Adult scoliosis (curved spine) occurs for two reasons. First, it may occur in adolescence (adolescent idiopathic scoliosis). Second, this degenerative or ab initio type of scoliosis occurs after the age of 40 and is thought to be the result of arthritis or spinal degeneration with changes in alignment due to degeneration of the intervertebral discs and joints. It is known that scoliosis that occurs in developing children will worsen as they grow. It is thought that scoliosis equal to or greater than 50 degrees may worsen at an average level of about 1 degree per year after skeletal maturity. Scoliosis of less than 30 degrees rarely worsens. This is known as a natural history, or if not treated the spine happens to be what was once caused. Scoliosis from the head may also worsen by a few degrees per year, especially if the patient has osteoporosis and sequential collapse of the vertebrae. Symptoms and diagnosis: Because both types of scoliosis are associated with arthritis, many patients will have back pain and muscle fatigue, and possibly leg pain. Larger scoliosis (more than 40 degrees) should be checked regularly due to the increase in the size of the scoliosis. Worsening of scoliosis and/or osteoporosis can lead to a decrease in height along with other symptoms as previously described. Evaluation involves the use of plain X-rays, MRI scans and possibly CT scans. These studies help identify abnormalities of the spine and surrounding nerve roots and spinal cord that may be associated with spinal deformities. Treatment: Treatment includes NSAIDs for pain relief, physical therapy to improve overall function, and exercise to improve strength. If medications and treatments do not work, steroid or local anesthetic injections into the muscles, joints, or spinal canal may be an option. If curvature increases or other symptoms worsen, surgical treatment is often necessary. The type of surgical treatment is variable, depending on the type and size of the scoliosis. The most common procedure is posterior spinal fusion with metal implants and bone grafting (from the pelvis and bone bank), with or without nerve root decompression. Sometimes, the surgery may need to be performed anteriorly (from the anterior spine) and is done for better stabilization, correction and healing. Sometimes a combination of anterior surgery (anterior spine) and posterior surgery (posterior spine) is necessary to correct the problem. Hospitalization for these procedures depends on the type of surgery and all of the patient’s conditions. Many adults smoke before and after scoliosis surgery treatment or receive medical conditions that may affect healing and recovery time. Braces may be used after surgery. Details about returning to normal physical and athletic activity, post-operative care, and other issues should be discussed with the patient’s surgeon prior to surgery.