CLEAR-certified Dr. J Hartley and Life Beyond the Curve Host, Ashley Brewer, tackle the topic of how to deal with adult degenerative scoliosis in Episode 18.
Throughout their discussion you'll hear:
The definition of adult degenerative scoliosis
Symptoms associated with adult degenerative scoliosis
How these symptoms differ from individuals with adolescent idiopathic scoliosis
Three important goals when it comes to treating adult degenerative scoliosis
You'll also hear Dr. Harley's latest in-clinic results with patients who have adult degenerative scoliosis. Enjoy the show!
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Hello, and welcome to the show. I'm Ashley Brewer, your host for Episode 18, How to Deal with Adult Degenerative Scoliosis. Our co-host for today practices in St. Augustine, Florida at Hartley Chiropractic and CLEAR Scoliosis Center. In addition to his clinical experience as a chiropractor treating scoliosis, Dr. J Hartley has personal experience with scoliosis, as he himself was diagnosed as a teenager. Dr. J graduated from Palmer College of Chiropractic in Davenport, Iowa in 1992. He became a board certified chiropractic neurologist in 1995 and a CLEAR certified doctor in 2015. Episode 18, How to Deal with Adult Degenerative Scoliosis with Dr. J Hartley, let's go.
You're listening to Life Beyond the Curve, a podcast brought to you by CLEAR Scoliosis Institute. Each week, we interview experts in the industry, answer your pressing questions, and empower you to take control of your scoliosis diagnosis and live life to its fullest. Enjoy the show!
Welcome, Dr. Hartley. It's always great to have you on Life Beyond the Curve.
Hi, Ashley, it's great to be here.
So today we are going to be talking about how to deal with adult degenerative scoliosis. Befer--before we jump into all of the details of how to deal with it, can you first just talk about what adult degenerative scoliosis is and what causes it?
Well, the most common, um, thing that we'll we'll hear is the patient will be 60, 70 years old, and they get some kind of x-ray done. Whether they're getting their digestive tract looked at, their heart looked at, a lung x-ray and they're told they have a scoliosis and the patient never had a scoliosis as a child. And all of a sudden they're told they have this scoliosis. Well, typically what happens is they will get a small misalignment and all of a sudden it degenerates very quickly and creates a scoliosis.
And so how are the symptoms of adult degenerative scoliosis different than that of adolescent idiopathic scoliosis, or even there are some cases where adolescent idiopathic scoliosis goes undiagnosed and they're not diagnosed until they're adult. What are the differences between that type of scoliosis and degenerative scoliosis?
So if you, um, some people may have a small scoliosis, so like 10 to 25 degrees as a child, but it was never bad enough to get any treatment. You know, they didn't wear a brace, they weren't recommended surgery. If they didn't have an x-ray as a child, they would be unaware that they had this small curve. You know, their posture didn't look that bad, they weren't having any symptoms. Most children with scoliosis do not have any symptoms. As an adult, when that usually it's in the lower back because the ribs are kinda lock your thoracic spine in place. So the degenerative scol--scoliosis, adult scoliosis is usually in the lumbar spine. So the lumbar spine refers mainly to the hips, the knees, the legs. So most of the degenerative adult scoliosis patients are going to be having lower back pain, hip pain, knee pain, referred pain down the leg.
And pain is something that often is not associated with adolescent idiopathic scoliosis. Correct? Whereas it is with adult scoliosis more often.
Correct. With kids, usually somebody notices the posture is off or there's a rib arch, and that generates the x-ray. With adult scoliosis, if they're not having a lot of symptoms, usually like I said, they're getting a GI study, a lung x-ray, or they're having hip pain, low back pain, things like that. The interesting thing is, is in the medical community, if they see a scoliosis in a child, it's like a red alert, but if they see a scoliosis in a 70 year old, they just think it's normal aging. But that curve can be causing the hip pain, the knee pain, the leg pain. So they may be getting injections, hip surgery, knee surgery, all kinds of different physical therapy that aren't specifically affecting the scoliosis, so their problem never goes away. So it's very common that we help people that have done all those treatments, but never had the scoliosis addressed. All of a sudden we addressed the adult degenerative scoliosis and they start feeling better.
That's interesting, because they just see it as a normal part of the aging process, therefore, if it's normal, then nothing can be done about it. Or like you said, they're going to all of the places where it hurts instead of addressing the actual scoliosis itself. Now, addressing scoliosis itself is something that you do. So let's talk a little bit about non-invasive treatment options for adult d--specifically, adult degenerative scoliosis. I know you deal with all types and cases and classifications of scoliosis in your clinic, but you practice a scoliosis-specific type of chiropractic care that is designed to stabilize the spine and reduce the curve when possible. So, and all of this is done noninvasively. Let's talk a little bit about this with regards to adult degenerative scoliosis. What does that noninvasive type of treatment look like in your office?
So the in-office part of the treatment, we use a process called Mix, Fix, and Set. Mix is a warming up of the spine to get it more pliable to change back to normal. The fix is a very specific adjustment, um, geared toward getting to the cause of scoliosis. And then the set are specific adjustments that gets the brain to hold everything in better alignment. And that is the in-office part of the care. If the curve is above 25 degrees and they have ligament damage, um, which with adult degenerative scoliosis, we very commonly will see what's called a lateral listhesis, which is where usually L3 or L2 will slide sideways, and it creates a lot of instability. Surgically, they could go and fuse the entire lumbar spine, um, which with scoliosis, you never want to have a minimally invasive surgery, because all that does is weaken the disc, and typically it's going to make the curve worse. So scoliosis patients are recommended to have a full fusion. So that means an adult degenerative scoliosis, usually that's going to be like a T12 to L4 fusion. So we're talking a complete fusion with hardware rods, because that's what's going to stabilize that instability.
Do you see that adults are often recommended surgery, or is it re--recommended less with adults than it is with adolescents?
I, less with adults. Um, with Obamacare, the criteria for back surgery has changed a lot. And if you have non-specific back pain, like they can't a hundred percent tell where it's coming from, or you don't have referred pain down the leg, then the odds of it working go down. You know, like if you have a specific muscle that's atrophying related to a bulging disc on an MRI, that's typically what they do surgery on. But if you have lower back pain with the scoliosis, they typically are not going to do, do surgery. Um, I'm just saying, if it is ever recommended and you have instability, a lateral listhesis, a curve larger than 25 or 40 degrees, you don't want to do like laser therapy or a minimally invasive surgery. It's going to require a larger type surgeon. Now, our alternative to that is what's called the ScoliBrace.
And in adults, usually it's going to be a lower fitting brace. So it's going to go from like the mid rib cage down to the hips. And it helps to stabilize and improve the curve as well as these lateral listhesis. And many patients have great symptomatic relief with the lumbar ScoliBrace for adult degenerative scoliosis. And we'll see patients that, you know, they can't, they wake up every day hurting. They can't go for walks on, they can't do the dishes. They can't do cooking. This brace helps to stabilize their spine so that they can do those things again.
That's awesome. Um, now in an article that you wrote for CLEAR's website, you talk about the goals of treatment for people with adult degenerative scoliosis. And I would assume, just based off of our conversation here, that one of your goals is pain reduction based off what you were just saying with the ScoliBrace, where many, many patients can receive symptomatic relief just from wearing that brace. Can you talk to me about some of the other goals you set for patients with adult degenerative scoliosis, how you go about deciding what those goals are? Are they realistic, kind of managing expectations for a patient? Because I think expectations are always important.
Well, the most important thing about the goals is listening to the patient, because they're going to tell, you know, I want a few more years just paying, playing with my grandkids. You know, I want to be able to walk on the beach is what they'll say down here, maybe where you live, they'll say, I want to put my snow shoes on and go out and walk in the snow. But they'll say, Hey, you know, I can't, I used to walk, you know, three miles on the beach every morning and now, you know, I can't walk more than a hundred yards. So usually they'll have a specific goal like that. They may be concerned about their posture, because many of them are losing their height. So they'll, they'll notice they're kind of getting hunched over. And so I would say usually those are the, the main types of things. And so we're always listening to that.
So our first goal, we try to get in alignment with what their goal is. Walking further. Is it being able to cook? Is it being able to walk? So a lot of it's symptomatic based, um, is the first goal. The second goal is to prevent progression. As you get older and the curve's getting larger, the odds are it's gonna continue to get larger. So we want to stabilize things so that that does not happen. The worse the curve gets, the worse your function's going to be, you're going to start to have more limitations. And the third goal is to have an actual reduction in the curve, and that's a little less predictable in adults, but we never like to put a number on what people's capability is because sometimes we're very surprised that, you know, we may see a 50% reduction in the curve, even though there's a lot of degeneration and the patient's 70 years old. Um, but we give them a lesser, um, goal, as far as the curve reduction. Like we might tell them 10%, cause we don't want to tell them something that that's not possible to happen, but it's not uncommon that we have a 50% reduction in the curve.
Do you ever have patients walk in where you feel like their goals are completely unrealistic and you kind of have to do a level set on those ex--? Like people walk in who are like, Hey, straighten me up, doc, fix me.
Yeah. I mean, if you come in with a, if you're a child and you have a 49 degree curve, you're always going to have scoliosis, even if you go through our treatment. But the goal is to reduce it below, like the surgery level, hopefully prevent it from progressing, teach you how to take care of it, you know, the rest of your life because people with large curves are always going to have scoliosis. As an adult, we may see huge spurs on an x-ray, disc may be totally degenerated. So the goal may be more to have you feeling better and have your posture be better. But based on your x-ray, you're probably not going to see a lot of change in the curve because, you know, a lot of degeneration there and your body's been trying to fuse this thing together and in the process it's just created more instability. So for that person, better posture, feeling better, and the curve not getting worse is a huge victory.
So when I hear the word degeneration, I just naturally think like stiff, tight, doesn't move. So do you find that a lot of your patients with adult degenerative scoliosis have like mobility issues as well?
Especially in the lower back. Um, now a lot of the degeneration can be a result of ligament damage, just the size of the curve. So we'll also see people be really active, like in yoga or Pilates, or doing different things and they have pretty good flexibility. But when you look at their x-ray, you're like, you know, it's pretty severe. So not always, but I would say most of the time, yes.
So I love hearing stories. So can you talk to me about the results of one of your patients with adult degenerative scoliosis?
Yeah. We just had two post, um, some really nice reviews, the, um, are on our website, but one, um, really came in because she was noticing her posture was really getting bad. And so we've been [inaudible] quite a bit and she gained an inch and a half of height. She was really excited about that. She also had, um, lower back and hip pain, which, which had gotten better. And then we had another one that was waking up every night, um, every morning in severe pain. And so she, they're both using the brace, one as a kyphoscoliosis brace, the other one is a lumbar ScoliBrace. And the one that was having trouble sleeping and waking up every night in severe pain, she is sleeping with the ScoliBrace on and now wakes up without any pain. She was having trouble walking to the, where, you know, even walking more than a hundred yards or so she would get a lot of pain. And so that is doing better also now. And so, it was some, two really exciting cases.
Yeah, that's very exciting. I want to touch on something you just said for people who are listening who may not fully comprehend or understand how that happens, but so you said gained an inch of height. And I know from talking to other CLEAR offices, that's something that a lot of their patients love is either the, the height that they gain or just how their posture changes. But can you talk for a second about how that happens?
Well, if you add up, you have 24 movable segments in your spine. So if you add up just a little bit of angle correction in each one of those, and then also you look at their overall posture. Um, so if they're really hunched over [inaudible] back, if the head's real far forward and they come out of that, they're going to end up, but it's very common for patients to tell us that, you know, let's say they're 70 and they'll say in the last 10 years, I've lost three inches of height, four inches of height, sometimes five inches of height. And so part of it is the individual vertebra, but part of it is the posture. And so, you know, when you add up all these little improvements, you know, it can end up making a difference in the height. Now we never guarantee somebody, Hey, you're going to get an inch taller, but it does happen.
And if it happens, I'm sure they are thrilled. So Dr. Hartley, if somebody is listening and has adult degenerative, what advice would you like to leave them with today?
Well, I would say the main thing is don't give up hope, because you know, my favorite story, well, not my favorite story, but a story is you have a seventy year old come in and they're like, man, I'm seventy years old. There's no reason for me to do a thing. You know, I'm on my last leg. Then they come back in, when they're 80, they've gotten worse. And they're like, man, I wish I would've done something back when I was 70. You know? So, you know, you're in, especially with these scoliosises, as you get older, the risk of progression increases. You know, so there's more people with scoliosis every year you get older. So if 5% of the population as a child has scoliosis, but 60% of senior citizens do. But when you go from sixty years, to seventy years old to eighty years old, those groups, that there's that group, more of them have scoliosis. So when you're younger, you have a greater chance to stabilize and prevent this from accelerating.
You know, I love what you said about not giving up hope. I would say at least a couple of times a month at CLEAR Scoliosis Institute, somebody emails us or chats with us on our website and just says, is it too late for me? And so I think there's this, this misconception out there, or maybe it's even what they're told when they're diagnosed with adult degenerative scoliosis, that it is too late, or that there is nothing that you can do or that it is just part of the natural aging process, it's life taking its course. And I think what I love about the work that you do at your office is you're able to take people who maybe believe that or have been told that, and you're able to not only give them hope, but give them back some of those things that they've been dealing with, whether it's pain, help them with pain relief, or mobility, or function and, um, stabilization of their spine and reducing their curves. So, um, I just want to thank you so much for sharing everything that you've shared today. You're a wealth of knowledge and we always look forward to having you again, on our show.
Thanks, Ashley! Glad to be here.
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