Spine Center - Scoliosis and Spinal Deformity

 

 

scoliosisSpinal deformity is a condition with abnormal alignment of the spine.  Scoliosis refers to a S-shaped curve when the spine is visualized from the back.  Kyphosis or positive sagittal balance spinal deformities refer to a C shaped curve when the spine is visualized from the side.  Patients with severe spinal deformity can have chronic pain, functional disability, and overall poor quality of life.  Normal alignment of the spine allow us humans to stand and walk efficiently, without overexpenditure of energy.  Humans achieve that efficiency by posturing our heads over the shoulder, our shoulders over the pelvis, and the pelvis over our knees and feet.  This posture allows transmission of gravitational forces on our body to the axial skeleton and muscles, and it minimizes the amount of energy we spend on standing and walking.  Patients with spinal deformity cannot achieve or maintain this optimal spinal alignment.  As a result, they experience pain, fatigue, and functional disability.

Causes:

Scoliosis and spinal deformity can result from a variety of causes.  The causes include congenital anomalies, neuromuscular diseases, degenerative disease, trauma, infection, and idiopathic (unknown).  The most common cause of scoliosis and spinal deformity in adult is degenerative spine diseases.  Asymmetry in the amount of degenerative changes in the spine cause eccentric force distribution to the spine.  In addition, it is not uncommon to have spinal instability associated with severe degenerative disease of the spine.  The combination of abnormal force distribution and the underlying spinal instability in a degenerative spine cause rotation and slippage of vertebral bodies, leading to scoliosis or kyphosis.

Unlike adults, scoliosis in children and adolescents are either from developmental anomalies or idiopathic (unknown).  Children who have failure to form proper spine anatomy have congenital scoliosis.  The extent of the deformity is related to the local curvature from the abnormal spine development and the number of levels involved.  In the adolescents, the most common cause of scoliosis or spinal deformity is unknown (adolescent idiopathic scoliosis and Schauermann’s disease). 

Symptoms:

During adolescence, obvious curvature of the spine is often noted by patients, parents, or medical staff during screening.  Severe deformity of the spine can result in pain, poor appearance, and low self-esteem in adolescence.   In adults, pain, fatigue and difficulty with walking and standing are the most common symptoms in patients with spinal deformity.  Other complaints include nerve pain (neurogenic claudication) from spinal stenosis or lumbar radiculopathy.  These patients often cannot stand or walk for a significant period of time.  In very severe spinal deformity, patients are unable to stand upright and they have visible, abnormal shifting of their upper body in relationship to their pelvis and legs.

Diagnostic tests:

Severe spinal deformity can often be diagnosed by physical examination alone.  Palpation over the spinous process will detect the curves and rotation of the spine.  Examination of postural stance will detect any inability to maintain normal upright posture.  Standing long-cassette 36 in x-rays with anterior posterior and lateral view is a standard to evaluate patient with spinal deformity.  The study allows determination of the affected region, number of levels involved, the extent of the curve, and magnitude of global spine imbalance.  Bending films are often obtained to determine the flexibility of the curves and areas of compensatory curves.  CT and MRI are typically obtained prior to a surgical intervention.  CT scan allows surgeons to determine the extent of osteophyte formations as an indicator of curve flexibility and it allow determination of appropriate pedicle screw sizes prior to surgery.  MRI should be obtained in patients with atypical curves and left sided curves.  Almost all idiopathic scoliosis are right-handed curves, and left-sided curves can be associated with underlying central nervous abnormalities, including spinal cord tumors, tethered cord syndrome, and Chiari malformations.  MRI should also be obtained in patients with symptoms of myelopathy, radiculopathy, or neurogenic claudication to determine the areas neural compression.    

Treatment:

The treatment of adult patients with spinal deformity is based on the severity of deformity and symptoms.  Patients with mild or moderate spinal deformity and without significant pain or neurological symptoms are treated conservatively with medication, bracing, physical therapy, or injection.  On the other hand, patients with severe spinal deformity with curves greater than 45 degree or severe positive sagittal balance deformity will have severe pain, functional disability, and cardiopulmonary compromise in some cases.  Surgical treatment is recommended for patients with large curves to stabilize and prevent progression of deformity, and to improve their pain and quality of life.  Spinal deformity surgeries are complex procedures that are performed to reconstruct spinal alignment and they are technically demanding.  Studies have shown that these procedures are effective for improving pain and quality of life in individuals with spinal deformity.  The success rate of surgical correction can be up to 90% when solid fusion and restoration of normal spinal balance is achieved.  However, these surgeries are associated with a mortality rate of approximately 5% and major morbidity rate of over 20%.  Over the past couple years, minimally invasive procedures are now available for selective spinal deformity patients and they can potentially reduce the overall complication rate associated with these surgeries.

For comments, questions, requests or to make an appointment, click here.