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Spinal Deformity

The normal spine is structurally balanced for optimal flexibility and support of the body’s weight. When viewed from the side, it has three gentle curves. The lumbar (lower) spine has an inward curve called lordosis. The thoracic (middle) spine has an outward curve called kyphosis. The cervical spine (spine in the neck) also has a lordosis. These curves work in harmony to keep the body’s center of gravity aligned over the hips and pelvis. When viewed from behind, the normal spine is straight.

Abnormal curvature in the spine can put it out of alignment. Abnormal curvature seen from the side is called sagittal imbalance.Types of sagittal imbalance include kyphosis, flatback syndrome, and chin-on-chest syndrome. Abnormal curvature of the spine seen from the back is called scoliosis.

Each of these conditions can arise for a variety of reasons, including congenital deformity (deformity present at birth), age-related degeneration, disease processes like tumors or infections, other conditions, or idiopathic causes (causes that are not yet understood).

Symptoms

Signs are observable indications of a condition. Signs can be seen or felt by people other than the patient. Signs of scoliosis may include a difference in shoulder or hip height, a difference in the way the arms hang beside the body, a spine that is visibly off-center, or a head that appears off-center with the body. Signs of sagittal imbalance may include a stooped forward posture, a hump in the back, or an inability to stand up straight.

Symptoms can be felt by the person with the condition. Symptoms of scoliosis vary: most cases of infantile, juvenile, and adolescent scoliosis, for example, produce no symptoms. Degenerative scoliosis is often accompanied by pain. Symptoms of sagittal imbalance range from mild discomfort to severe pain. Spinal deformities also have the capacity to interfere with the spinal cord or nerve roots. Stretch or compression of the spinal cord or nerve roots produces symptoms that may include pain, weakness, numbness, or tingling that travel down an arm or a leg.

Diagnosis

To establish the existence and extent of spinal deformity, the following tests may be useful:

X-ray (also known as plain films): test that uses invisible electromagnetic energy beams (X-rays) to produce images of bones. Soft tissue structures such as the spinal cord, spinal nerves, the disc and ligaments are usually not seen on X-rays, nor on most tumors, vascular malformations, or cysts. X-rays provide an overall assessment of the bone anatomy as well as the curvature and alignment of the vertebral column. Spinal dislocation or slippage (also known as spondylolisthesis), kyphosis, scoliosis, as well as local and overall spine balance can be assessed with X-rays. Specific bony abnormalities such as bone spurs, disc space narrowing, vertebral body fracture, collapse or erosion can also be identified on plain film X-rays. Dynamic, or flexion/extension X-rays (X-rays that show the spine in motion) may be obtained to see if there is any abnormal or excessive movement or instability in the spine at the affected levels.
Magnetic resonance (MR) imaging: uses a magnet and radio waves to provide detailed images of the spine as well as the spinal cord, the spinal nerves, and other soft tissues
Computed tomography (CT) scan: a diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce detailed images of bones and soft tissues. CT scans are more detailed than general X-rays.

Treatments

For the most part, nonoperative treatments are recommended before surgery is considered. Nonoperative treatments include pain medications, physical therapy (including gait and posture training), and certain braces.

Surgery is considered if:

The patient experiences severe pain that is not relieved by physical therapy, bracing, and/or pain medications
The spinal deformity is progressing
The condition has caused a physical deformity that is unbearable to the patient
The condition has caused compression of the spinal cord or nerve roots
The deformity has resulted from fractures, usually caused by osteoporosis
The deformity is of such a magnitude that it is likely to progress even once skeletal growth is complete

The goals of surgery are to relieve symptoms and to align and stabilize the spine. However, since spinal deformity varies from patient to patient, no two surgical treatments will be the same. Our experienced surgeons can determine the best treatment for each patient and each situation.

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