Spine Deformities
What Is a Spinal Deformity?
A healthy human spine has a gentle curvature that optimally distributes our body weight, allowing us to walk, bend, stretch, and rotate. An excessive or distorted curvature, or spinal deformity, redistributes body weight in a way that can cause pain, limit mobility, reduce range of motion, and force other structures, such as the pelvis, to compensate.
A spinal deformity may be evident at birth or develop during adolescence. We’ll confine our discussion to curvatures that develop during adulthood. This phenomenon is sometimes called adult spinal deformity (ASD).
Spinal deformity is an umbrella term covering an extensive list of diagnoses associated with irregularities in the shape or curvature of the spine. Depending on their shape, location, and direction, these curvature disorders are known as scoliosis, lordosis, or kyphosis:
- Scoliosis is an abnormal S- or C-shaped sideways curve.
- Lordosis is an exaggerated front-to-back curvature affecting the lumbar, thoracic, or thoracolumbar spine.
- Kyphosis is an abnormally convex (rounded), humplike curvature, usually affecting the cervical spine.
How Common Is Spinal Deformity?
The incidence of spinal deformity varies, depending on its cause. Overall, this phenomenon is increasing as the nation’s 11 million Baby Boomers reach age 60. In fact, the average age of a patient undergoing surgery for spinal deformity is 59½ years. Six in 10 patients are women, and eight in 10 are white.
These statistics suggest that women and whites are more likely to develop spinal deformities; however, people in these groups might simply be more likely to receive treatment.
Spinal Deformity Symptoms
The cardinal symptom of spinal deformity is back and leg pain.2 This pain often intensifies over the course of the day, as you become fatigued. You may also be stiff in the morning or have pain when walking. Some patients are unable to walk at all.
Your doctor will probably ask you to rate your pain at each visit. This rating is subjective. A patient with severe, disabling pain might give it a 5 or 6 out of 10, while a patient with only moderate pain might report a score of 8 or 9. The purpose of this rating, though, is not to compare patients to each other, but to compare your own scores over time. In other words, asking you to rate your pain will help your doctor gauge how well your treatment is working.
Spinal Deformity Causes
Spinal deformity is characterized by degeneration, misalignment, or malformation of spinal structures. Scientists are investigating various genetic predispositions, and disorders such as osteoporosis (fragile bones), osteopenia (low bone mineral density), degenerative disc disease, and spinal arthritis are associated with the development of spinal deformity. But usually no cause can be found, and the disease is said to be idiopathic.
How Spinal Deformity Is Diagnosed
Your doctor will ask about your medical, family, and social history; perform a thorough physical examination to determine your range of motion; measure your height and weight; and ask about your activities of daily living (ADLs).
Treatment becomes more urgent if your spinal deformity is making it hard for you to perform simple tasks like grocery shopping, cooking, or showering.
Documenting Spinal Curvature
When you get a blood test for diabetes, the lab returns a value—let’s imagine your blood sugar level was reported to be 170. This value means nothing unless you know that the normal range for blood sugar is 70 to 140. Thus, a level of 170 may indicate that you have diabetes.
Likewise, your spine doctor must not only measure your spine, but also figure out how much its curvature deviates (that is, departs or diverges) from the curvature of a healthy spine. Your spine, of course, can be examined by the doctor. X-rays, too, are important in diagnosing spinal deformities.
Analyzing the Spine in Three Dimensions
Your physician will analyze your spine not just by itself, but also relative to the position of other structures, such as the pelvis. That’s important, since the body may compensate for a spinal deformity by recruiting other structures for help in walking, weight bearing, and the like. This compensatory mechanism may affect the tilt of the pelvis or the flexion of the hips, knees, or ankles.
Human Anatomy Planes
Dividing the body into different imaginary planes, or layers, makes it easier for doctors to measure various three-dimensional angles and positions:
- The coronal plane segments the body in half from front to back.
- The sagittal plane divides the body into left and right halves.
- The transverse plane creates a cross-section through the body.
Notice that all these planes create right angles—perfectly straight L shapes or T shapes. The doctors can then measure the amount of deviation from any of these straight lines.
In the past, your doctor would simply have formed a mental picture of the geometry of your spine. Perhaps he or she would’ve jotted down a few angles and measurements, or even made a little sketch. But thanks to advances in biocomputing, your doctor can now create a 3D rendering of your actual and ideal spine. This electronic model of your anatomy is invaluable in surgical planning.
Classifying Spinal Deformities
The Scoliosis Research Society (SRS)–Schwab classification system categorizes spinal curvature using a letter system:
- T = Thoracic only
- L = Thoracolumbar only
- D = Double curve
- N = No curve
This system also includes a series of precise modifiers to indicate global alignment, identify the angle of pelvic tilt, and so on. The important thing to know is that the SRS–Schwab designations are widely used in diagnosis and surgical planning.
How a Spinal Deformity Is Diagnosed
Your doctor will ask about your medical, family, and social history; perform a thorough physical examination to determine your range of motion; measure your height and weight; and ask about your activities of daily living (ADLs). Treatment becomes more urgent if your spinal deformity is making it hard for you to perform simple tasks like grocery shopping, cooking, or showering.
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