Spinal Deformity: Young and Not-So-Young

Spinal deformity is the presence of an abnormal curvature of the spine. This may present as either an “S” shaped curve noticeable from behind the patient or a “C” shaped curvature noticeable from the side of the patient, sometimes referred to as a “roundback” deformity or “hump.”

Scoliosis

Scoliosis is the S-Shaped curvature seen from a person’s back. It is sometimes associated with a tilted shoulder or prominent shoulder blade or rib hump. It is most commonly seen in adolescent females, around the pubertal growth spurt (age 10-14). The problem is that the condition is usually painless in its early phase and is not visibly detectable, so it eludes diagnosis. That is why it must be screened at either school, the pediatrician’s, or family doctor’s office. If undetected, the spinal curvature may progress to surgical proportions, disallowing any other treatment options.

If, however, the condition is diagnosed early, then the spine may either be observed with serial exams and/or x-rays or may require a brace to prevent progression (worsening) of the curvature. Usually a brace must be worn 2-4 years until skeletal maturity is achieved and spinal growth is complete. In most cases, this marks the end of progression of the scoliosis. Most children are followed with semi-annual x-rays, which should show little worsening of the curvature. Less than 25% of kids need a brace and less than 5% require surgery.

Diagnosis

The easiest way to diagnose scoliosis is to have the patient bend forward (Adam’s Forward Flexion Test) while the examiner inspects the trunk and chest while standing at the patient’s head. Observe the chest wall asymmetry and the “rib hump” resulting from the spinal rotation of the thoracic spine. The final and quantitative diagnosis is then made by x-ray evaluation to show the actual spinal curvature and the degree (severity) of the curve. If scoliosis greater than 10°-20° is noted (in a skeletally immature patient), then follow up x-rays and office visits are performed every 6 months.

Kyphosis

This is the spinal deformity resulting in a “roundback” deformity sometimes known as “Dowagers Hump.”

In the adolescent, this is most commonly seen in males. Most often it results from Scheuermann’s disease which represent vertebral growth plate arrest and irregularities which cause several vertebrae to deform, then causing the spine to deform. This also occurs during the pubertal growth spurt and often times is asymptomatic (no pain). This makes the need for screening of this condition crucial. Kyphosis can respond very well to bracing, however, the brace is more demanding to wear.

Adults can develop spinal deformity if an adolescent deformity simply continues to deform over time. Other spines may develop abnormal curvature resulting from progressive asymmetric disc degeneration. Occasionally spine fractures may result in a kyphotic deformity.

Surgery

Surgery becomes necessary if a deformity gets too large or if the patient develops chronic unrelenting pain and disability from the deformed spine. Occasionally there may be neurologic deterioration of the legs which may impair the ability to walk.

Goals:

  • Relieve the pain
  • Improve the function (of the legs and back)
  • To try to reconstruct and correct the spinal deformity

Reconstruction usually requires some form of instrumentation (titanium screws and rods) of the vertebra, at which time some sort of fusion is performed. Most often, a very significant correction of the deformity can be achieved. This can be performed safely now with advanced techniques of spinal cord monitoring and anesthesia.

Results

  • Pain and function are usually resolved/restored.
  • Patient’s self-image is markedly improved as a result of the re-sculpturing of the spine and trunk.

Follow-up office visits extend up to a year and often up to 2-5 years post-op to monitor stability of the fusion.