Complex Spinal Deformity

Scoliosis

Scoliosis is a lateral (toward the side) curvature in the normally straight vertical line of the spine. When viewed from the side, the spine should show a mild roundness in the upper back and shows a degree of swayback (inward curvature) in the lower back. When a person with a normal spine is viewed from the front or back, the spine appears to be straight. When a person with scoliosis is viewed from the front or back, the spine appears to be curved.

Treatments for scoliosis include:

  • Braces. Bracing is the usual treatment choice for adolescents who have a spinal curve between 25 degrees to 40 degrees — particularly if their bones are still maturing and if they have at least 2 years of growth remaining. The purpose of bracing is to halt progression of the curve. It may provide a temporary correction, but usually the curve will assume its original magnitude when bracing is eliminated.
  • Surgery. Those who have curves beyond 40 degrees to 50 degrees are often considered for scoliosis surgery. The goal is to make sure the curve does not get worse, but surgery does not perfectly straighten the spine. During the procedure, metallic implants are utilized to correct some of the curvature and hold it in the correct position until a bone graft, placed at the time of surgery, consolidates and creates a rigid fusion in the area of the curve. Scoliosis surgery usually involves joining the vertebrae together permanently– called spinal fusion

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Kyphosis

The most common symptoms for patients with an abnormal kyphosis are the appearance of poor posture with a hump appearance of the back or “hunchback,” back pain, muscle fatigue, and stiffness in the back. Most often, these symptoms remain fairly constant and do not become progressively worse with time.

In more severe situations, the patient may notice their symptoms worsening with time. The kyphosis can progress, causing a more exaggerated hunchback. In rare cases, this can lead to compression of the spinal cord with neurologic symptoms including weakness, loss of sensation, or loss of bowel and bladder control. Severe cases of thoracic kyphosis can also limit the amount of space in the chest and cause cardiac and pulmonary problems leading to chest pain and shortness of breath.

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Spondylolisthesis

Spondylolisthesis is a condition of the spine whereby one of the vertebra slips forward or backward compared to the next vertebra. Forward slippage of one vertebra on another is referred to as anterolisthesis, while backward slippage is referred to as retrolisthesis. Spondylolisthesis can lead to a deformity of the spine as well as a narrowing of the spinal canal (central spinal stenosis) or compression of the exiting nerve roots (foraminal stenosis). In most cases it is not possible to see visible signs of spondylolisthesis by examining a patient. Patients typically have complaints of pain in the back with intermittent pain to the legs. Spondylolisthesis can often cause muscle spasms, or tightness in the hamstrings. Spondylolisthesis is easily identified with X-rays.

Types of spondylolisthesis

There are different types of spondylolisthesis. The more common types include:

  • Congenital spondylolisthesis — Congenital means “present at birth.” Congenital spondylolisthesis is the result of abnormal bone formation. In this case, the abnormal arrangement of the vertebrae puts them at greater risk for slipping.
  • Isthmic spondylolisthesis — This type occurs as the result of spondylolysis, a condition that leads to small stress fractures (breaks) in the vertebrae. In some cases, the fractures weaken the bone so much that it slips out of place.
  • Degenerative spondylolisthesis — This is the most common form of the disorder. With aging, the discs — the cushions between the vertebral bones — lose water, becoming less spongy and less able to resist movement by the vertebrae.

Less common forms of spondylolisthesis include:

  • Traumatic spondylolisthesis, in which an injury leads to a spinal fracture or slippage
  • Pathological spondylolisthesis, which results when the spine is weakened by disease — such as osteoporosis — an infection, or tumor
  • Post-surgical spondylolisthesis, which refers to slippage that occurs or becomes worse after spinal surgery

Spondylolisthesis is graded according the percentage of slip of the vertebra compared to the neighboring vertebra.

  1. Grade I is a slip of up to 25%,
  2. Grade II is between 26%-50%,
  3. Grade III is between 51%-75%,
  4. Grade IV is between 76% and 100%, and
  5. Grade V, or spondyloptosis occurs when the vertebra has completely fallen off the next vertebra.

The most common symptom of spondylolisthesis is lower back pain. This is often worse after exercise especially with extension of the lumbar spine. Other symptoms include tightness of the hamstrings and decreased range of motion of the lower back. Some patients can develop pain, numbness, tingling or weakness in the legs due to nerve compression. Severe compression of the nerves can cause loss of control of bowel or bladder function.

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