The discs of the spine perform many important functions. If they experience a loss of disc height or start to dry out, the spine’s structure is compromised, potentially leading to the development of a scoliotic curve over time. When an adult develops degenerative disc disease that leads to degenerative scoliosis, treatment can include a combination of disciplines, including core strengthening and chiropractic care that works towards restoring as much of the spine’s healthy curves as possible.
Degenerative disc disease develops as the spine’s intervertebral discs face degenerative changes, and this can lead to the development of an unnatural spinal curvature: degenerative scoliosis. In order to treat these conditions, their underlying causes have to be addressed.
In order to better understand the role of the spine’s natural curvatures, the intervertebral discs, and the connection between the two, let’s first explore some basic spinal anatomy.
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The spine is important. Not only does it work in tandem with the brain to form the body’s central nervous system (CNS), it also provides the body with structure, allows us to stand upright, practice good posture, and engage in flexible movement.
When viewed from the side, a healthy spine has a soft ‘S’ shape, and when viewed from the front or back, it will appear straight.
The spine’s healthy curvatures give it added strength, flexibility, and aid in the even distribution of mechanical stress; these are important aspects of the spine’s overall health and function.
The spine is made up of bones called vertebrae. These bones are rectangular in shape and are stacked on top of one another in a healthy and natural alignment.
The intervertebral discs also play many important roles when it comes to how the spine functions and maintains its structure, so let’s discuss those.
There are 23 intervertebral discs in the spine that are made up of two main parts: the annulus and the nucleus. The annulus fibrosus is the tough outer layer, and the nucleus pulposus is the inner portion that contains a malleable gel-like substance.
The intervertebral discs sit between adjacent vertebrae, providing cushioning so the individual bones of the spine don’t rub up against one another, creating friction during movement.
The outer layers act as tough ligaments providing the spine with structure and support, while the soft inner layers act as cartilaginous joints that help facilitate the spine’s flexibility.
The outer layer hydraulically seals the inner gelatinous nucleus and helps evenly distribute pressure and force that is exerted on the spine. In addition, the outer portion contains cartilaginous end plates that firmly attach the discs to adjacent vertebrae, giving the spine structure.
The discs provide the spine with the majority of its weight-bearing ability, so what happens if the spine’s intervertebral discs start to deteriorate over time?
At birth, the discs are made up of approximately 80-percent water. In order for the discs to perform optimally, they need to be well hydrated. As people age, the discs can start to lose hydration.
The inner nucleus of the disc is the primary carrier of the body’s axial load, relying on its water-based contents to stay strong and pliable. Over time, the intervertebral discs can lose hydration, becoming stiffer, losing height, and compromising their ability to adjust to compression, bear weight evenly, and maintain the spine’s structure and healthy curves.
While this can happen naturally as part of the aging process, certain lifestyle choices such as not maintaining a healthy weight, chronic poor posture, not staying hydrated, and/or repeatedly lifting heavy objects incorrectly and straining the back can also play a role.
In fact, the root cause behind the development of many degenerative disc disease cases is a lack of motion. As the spine’s very design is based on movement, a sedentary life does not keep a spine healthy.
The intervertebral discs don’t have their own vascular supply, meaning they are only able to replenish their hydration naturally through movement. As movement generates blood flow, and blood flow transports moisture and nutrients to the dics, without movement and moisture, the discs will gradually deteriorate.
In addition, if the spine is facing other spinal conditions such as osteoarthritis or osteoporosis, the spine’s overall health can be compromised, including its intervertebral discs.
Osteoarthritis occurs when the spine’s joints break down, and osteoporosis is reduced bone mass, making the vertebrae weak and prone to injuries like fractures; these conditions often present with degenerative disc disease and degenerative scoliosis.
A twisting injury can also damage a disc and initiate the process of degeneration, and in addition, some people are simply more genetically predisposed to disc issues. It’s generally thought that degenerative disc disease causation is a combination of genetic and environmental factors.
As degenerative disc disease develops, the degeneration can cause micromotion instability, and the inflammatory proteins housed within the soft inner core can leak out of the disc space, causing inflammation of nerves and nerve fibers nearby, which can make the condition painful.
Now, what exactly does the development of degenerative disc disease have to do with adult scoliosis? Let’s start answering that question by addressing what’s happening to the spine as scoliosis develops and progresses.
Scoliosis is an abnormal sideways curvature of the spine that also rotates and has a minimum Cobb angle measurement of 10 degrees.
A patient’s Cobb angle is a measurement taken via X-ray that indicates how far out of alignment a scoliotic spine is.
No two cases of scoliosis are the same, and part of the reason for that is that there is a large range of condition severity from mild to moderate and severe to very severe. Cobb angle also places a condition on its severity scale:
When an adolescent is diagnosed, if the condition is mild and doesn’t progress quickly, it’s not uncommon for it to go unnoticed, especially if no noticeable functional deficits or overt postural changes occur.
It might seem like a progressive spinal condition that makes the spine bend and twist unnaturally would be painful and impossible not to notice, but that’s not always the case.
While scoliosis is most prevalent among children and adolescents, adults can develop the condition too. There are two main forms that affect adults: idiopathic and degenerative.
Idiopathic is the most common form of adult scoliosis, and this type starts as adolescent idiopathic scoliosis (the condition’s most prevalent form) diagnosed between the ages of 10 and 18.
The reason why scoliosis is not always painful is largely related to patient age and compression. For children and adolescents who have not yet reached skeletal maturity, their spines are constantly lengthening, and this motion counteracts the compressive force of the curvature.
This is why so many adults are diagnosed with idiopathic scoliosis that they developed during adolescence, but progressed with into maturity.
While every case is different, generally, once skeletal maturity has been reached in adulthood, compression of the spine and its surrounding vessels, muscles, and nerves makes the condition painful, and it’s this pain that brings them in for a diagnosis and treatment.
After idiopathic scoliosis in adults, the next most common form is degenerative scoliosis, and as touched on, this form is caused by degenerative changes to the spine, mainly its intervertebral discs.
Degenerative disc disease can lead to the development of degenerative scoliosis because as the discs deteriorate, without their support and optimal function, the spine can develop an unnatural curvature.
Also called ‘de novo’, meaning freshly developed in adulthood with no prior history of the condition, degenerative scoliosis is most commonly found in people over the age of 40.
Degenerative scoliosis most commonly affects the lumbar region of the spine (lower back) and on an X-ray commonly appears as a steep lumbar curve with the middle bone of the curvature often slipping to the side (lateral listhesis); this happens because of the weakened fibers in the deteriorating discs.
In addition, the holes through which the spinal nerves pass can also decrease in size, and this can become painful as nerve compression can send shooting pains into the hips and legs.
As the sciatic nerve starts in the lower back, degenerative scoliosis can also cause sciatica nerve pain as the nerve is exposed to uneven pressure, causing pain that extends down the buttocks, the back of the legs (although more commonly the left) and into the feet.
So once a person is diagnosed with degenerative disc disease and/or degenerative scoliosis, what are the treatment options moving forward?
When it comes to treatment options for degenerative disc disease and degenerative scoliosis, most have the same goals in mind: reduce related pain and discomfort so therapeutic exercises are possible, address lifestyle habits that contributed to its development, and work towards restoring the spine’s healthy curves, function and health.
The majority of people with degenerative disc disease and degenerative scoliosis experience postural changes and lower back pain to varying degrees. Related back pain can range from mild to severe, flare up periodically, or be more persistent and chronic.
Nerve-related back pain is often described as the most debilitating form of back pain, such as when the sciatic nerve is compressed, so degenerative disc disease treatment commonly includes some form of pain management.
Traditional treatment for degenerative disc disease tends to focus on managing pain through medication, bracing for stabilization, and eventual surgery; however, most surgeries that address chronic debilitating pain related to degenerative disc disease are invasive.
Traditional treatment for degenerative scoliosis also doesn’t include a lot of options, other than medication, bracing, and spinal surgery once a condition passes the surgical-level threshold.
It’s always best to try less-invasive treatment options first, and it’s my experience that conservative forms of treatment can offer patients very positive outcomes without the heavy potential risks and side effects that invasive spinal surgeries carry.
In addition, it’s not uncommon for back pain and other related degenerative disc disease symptoms to subside over time as the discs start to stiffen with age, and while less flexible, a stiffer disc stabilizes the micromotion instability, reducing pain. However, this process is gradual, can take many years to occur naturally, and comes at the price of spinal flexibility. In the meantime, there are conservative treatment options capable of managing pain, promoting disc regeneration, and reducing scoliotic curves.
As it’s the deterioration of the intervertebral discs that is the problem in both degenerative disc disease and degenerative scoliosis, treatment should focus on how to work towards reversing some of these effects to restore the health and function of the discs.
Here at the Scoliosis Reduction Center, when treating patients with degenerative disc disease and/or degenerative scoliosis, the goal is to restore the health of the discs and the spine’s healthy curves as much as possible; by doing this, we are addressing the underlying cause of any related pain by working towards realigning the spine, improving its ability to evenly distribute weight and stress.
Degenerative disc disease can’t be fully reversed, and degenerative scoliosis can’t be cured, but proactive treatment can work towards controlling their progression, promoting some level of disc regeneration, and restoring as much of the spine’s healthy curves as possible.
I see a big difference between treating a condition’s symptoms, or the underlying cause of the symptoms: the condition itself.
Treating the Underlying Cause: Asymmetrical Load Bearing
Here at the Center, every condition is addressed with a treatment plan that targets its underlying cause; that way, related symptoms are also addressed as their underlying cause is positively impacted.
The only way to potentially reverse some of the effects of degenerative disc disease and degenerative scoliosis is to address the structural misalignment of the spine as this is at the root of the issue. The straighter a spine is, the healthier it is both in terms of function and resistance to deterioration. In addition, a spine has to be aligned in order to evenly distribute weight and stress.
So by addressing the cause of degenerative disc disease and degenerative scoliosis, we are attempting to make improvements to the spine’s misalignment on a structural level.
Just as degenerative spinal conditions are known to develop slowly over time, efforts made to reverse some of their effects can be equally lengthy. It can take a comprehensive treatment plan and full commitment from the patient, but when we work towards restoring as much of the spine’s healthy curvatures as possible, we are realigning the spine on a structural level.
To better understand this, if you think of a misaligned car with one tire wearing out faster than the others, it’s not that there is actually anything wrong with that one tire; the tire is wearing out faster because there is an asymmetrical load causing uneven wear on the tires; this concept also explains what can happen to the spine.
While aging can contribute to degeneration, it’s not the sole cause because if it was, every disc of the spine would wear evenly, but instead, the discs facing the most degeneration are at the site of the misalignment.
So to treat degenerative disc disease effectively, the underlying cause of weight-bearing issues due to misalignment has to be addressed. The challenge with treating degenerative disc disease in scoliosis patients is that, although we can make improvements, we are never going to get a perfectly-aligned spine, which is why we can’t completely reverse the disc degeneration that has developed over time.
Effective proactive treatment involves removing the asymmetrical load from the affected discs for as long as possible and as much as possible, meaning that work has to continue even after the curvature has been reduced to sustain the results.
By reducing a patient’s scoliosis and correcting as much of the misalignment as possible, the discs have the potential to recover and regenerate to a certain extent; however, just as the effects of disc degeneration take place slowly over time, so too is the process of restoring their health.
Through chiropractic care, in-office therapy, custom-prescribed asymmetrical mobility exercises, and specialized corrective bracing when needed, we can work towards strengthening the muscles that have become lax on the interior of the curve and tighten those on the curve’s outer side.
By working towards restoring balance and strength to the spine’s surrounding muscle groups that have grown lax on the curvature’s inner side, the muscles are better equipped to support and stabilize the spinal column in a natural position; this reduces the asymmetrical load being placed on the discs and can gradually restore some of their health and function.
Degenerative disc disease and degenerative scoliosis often present together as the intervertebral discs and the alignment of the spine are inextricably linked.
Not only do the discs help facilitate movement of the spine and act as its shock absorbers, they also provide the spine with structure. If discs start to degenerate as part of the natural aging process, or for another reason, they lose height, and this loss of height can cause the ligaments supporting the spine to become lax, and this can cause the vertebrae to twist and shift into an unnatural curve: scoliosis.
A degree of regeneration of the intervertebral discs is possible if the condition is caught in its early stages, before it has progressed significantly. By addressing the underlying cause and reducing the asymmetrical-load issues the discs are experiencing, the discs can regenerate and regain some of their function over time.
As degenerative scoliosis is treated proactively by working towards a curvature reduction and strengthening the surrounding spinal muscles, the misalignment that is causing that uneven load bearing is improved upon as the spine’s healthy and natural curvatures are restored, and muscles are strengthened to provide the spine with better support and stabilization.
While there is no quick fix that works to reverse the effects of disc degeneration that has occurred over time, just as degenerative scoliosis can be improved upon through proactive treatment, ideally started early on in the condition’s progressive line, disc and overall spinal health can also be improved upon.
Here at the Scoliosis Reduction Center, degenerative disc disease and degenerative scoliosis are conditions we treat proactively through a dynamic and integrative approach combining chiropractic care, in-office therapy, specialized corrective bracing, and custom-prescribed home exercises.
If you, or a loved one, is facing the development of a spinal condition that impacts its overall health and function, the time to act is now before the condition further progresses and becomes more difficult to treat.
With proactive treatment and commitment, patients can experience marked and measurable improvements both with degenerative disc disease and degenerative scoliosis.