​Getting Straight About The Curve

Lifestyle adjustments and early intervention can help manage adult degenerative scoliosis to ensure that seniors continue to lead fulfilling lives.

Many individuals dismiss back pain and leg discomfort as merely the natural wear and tear of the body due to ageing. Yet, these aches could sometimes manifest as scoliosis, an abnormal twisting and curvature of the spine.

There are several different types of scoliosis, but the one that commonly impacts seniors is adult degenerative scoliosis. Usually underestimated and under-recognised, this condition affects up to 68 per cent of seniors aged over 60, according to international studies. “With an ageing global population, we can expect this number to rise,” says Adjunct Associate Professor Jacob Oh Yoong Leong, Head of Spine Surgery at Tan Tock Seng Hospital (TTSH).​


Adult degenerative scoliosis is caused by the deterioration of intervertebral discs, which act as shock absorbers between the small bones (vertebrae) of the spinal canal. When these discs wear down unevenly over time, it can lead to an imbalanced distribution of body weight on the spine, causing it to curve. Age and genetics are the primary risk factors, but spinal injuries, and certain diseases can also contribute to the development of this condition.

Akin to osteoarthritis of the spine, severe cases of adult degenerative scoliosis can lead to intense back pain, particularly when the vertebrae make direct contact with one another. Nerve compression also takes place when the spaces within the spine are narrowed, or when the bulging discs press on the nerve roots nearby, triggering significant leg pain.​

Yet, many seniors are unaware of their adult degenerative scoliosis condition, as it often presents without noticeable symptoms at the start. “They only seek medical attention when they experience considerable pain and find it a challenge to stand upright,” says A/Prof Oh.

In his work at TTSH’s Orthopaedic Surgery department, A/Prof Oh has observed how scoliosis restricts many once-active patients. “Those with severe scoliosis grapple with pain that prevents them from standing for more than a few minutes and walking short distances, hindering their ability to engage in simple tasks like shopping, cooking, and exercising,” says A/Prof Oh.

“Over time, this diminished mobility can confine them to their homes. This loss of independence and disruption to social routines can lead to psychological issues, such as depression,” he adds.​

Correcting The Bend​

Adult degenerative scoliosis is often detected during a clinical examination when a doctor assesses a patient’s posture from the front or back. In a normal upright stance, individuals without the condition should have their head aligned between their shoulders, hips, and legs. “If you find yourself leaning to the side, or if there’s a noticeable hump on your back when you lean forward, it could indicate an underlying deformity,” says A/Prof Oh.

When doctors observe any of the symptoms (see Scoliosis Symptoms Checklist), they typically direct patients to a spine clinic. At TTSH, an X-ray is conducted to assess spinal alignment and confirm a diagnosis. While adult degenerative scoliosis cannot be reversed, an early diagnosis allows patients to take measures to halt or slow its progression.



“It is important to maintain a good posture and refrain from slouching while sitting,” advises A/Prof Oh. “Regular stretching and strengthening exercises are also beneficial,” he says. A strong core — referring to the muscles around the abdomen, lower back, and pelvis — and spine can reduce the risk of injuries and the likelihood of back pain episodes caused by muscle spasms. Individuals with underlying scoliosis are particularly vulnerable to these issue.

If lifestyle adjustments do not bring adequate relief, doctors might​ prescribe pain relievers, or suggest alternative measures such as physiotherapy, acupuncture, or massage.​

Operative Measures​

For patients with extremely severe scoliosis, where daily activities become unmanageable even after different interventions, surgery may be required. This procedure aims to correct the deformity, straighten the back, alleviate pain, and stabilise the condition to prevent further deterioration.

The choice of surgical approach differs, depending on a patient’s specific condition and severity of scoliosis. A common procedure is spinal instrumentation and fusion, which involves the insertion of metal rods and screws to enhance spinal alignment.​

Fewer than 10 per cent of scoliosis patients require surgery. For those who might need it, doctors meticulously assess the risks and benefits of the​ procedure. “As patients age, surgeries tend to become more complex. Older patients often have diminished physical reserves, making them more susceptible to risks associated with general anaesthesia,” explains A/Prof Oh.


X-rays showing the spine of a patient before (left) and after (right) a scoliosis surgery.

Furthermore, older patients often have reduced bone quality, which can affect how well the metal screws and rods provide support, potentially leading to a slower recovery. Complications can also arise if the patient has pre-existing medical conditions like hypertension, coronary heart disease, or diabetes.

A/Prof Oh notes that patients with severe scoliosis, who are deemed suitable for surgery, often experience better outcomes postsurgery compared to if they forego the procedure. This is consistent with many international research studies.



Living With Scoliosis

Fortunately, most of A/Prof Oh’s patients have mild scoliosis that can be managed well without surgery. He advises such patients to make minor adjustments to their everyday activities. “Be careful when lifting heavy items and avoid excessive bending and twisting, as actions as such could strain a muscle or trigger an arthritic flare-up swelling — particularly if scoliosis is already present.”

Additionally, he recommends maintaining an active lifestyle and a healthy diet. Consuming calcium-rich foods like milk helps ward off osteoporosis compression fractures. These small breaks in the spinal bones can, over time, cause the spine to collapse and curve, a scenario often linked with scoliosis.



While scoliosis might not always be debilitating, it is vital for those unaffected to adopt daily  preventive measures. These include maintaining proper posture, avoiding prolonged sitting or heavy lifting, engaging in regular exercise to strengthen back and core muscles, and ensuring adequate calcium and vitamin D intake for bone health. “Being proactive about your health is a key defence in preventing complications associated with scoliosis,” says A/Prof Oh. LW

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