arise from the concave (compressed) side of the curve.
Postural Changes and Balance Problems
Progressive scoliosis and sagittal imbalance (forward lean) cause visible postural changes — one hip appearing higher than the other, asymmetric waist, or a forward-flexed stooped posture. Balance and walking can be affected in more advanced cases.
Functional Limitation
Progressive loss of walking tolerance, difficulty with daily activities, and reduced quality of life are common in moderate to severe degenerative scoliosis.
How is Degenerative Scoliosis Diagnosed?
- Full-length standing X-ray (EOS scan) — essential for measuring the Cobb angle (degree of curvature), assessing global sagittal and coronal balance, and monitoring progression over time
- MRI of the lumbar spine — demonstrates disc degeneration, nerve root compression, and stenosis at the curved levels
- CT scan — provides bony detail for surgical planning in complex cases
- Dynamic X-rays — assesses flexibility of the curve and segmental instability
Treatments
Non-Surgical Treatment Options
Mild degenerative scoliosis causing manageable symptoms is treated conservatively:
- Physiotherapy and exercise — core strengthening, postural exercises, and aerobic conditioning to reduce back pain and maintain function
- Clinical Pilates — particularly effective for managing pain and improving functional capacity
- Epidural steroid injections — for neurogenic claudication and leg pain from associated stenosis
- Facet joint injections — for facet-mediated back pain
- Pain management — multimodal pain management for chronic pain associated with progressive deformity
- Osteoporosis treatment — if present, optimising bone density is important before any surgical consideration
When is Surgery Required?
Surgery for degenerative scoliosis is considered when symptoms are severe, progressive, and unresponsive to conservative management. The primary indications are:
- Severe, disabling back pain refractory to conservative management
- Progressive neurological deficit from nerve compression
- Progressive curvature with worsening functional limitation
- Significant sagittal imbalance causing a forward-tilted posture that cannot be self-corrected
Surgical Treatment Options
Surgery for degenerative scoliosis ranges from limited decompression with short fusion for focal disease, to complex multi-level spinal reconstruction for severe deformity. The extent of surgery is determined by the severity and location of the curvature, the degree of neurological compromise, and the patient's overall health and functional goals.
At One Brain and Spine, our Melbourne neurosurgeons offer minimally invasive and robotic-assisted techniques where appropriate to reduce surgical morbidity in this often older patient population. The surgical plan is always individualised and discussed in detail with the patient prior to proceeding.
Frequently Asked Questions — Degenerative Scoliosis Melbourne
Is adult degenerative scoliosis the same as adolescent scoliosis?
No. Adolescent idiopathic scoliosis develops during growth and is primarily a structural spinal curvature. Degenerative scoliosis develops in adulthood from asymmetric disc and joint degeneration. The two types have different causes, natural histories, and treatment considerations, though both may cause significant spinal curvature.
Will my scoliosis get worse over time?
Degenerative scoliosis tends to progress slowly over time, particularly if disc and facet degeneration continues. The rate of progression varies considerably. Regular monitoring with standing X-rays is recommended to track progression and guide treatment decisions.
Can physiotherapy prevent degenerative scoliosis from progressing?
While physiotherapy and exercise cannot reverse the spinal curvature, they are effective at managing symptoms, improving function, and slowing progression by strengthening the supporting musculature and maintaining mobility. Core strengthening in particular helps stabilise the curved spine.
How do I know if I need surgery for scoliosis?
Surgery is considered when symptoms are severe, progressive, and unresponsive to conservative management. Not all patients with degenerative scoliosis need surgery. A thorough assessment at One Brain and Spine will help determine the most appropriate management for your individual situation.
Why Choose One Brain and Spine for Degenerative Scoliosis in Melbourne?
One Brain and Spine is a specialist neurosurgical group practice in Melbourne, formed by three experienced neurosurgeons committed to the highest standard of spinal care. We offer the full spectrum of evidence-based treatments from conservative management through to the most advanced minimally invasive and endoscopic surgical techniques available in Australia.
- Specialist neurosurgeons — all fellowship-trained with subspecialty expertise in spinal surgery
- Latest surgical technology — robotic-assisted navigation, endoscopic techniques, and microsurgery
- Conservative-first approach — surgery recommended only when clearly indicated
- Multidisciplinary care — working with physiotherapists, pain specialists, and radiologists across Melbourne
- Transparent, patient-centred consultations — your diagnosis and all options explained clearly
- Privately insured patients welcome — all major health funds accepted