Spinal Curvature Disorders
Causes of spine curvature disorders can include:
● bones being formed abnormally during development – birth defects,
● poor posture,
● diseases or conditions that cause the bones of the spine to be shaped abnormally,
● softening of the bones - osteoporosis,
● trauma or injuries and/or cancer and
● treatment of cancer.
Lordosis is a secondary curve of the spine. The cervical spine and lumbar spine regions have lordotic curvature – neck and lower back respectively. If the lordotic curve is increased in the lower back, the layman’s term is “sway back”.
Symptoms of lordosis may include: back pain, problems/pains with certain movements, swaying of the back, buttock appearing more pronounced.
Treatment for lordosis may include: medications, exercises to work on strengthening and flexibility, bracing, weight reduction and possibly surgery.
Loss of lordosis is considered “flat back”. This can result due to an injury resulting in or causing muscle spasms. This may also present as pain due to muscle spasms.
The primary curve of the spine is the kyphotic curve. This curve is located in the thoracic spine or middle back. When this curve is increased, the person may have a rounded upper back appearance, hence the terms "round back" and/or "hunch back."
Symptoms of kyphosis may include: humping or rounded back, head appearing to be bent more forward in relation to the body and/or pain and stiffness.
Causes of kyphosis can include:
1) bones being formed abnormally during development – birth defects,
2) poor posture,
3) diseases or conditions that cause the bones of the spine to be shaped abnormally,
4) softening of the bones - osteoporosis,
7) tumors, and
8) trauma, injuries and/or cancer (including the treatment of cancer).
There are people that are at a higher risk of developing kyphosis: pre-teenage girls with poor posture, boys between the ages of 10-15 can develop Scheuermann’s kyphosis, older adults with osteoporosis and people with connective tissue disorders.
Complications of kyphosis may include: back pain, difficulty with breathing and/or being self- conscious regarding how one looks.
Diagnostic testing may be recommended to further evaluate kyphosis. This may include x-rays, CT scan, MRI, nerve testing and lung testing. X-rays are used to evaluate the curvature and detect any deformities that may be present. CT scan provides a more detailed description of the spine structures. MRI provides a more detailed description of the bone and soft tissue structures. Nerve testing evaluates how well the nerves are functioning from the origin in the spinal cord to arms/legs.
Lung function testing measures the amount of air your lungs can hold and the amount of time needed to empty the air from the lungs.
Treatment for kyphosis may include: medications, exercises to increase strength and flexibility, bracing and possibly surgery.
Scoliosis is an abnormal curvature of the spine. This abnormal curvature may be “S” shape or a “C” shape curve.
Adolescent Idiopathic Scoliosis (AIS) is the most common cause of scoliosis. This is a persistent lateral curvature of the spine of more than 10 degrees in the standing position. There can also be a rotational component of the spine.
There are three categories of scoliosis: congenital, neuromuscular and idiopathic.
Congenital is one that you are born with. This results from a failure of the vertebrae to individually form or separate from each other.
Neuromuscular scoliosis can be caused by cerebral palsy, Duchenne muscular dystrophy and spina bifida. The treatment protocols for this type of scoliosis are different than those of adolescent idiopathic scoliosis. Bracing is typically not effective for treatment. Smaller curves can be treated with modifying the wheelchair in order to improve function. These cases are generally treated by a team of specialist to coordinate care as necessary.
The cause of neuromuscular scoliosis determines the methodology of treatment. Spinal stabilization is indicated for those who:
● have a curve greater than 50 degrees that are still growing,
● progression of the curve greater than 10 degrees after maturation of skeleton,
● deterioration of functional abilities,
● pain and heart and lung function being compromised.
Factors involved with respect to stabilization of the spine with neuromuscular type scoliosis – age, whether or not the patient can walk and the underlying condition.
Syndromic scoliosis is a scoliotic deformity that is caused by genetic disorders. This can include: Marfan’s syndrome, Ehlers-Danlos syndrome, dwarfism (osteochondrodystrophy), neurofibromatosis, Noonan Syndrome, VATER syndrome and Angleman syndrome.
Idiopathic scoliosis cause is unknown. There are multiple causes that may contribute to idiopathic scoliosis: melatonic synthase, connective tissue disorder, skeletal muscle abnormalities, contractile protein dysfunction or neural mechanism problem. There are three age categories based on the presentation of the curve of the spine: infantile, juvenile and adolescent. Infantile idiopathic scoliosis is from birth to 2 years of age. This form accounts for less than 1% of all cases. This type of scoliosis has a high association with tumors, syringomyelia and descending of the cerebellum into the spinal canal. Juvenile idiopathic scoliosis is between the age of 3 – 10 years old. This form accounts for 12 – 21% of all cases. There is a high association with tumors, syringomyelia and descending of the cerebellum into the spinal canal. Adolescent idiopathic scoliosis occurs between the ages of 11 – 15 years old. This type accounts for the majority of idiopathic scoliosis types.
AIS is usually identified by a family member, screening, pediatrician or family physician. After a diagnosis is made, a referral to a scoliosis specialist is recommended. Symptoms of AIS can include: uneven shoulders, uneven hips or unequal leg lengths.
Treatment options for scoliosis may include depend on the curvature of the spine. 0-20 ˚ - curve is observed for progression; 20-25˚ - curve brace if progression documented and substantial growth remaining; 25-30˚ - brace if progressive and growth remains; 30-40˚ - brace if growth remains; 40-45˚ - brace if growth remains versus surgery; 50˚ - surgery.
Surgical options for scoliosis can include spinal fusion, artificial disc replacement, or kyphoplasty.
Adult Idiopathic Scoliosis is scoliosis that is diagnosed in an adult. This is a different spinal deformity than that of the scoliosis seen in infants and adolescents. This deformity may have been present in childhood and may have progressed due to aging. The treatment in adult scoliosis is different than children. Adult scoliosis is usually found when the person presents to their doctor due to pain. Treatment is directed at restoring function of the individual. Common causes include: present during childhood, deformity that began in adulthood due to wear and tear on the spine (adult degenerative scoliosis), osteoporosis, fractures, spondylolisthesis, infections and or tumors. In adult idiopathic scoliosis, tumors and infections rarely are the cause. Spinal curves in adult scoliosis may gradually progress each year.
Adult degenerative scoliosis is also known as, de novo scoliosis. This type of adult scoliosis develops due to the degeneration of the spinal elements – disc, facet joints – and the vertebra becoming wedged. This is primarily seen in the lumbar spine and straightening of the lumbar lordosis usually found in this degenerative scoliosis.
Adult idiopathic scoliosis can also develop after a person has had spinal surgery. Post-laminectomy scoliosis or kyphosis can develop after surgery is performed to treat spinal stenosis. Post-surgical instability or Failed Fusion can result in scoliosis. There are occasions where the fusion surgery can fail and further collapse of the spine can occur. Adjacent-level disease can result in the patient developing scoliosis due to acceleration of spinal arthritis or from the body adjusting to pain – symptomatic curves. Flat-back syndrome” occurs when patients are not able to stand upright and are hunched forward. This results in the lumbar spine losing its normal curvature or lordosis. Traumatic scoliosis or kyphosis can result in scoliosis when a spinal bone (vertebra) is deformed due to trauma. The other spinal bones will try to correct the spine or straighten it out. If the deformity is too severe or unable to be corrected, scoliosis or kyphosis can result.