Differential Diagnosis for Scoliosis of the Thoracic Spine in a 60-year-old
- Single Most Likely Diagnosis
- Degenerative scoliosis: This is the most common cause of scoliosis in adults over 60, resulting from wear and tear on the spine, disc degeneration, and facet joint osteoarthritis. The curvature can lead to back pain, stiffness, and neurological symptoms.
- Other Likely Diagnoses
- Idiopathic scoliosis: Although often diagnosed in adolescence, some cases may not be severe enough to be noticed until adulthood. The curvature can progress over time, especially in older adults.
- Osteoporotic compression fractures: These can lead to a kyphotic deformity, which may be mistaken for or contribute to scoliosis. Osteoporosis is common in older adults, especially postmenopausal women.
- Spondylolisthesis: This condition, where one vertebra slips forward over another, can cause or contribute to scoliosis, especially in the presence of degenerative changes.
- Do Not Miss Diagnoses
- Spinal tumor: Both primary and metastatic tumors can cause scoliosis by weakening the spine or compressing the spinal cord. Early detection is crucial for treatment and prognosis.
- Infection (e.g., osteomyelitis, discitis): Infections of the spine can lead to rapid progression of deformity and neurological compromise. Prompt diagnosis and treatment are essential to prevent long-term damage.
- Neurological conditions (e.g., Parkinson's disease, cerebral palsy): Certain neurological conditions can cause or contribute to scoliosis due to muscle imbalances or spasticity.
- Rare Diagnoses
- Neuromuscular scoliosis: Conditions like muscular dystrophy can cause scoliosis, although they are less common in a 60-year-old population.
- Congenital scoliosis: Although typically diagnosed in childhood, some mild cases might not be recognized until adulthood.
- Traumatic scoliosis: Significant trauma can cause a spinal deformity, including scoliosis, especially if there are fractures or ligamentous injuries involved.