From the Research
The management of degenerative lumbar scoliosis should prioritize a stepwise approach, starting with conservative measures such as physical therapy and pain management, before considering surgical intervention, as supported by the most recent and highest quality study 1. The initial treatment includes physical therapy focusing on core strengthening and flexibility exercises, performed 2-3 times weekly for at least 6-8 weeks.
- Pain management often involves NSAIDs such as ibuprofen (400-800mg three times daily) or naproxen (250-500mg twice daily), with acetaminophen (500-1000mg every 6 hours, not exceeding 4000mg daily) as an alternative.
- For more severe pain, short-term muscle relaxants like cyclobenzaprine (5-10mg three times daily for 2-3 weeks) may be prescribed.
- Epidural steroid injections can provide temporary relief for radicular symptoms, as shown in a study on transforaminal injection for degenerative lumbar scoliosis combined with spinal stenosis 2. Bracing is generally not recommended as a long-term solution due to potential muscle weakening. Surgery becomes an option when conservative measures fail, neurological deficits develop, or quality of life significantly deteriorates. Surgical approaches may include decompression for nerve impingement and spinal fusion to stabilize the curve, with the extent determined by curve severity and patient factors, as discussed in a study on operative management of degenerative scoliosis 3. This stepwise approach acknowledges that degenerative scoliosis results from asymmetric disc and facet joint degeneration, causing progressive spinal curvature and potential nerve compression in adults over 50, with management tailored to symptom severity and functional limitations. Key considerations in the management of degenerative lumbar scoliosis include:
- Accurate diagnosis and assessment of the degree of scoliosis and spinal stenosis
- Individualized treatment planning based on patient factors, such as age, medical comorbidities, and symptom severity
- A multidisciplinary approach, incorporating physical therapy, pain management, and surgical intervention as needed
- Regular follow-up and monitoring to assess treatment response and adjust the management plan as necessary, as emphasized in a study on the step treatment strategy of degenerative lumbar scoliosis and spinal stenosis 4.