Scoliosis is a descriptive term that describes the curvature of the spine. When looking at the spine from the side, the spine is normally curved. For instance, the cervical and the lumbar spine have lordosis (backwards sway) while the thoracic spine has kyphosis (forward sway). These curves help maintain the normal neutral position of the body and help keep the head centered above the pelvis. If the head is not centered above the pelvis when a person is standing, then the spine is described as having a kyphotic deformity (i.e. has an abnormal amount of kyphosis).
When looking at the spine from the front or back, the spine is straight. However, when there is a curvature of the spine when viewed from the front or back, then the term scoliosis is used. There are many causes for scoliosis and include congenital, idiopathic, neuromuscular, iatrogenic or degenerative.
Congenital scoliosis is a curvature of the spine that is the result of malformations of the vertebral of the spine. The early stages of development of the spine happens during the 3rd-6th week of pregnancy. If there is an abnormality with the development, congenital scoliosis can occur. Example of congenital malformations of the spine include hemivertebra and spina bifida.
Idiopathic or Adolescent Scoliosis
Idiopathic or adolescent scoliosis is the most common form of scoliosis. It is more common in females and can affect up to 2 % of the U.S. population. The curve magnitude is usually worsened during the pubertal growth spurt. In order for a physician to diagnose and treat idiopathic scoliosis, he or she must first rule out all other causes of scoliosis. Most idiopathic curves that present in adolescence are painless but they may gradually increase in magnitude over time and become symptomatic. Our doctors provide the necessary long term follow-up and serial evaluations, both clinically and radiographically in these patients.
Kyphosis is normal in the thoracic spine (if less than 50 degrees), but is typically abnormal in the cervical and lumbar spines.
Examples of excess kyphosis in the thoracic spine include Scheueremann’s kyphosis and Postural roundback. Scheueremann’s kyphosis typically happens in teenage boys and is characterized by a short, sharp hunchback in the middle part of the upper spine. X-rays and an MRI help determine the degree of kyphosis and look for other causes of kyphosis.
Postural roundback is noted by a smooth, flexible kyphosis that is not typically associated with pain. The curve is easily corrected by asking the patient to stand up straight. Radiographically, the criteria for the diagnosis of postural roundback are kyphosis greater than 50 degrees, but without the other x-ray findings seen with Scheueremann’s kyphosis. These curves tend to be mild and extend over a longer number of vertebral segments when compared to Scheueremann’s kyphosis.
Post-traumatic or post-compression fracture kyphosis is also a common cause of this disease. Compression fractures typically occur secondary to trauma, tumor or osteoporosis. This condition may cause a focal kyphotic deformity and lead to pain. The deformity is corrected by various surgical techniques which offer improvement in pain and spinal balance. Correction of balance places the back muscles in a bio-mechanically advantageous position and helps reduce fatigue-related pain. Surgical techniques that our surgeons commonly employ include the pedicle subtraction osteotomy and Smith-Peterson osteotomy. These advanced surgeries require a lot of surgical skill and experience, but are some of the most rewarding surgeries for our patients.
Neuromuscular scoliosis can happen in children who have a disorder of the neurological system such as cerebral palsy, spina bifida, muscular dystrophy, Parkinson’s disease and spinal cord injuries. Patients have weakness of the trunk muscles and can therefore develop a progressive deformity of the spine resulting in a C-type scoliosis curve. Progressive curves may affect the patient’s ability ambulate or even sit comfortably. They typically adversely affect quality of life if the deformity progresses. Our doctors operate to fuse the spine to not only halt the progression of curve but to reconstruct the spine and provide a stable and upright posture.
Iatrogenic Deformity & Scoliosis
Deformity that develops after surgical procedures is termed iatrogenic. For instance, extensive laminectomy that destabilizes the facet joints of the lumbar spine can cause flatback or scoliosis. In flatback syndrome, the head of the patient is pitched forward and the person has difficulty looking straight ahead. As a result, the patient has to bend at the hips and knees in order to stand upright.
Occasionally, fusion surgeries if done improperly can cause imbalance and/or problems at the adjacent level of the spine. If this occurs, the patient may need revision surgery in order to correct the posture of the spine.
As a person ages, the disk and facet joints wear out. If severe, scoliosis occurs and is classified as degenerative scoliosis if the primary reason for the curvature is advanced degeneration of the spine. Typically, degenerative scoliosis occurs in the lumbar spine. Symptoms include back pain, leg pain, and deformity (inability to stand and look upright). This is a common condition which can now be treated with minimally invasive surgeries such as XLIF. The XLIF (Extreme Lateral Interbody Fusion) surgery allows our surgeons to correct the abnormal curve through small incisions. The surgery is guided using intra-operative fluoroscopy (x-rays) and newly developed nerve monitoring technology.
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