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Spinal Deformity

  • An abnormal alignment or curve in the bony vertebral column that forms the spine
  • Symptoms may include a visible curve in the spine, feeling off balance, and pain
  • Physical therapies can help reorient the spine and slow down the advancement of the curve
  • Involves spine center, spine surgery, and neurosurgery

Overview

The spine consists of an elegant stack of vertebrae and disks, which appear straight from the front and curved from the side, to keep the body erect and the head level. An abnormal curve in your spine, such as scoliosis or kyphosis, is known as a spinal deformity. It can affect your spine's ability to do its job, leading to pain, neurological problems, and mobility challenges. Spinal deformities can occur for a wide range of reasons, including birth defects, aging and degeneration, to trauma.

When the spine becomes weak or deformed, the rest of the body reacts. Muscles strain, lungs pump harder, and simple functions (such as walking) become difficult. The Yale Medicine Spine Center offers neurosurgery, orthopedics, pain management and physical therapy to patients, depending on their needs. "It's a team-based approach, which is different from physicians who are just focused on their own practice," says neurosurgeon Joseph Cheng, MD.

What are spinal deformities?

All spinal deformities involve problems of the curve or rotation of the spine. Common adult spinal deformities are scoliosis, kyphosis, and lordosis.

  • Kyphosis involves the upper back curving forward. The condition can create the form of a hump.
  • Lordosis is also known as swayback. This is a deformity of the lower back, in which it curves inward instead of outward.
  • Scoliosis is a frontal deformity in which the spine, when viewed straight on, curves to the left or the right. This curving ordinarily ends at the same time the skeleton stops growing but in adulthood, the curve can still progress slightly, often as a result of disk degeneration.

What are the symptoms of spinal deformity?

Symptoms differ, depending on the type of deformity. They may take the form of:

  • Pain. For scoliosis, this pain may occur in the upper spine and the ribs.
  • Feeling of being off balance or difficulty walking or standing. When the spine isn’t in correct alignment, the body and head aren’t either.
  • Visible curve (hunched over). In kyphosis, in particular, the outer curve in the upper back may be noticeable. In scoliosis, one shoulder blade, or hip, may appear higher than the other.
  • No symptoms. For some patients with mild deformities, the curves may not cause any symptoms.

When these spinal deformities lead to pain or affect your ability to perform daily activities, or if they cause dysfunction of the spinal cord/nerve roots, treatment (surgical and/or non-surgical) may be required.

How are spinal deformities diagnosed?

To diagnose a spinal deformity, a specialist will perform a physical examination and order x-rays of the spine. During an exam, the doctor will usually ask the patient to move into a few positions, such as a forward bend, in order to observe the spine as it moves. To see whether there is an underlying cause of the curve, we may recommend imaging, such as magnetic resonance imaging (MRI) or computerized tomography (CT) scans, in order to analyze the internal structure of the spine and surrounding area.

What are treatments for spinal deformities?

To treat spinal deformities, we look to relieve pain, lighten the strains on the spine, prevent deterioration of spinal structures such as disks and vertebrae, ease breathing if the lungs are affected, and reduce the appearance of the deformity.

When doctors determine the best approach, they consider whether a spinal deformity is stable or unstable. Intervention may not be needed if the deformity is not progressing and the symptoms aren’t a problem for the patient. In these cases, specialists will monitor the curve and treat when necessary. There are also several methods of physical therapies to treat spinal deformities by helping to reorient the spine and slow down the advancement of the curve.

When is spinal surgery necessary?

Surgery is performed is the curve is symptomatically compressing your organs or if the curve continues to progress or if the pain become severe and is unresponsive to medical and conservative care. Spinal surgery involves mobilizing and straightening the spine, and then placement of instrumentation with a spinal fusion in order to hold the spine in the new position and prevent further progression of the curve. 

Neurosurgeons use a combination of screws and rods and bones (taken from another part of the body) to encourage growth of new bones in better positions.

Patients can expert to recover from this surgery within two months.

What are risk factors for spinal deformities?

Many cases of scoliosis have no identifiable cause. There are a few known genetic conditions that may put someone at risk of developing scoliosis, including cerebral palsy, muscular dystrophy, and achondroplasia, which is a condition affecting cartilage, or spinal muscular atrophy, a disorder that affects voluntary muscle movement.

For kyphosis, risk factors include poor posture and fractures resulting from osteoporosis or injury.

Osteoporosis is also a risk factor for lordosis. Slipped vertebrae and obesity may also cause the condition. 

Are spinal deformities treated differently in children, adults, and the elderly?

Children and adults are treated differently. When treating children with spinal deformities, nonsurgical treatments are often chosen since children's bones are still developing. A brace, for example, can direct a child’s growing spine into the right alignment. In adults, the same treatment would be less effective because the spine is already rigid in its position.

In older adults, if osteoporosis is the underlying cause of the deformity, we may treat it with calcium, hormone replacement therapy, or weight-bearing exercises. Bracing is another nonsurgical option for adults. It will not change the position of the spine, but it may ease pressure and pain. Orthotics (shoe inserts) can also help reduce back pain if the legs have been affected by the spine’s changing shape.

How does Yale Medicine treat spinal deformities differently from other institutions?

Yale Medicine's world-class research programs set it apart from other health institutions.

"Patients will always have their case scrutinized by multiple doctors to see how we could improve," Dr. Cheng says. "That's the difference between an academic institution and a community hospital."

In addition, Yale Medicine provides a breadth of services for patients with complex problems that is unparalleled by other institutions. Dr. Cheng and his team work with pain physicians, podiatrists, and other neurosurgeons to develop a comprehensive treatment plan for their patients.