Scoliosis
Expert Adult Scoliosis Treatment in Bergen County, New Jersey.
Scoliosis is an abnormal sideways curvature of the spine. Where a healthy spine curves gently front to back when viewed from the side, scoliosis involves a lateral curve that gives the spine an S or C shape when viewed from behind. In mild cases it causes no symptoms at all and requires only monitoring. In more significant cases it can produce chronic back pain, nerve compression, uneven posture, and a progressive deformity that affects both physical function and quality of life.
Most people associate scoliosis with teenagers, and adolescent idiopathic scoliosis is indeed the most common form. But scoliosis does not stop being a concern after adolescence. Adult scoliosis is a distinct and frequently underdiagnosed condition that affects a meaningful proportion of adults, particularly those over 40. It takes two forms. Some adults carry a scoliotic curve from adolescence that was mild enough not to require treatment at the time but has progressed or become symptomatic as the spine has aged. Others develop what is called de novo adult scoliosis, a spinal curvature that develops entirely in adulthood as a consequence of asymmetric disc degeneration and facet joint wear that gradually pulls the spine out of alignment.
At Spine Care New Jersey, Rishi N. Sheth, MD specializes in adult scoliosis. He evaluates each patient to understand the degree and pattern of the curvature, the structural changes driving it, the symptoms it is producing, and the treatment approach most likely to provide meaningful, lasting improvement.
SYMPTOMS Adult Scoliosis Symptoms Go Beyond a Curved Spine.
Adult scoliosis is not just about the appearance of the spine. For many patients, the symptoms that bring them to a spine specialist have nothing to do with noticing a curve. They come because of pain, because of nerve symptoms in the legs, or because their function and endurance have quietly declined to a point they can no longer ignore.
Back pain is the most common symptom of adult scoliosis. Unlike adolescent scoliosis, which is usually painless, adult scoliosis frequently causes significant axial back pain due to the degenerative changes driving the curvature and the asymmetric loading those changes create on the spinal joints and muscles. The pain is often worse with prolonged standing or walking and may improve somewhat with sitting.
As the curvature progresses and degenerative changes accumulate at the apex of the curve, nerve roots can become compressed in the narrowed spaces on the concave side of the deformity. This produces radicular symptoms including leg pain, numbness, and tingling that mimic sciatica. Some patients with adult scoliosis and associated spinal stenosis develop neurogenic claudication, the pattern of leg cramping and heaviness with walking that improves with rest.
Postural changes and visible asymmetry become more apparent as the curve progresses. Patients may notice that one shoulder sits higher than the other, that their waistline appears uneven, or that they have a tendency to lean to one side. A prominent rib hump or shoulder blade elevation may be visible when bending forward.
Fatigue of the paraspinal muscles, the muscles that run along either side of the spine, is a common and often overlooked symptom. Maintaining an upright posture against an unbalanced spinal column requires constant muscular effort, and many adult scoliosis patients describe an exhausting sense of heaviness in their back and core by mid-afternoon.
TypesUnderstanding the Two Main Types of Adult Scoliosis.
Not all adult scoliosis is the same. Understanding which type a patient has informs both the prognosis and the most effective treatment approach.
Adolescent Idiopathic Scoliosis Persisting into Adulthood
This is scoliosis that began during the growth years and was either undetected or managed conservatively during adolescence. The curve may have been small enough at skeletal maturity that no treatment was pursued, but over the decades of adult life, degenerative changes at the curved segments can accelerate, causing a curve that was stable for years to begin progressing again. When this happens, symptoms that were absent or mild in earlier adulthood can become significantly more pronounced.
De Novo Adult Degenerative Scoliosis
This type develops entirely in adulthood, without any prior history of scoliosis. It occurs when disc degeneration and facet joint arthritis develop asymmetrically across the lumbar spine. As one side of the disc degenerates faster than the other, the vertebra above tilts, pulling the spine gradually out of alignment. This process builds over years, often silently, until the cumulative curve becomes large enough to produce symptoms. De novo degenerative scoliosis is most common in adults over 50 and tends to be centered in the lumbar spine.
TREATMENTsManaging Adult Scoliosis Through Every Stage of Its Progression.
Treatment decisions in adult scoliosis are guided by the size and pattern of the curve, the severity of symptoms, the degree of neurological involvement, and the patient's overall health and goals. The aim is always to achieve the best possible quality of life using the least invasive appropriate approach.
Non-Surgical Treatment
The majority of adult scoliosis patients can be managed effectively without surgery, particularly those with curves in the mild to moderate range and symptoms that are primarily pain-related rather than neurological.
Physical therapy
Physical therapy for adult scoliosis focuses on strengthening the paraspinal and core muscles that support the curved spine, improving overall posture and balance, and reducing the muscular fatigue and pain that result from compensating for the deformity. A skilled physical
therapist working with a spine specialist can help patients maintain function and delay or avoid the need for surgical intervention.
Epidural Steroid Injections
Epidural steroid injections and targeted nerve root injections are valuable tools for adult scoliosis patients experiencing radicular leg pain or neurogenic claudication from stenosis associated with the curvature. By reducing nerve inflammation at specific compressed levels, these injections can provide meaningful symptomatic relief and allow patients to remain active.
Facet Joint Injections
Facet joint injections address the joint-level pain that commonly accompanies the degenerative changes driving adult degenerative scoliosis. Combined with physical therapy, they form a practical and often effective non-surgical management strategy.
Spinal Bracing
Spinal bracing in adults is primarily a pain management tool rather than a curve correction tool, as the adult spine does not remodel in response to bracing the way an adolescent spine does. It can provide symptomatic support for certain patients during high-demand activities.
Surgical Treatment
Surgery for adult scoliosis is considered when non-surgical treatment has not adequately controlled symptoms, when the curve is large or rapidly progressing, when significant neurological compromise is present, or when the deformity is producing a meaningful functional limitation that conservative care cannot address.
The surgical goals in adult scoliosis are decompression of compressed nerves, correction of the curve to reduce further progression, and stabilization of the spine to maintain the correction. Rishi N. Sheth, MD performs scoliosis surgery using minimally invasive techniques where anatomically feasible, with Mazor robotic assistance to enhance the precision of instrumentation placement and reduce operative risk.
The scope and complexity of scoliosis surgery varies considerably depending on the size of the curve, the number of levels involved, the bone quality, and the patient's medical history. Every surgical candidate at Spine Care New Jersey receives a thorough preoperative evaluation and a detailed, honest discussion of what the procedure involves, what outcomes are realistic, and what recovery looks like.
Adult Scoliosis Care That Starts with an Honest Assessment.
Adult scoliosis is one of the conditions in spine care where the range of appropriate treatment varies most widely from patient to patient. One person with a 35-degree lumbar curve may be
doing very well with physical therapy and periodic injections. Another with the same curve measurement may have significant nerve compression, progressive symptoms, and rapidly declining function that genuinely warrants surgical consideration. The curve number on the MRI report is only part of the story.
Rishi N. Sheth, MD approaches every adult scoliosis evaluation by understanding the complete picture. Where is the patient functionally? What are their symptoms actually limiting? Are the neurological findings stable or progressing? Is this a curve that conservative care can realistically address, or one that will continue to deteriorate without structural intervention? These are the questions that shape a genuinely useful treatment recommendation, and they are the questions Rishi N. Sheth, MD takes the time to answer carefully with every patient.
For patients who need surgery, the combination of Mazor robotic instrumentation, minimally invasive surgical training, and the clinical depth of dual fellowship training at the University of Miami and Memorial Sloan Kettering Cancer Center means that Bergen County patients have access to a level of scoliosis surgical expertise that has historically required traveling to a major academic center to find.
Common Questions About Scoliosis Treatment at Spine Care New Jersey.
Early signs of scoliosis include uneven shoulder height, one shoulder blade that appears more prominent than the other, an uneven waistline, and a tendency to lean to one side. When bending forward, a visible rib hump on one side is a key early indicator. In teenagers, these signs are most apparent during growth spurts. In adults, early symptoms are often subtle postural changes combined with new or worsening back pain. An X-ray from a spine specialist can confirm the presence and degree of curvature.
Spine Care New Jersey in Bergen County is a dedicated spine neurosurgery practice led by Rishi N. Sheth, MD, a board-certified neurosurgeon with extensive experience treating adult scoliosis. The practice offers the full range of scoliosis treatment options, from physical therapy coordination and targeted spinal injections to minimally invasive surgical correction using Mazor robotic technology. Patients throughout Bergen County and northern New Jersey can book a consultation or request a free MRI review at spinecarenj.com.
The most effective non-surgical treatments for adult scoliosis pain include a targeted physical therapy program to strengthen the core and paraspinal muscles, epidural steroid injections for nerve-related leg pain, facet joint injections for joint-level back pain, and a supervised home exercise program for long-term management. The right combination depends on the degree of the curve, the pattern of symptoms, and whether neurological involvement is present. Rishi N. Sheth, MD evaluates each patient individually before recommending any treatment plan.
Effective physical therapy for scoliosis focuses on strengthening the core and paraspinal muscles that support the curved spine, improving overall spinal balance, and addressing any muscle imbalances created by the asymmetric curvature. Specific approaches such as Schroth method therapy, which uses curve-specific corrective exercises and breathing techniques, have shown good evidence for adult scoliosis management. The most beneficial program is one prescribed after a thorough evaluation of the specific curve pattern, as exercises helpful for one type of scoliosis can be counterproductive for another.
Surgery for adult scoliosis is typically considered when the curve measures greater than 50 degrees and is progressing, when significant nerve compression is causing persistent leg pain or neurological weakness that has not responded to conservative care, or when the deformity is causing a meaningful decline in daily function and quality of life. Not every patient with a large curve needs surgery, and not every patient with a smaller curve can be managed without it. The decision depends on the complete clinical picture, which Rishi N. Sheth, MD reviews personally with every scoliosis patient at Spine Care New Jersey