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 degenerative changes in the spine, such as disc degeneration, facet joint osteoarthritis, and ligamentous laxity. The symptoms can include back pain, deformity, and neurological symptoms due to spinal stenosis or foraminal narrowing.
Other Likely Diagnoses
- Osteoporotic Compression Fractures: These can lead to kyphosis or scoliosis, especially in the thoracic spine, due to weakened bone structure. The patient may present with back pain, height loss, and deformity.
- Idiopathic Scoliosis: Although more common in adolescents, idiopathic scoliosis can also present in adults, either as a progression of untreated adolescent scoliosis or as a de novo condition. Symptoms can include back pain, deformity, and respiratory issues if the curvature is significant.
- Spondylolisthesis: This condition, where one vertebra slips forward over another, can contribute to scoliosis, especially in the presence of degenerative changes. Symptoms may include back pain, neurological deficits, and deformity.
Do Not Miss Diagnoses
- Spinal Tumors: Both primary and metastatic tumors can cause scoliosis by weakening the spine or by direct invasion of the spinal elements. It's crucial to consider this diagnosis due to its significant implications for treatment and prognosis.
- Infection (Osteomyelitis, Discitis): Infections of the spine can lead to rapid progression of deformity and neurological compromise. Early diagnosis is critical for effective treatment.
- Trauma: Acute or chronic trauma can result in scoliosis, especially if there are fractures or ligamentous injuries that destabilize the spine.
Rare Diagnoses
- Neuromuscular Scoliosis: Conditions such as muscular dystrophy, spinal muscular atrophy, or Parkinson's disease can cause scoliosis due to muscle imbalance. While less common in a 60-year-old, these conditions can present at any age.
- Congenital Scoliosis: Although typically diagnosed in childhood, some cases of congenital scoliosis may not become apparent until adulthood, especially if the curvature is mild.
- Ehlers-Danlos Syndrome: This genetic disorder can lead to hypermobile joints and, in some cases, scoliosis. It's a rare consideration but important in patients with a known family history or other systemic manifestations.