Adult Spinal Deformity

Some adults have a spinal deformity in which their spine has a large curvature. This spine curvature can cause debilitating pain and other symptoms, including pressure on the spinal nerves. With treatment, symptoms can be relieved and long-term damage can be prevented.

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Symptoms
Causes
Treatment Options

Pain or stiffness in the mid-to-lower back
Numbness or weakness in the legs or feet
Shooting pain down the leg (sciatica)
In severe cases, an inability to stand up straight or walk more than a short distance
Visible spinal imbalance
Strain on the hips and knees
Increased likelihood of falling
Standing hunched
Difficulty lying flat
Compression of the nerves of the spinal cord
Problems with heart and lung function (depending on the location of the curvature)
Problems with balance, dexterity, and reflexes
Other bodily function issues, such as incontinence
Sometimes irreversible loss of function
Sometimes irreversible paralysis

Conservative Treatment: Treatment varies depending on the cause of the deformity. In nearly all cases, conservative nonsurgical treatments will be attempted before surgery is considered. Nonsurgical treatments such as physical therapy, lifestyle modifications, medication, and/or spinal steroid injections may be effective alleviating symptoms and reducing pressure on the spinal nerves. In some cases, surgery may be necessary to prevent irreversible nerve damage and significantly improve quality of life.

Surgery for Adult Spinal Deformity: Surgery for adult spinal deformity focuses on easing symptoms, straightening the spine, removing pressure on the organs and/or nerves, and stopping progressive deformity. Depending on the individual, the appropriate surgery may be:

Muscle Sparing and Minimally Invasive Fusion: This surgery uses a tubular retractor to allow direct access to the spine with significantly less damage to the soft tissue and muscles. Damaged or arthritic tissue is removed, and a bone graft and implant (such as a rod or plate) are inserted to fuse the vertebrae together and relieve pressure on the spinal cord. This can alleviate symptoms but restricts some movement due to the vertebral fusion.
Spinal Fusion: This surgery removes a degenerative disc and fuses the adjacent vertebrae together. This procedure may be recommended for patients with instability, pathologic motion, and nerve compression in the spine. Spinal fusion can alleviate symptoms but restricts some movement due to the vertebral fusion.
Anterior Cervical Corpectomy and Fusion: This surgery, performed through the front of the neck, is performed for individuals with severe spinal cord compression due to a spinal deformity. It removes a majority of the vertebral body where there is multi-level compression, bone spurs, or disc herniations. This can alleviate symptoms but restricts some movement due to the vertebral fusion.
Cervical Stenosis Surgery: This surgery removes arthritic and damaged discs, bones, or bone spurs, and aligns and decompresses enlarged facet joints to relieve pressure on the spinal cord.
Lumbar Stenosis Surgery (Laminectomy): This surgery removes the excess bone and arthritic debris that are compressing the nerves of the back to relieve pressure on the spinal cord.
Interspinous Process Spacer: This surgery involves the insertion of a spacer device between the spinous processes to decompress the nerves.
Other techniques (such as disc replacement) may be considered where necessary to correct spinal alignment and relieve your symptoms.

Frequently Asked Questions

What types of adult spinal deformities are there?

Most adult spinal deformities are either scoliosis, kyphosis, or lordosis. Scoliosis is a side-to-side curvature of the spine; this condition may develop as the facet joints and discs deteriorate over time. Kyphosis is a forward curve of the spine that shifts the individual’s center of balance forward; this condition may develop due to injury or complications from a previous back surgery. Lordosis is a concave lower back curvature that thrusts the hips forward; this condition may be caused by arthritis or other physical conditions.

Which treatment for adult spinal deformity is best?

Nonsurgical treatments, especially physical therapy, are nearly always recommended as the primary treatment for adult spinal deformities. If the deformity is mild or does not cause symptoms, treatment is unnecessary. Mild to moderate cases with symptoms can often be successfully treated with conservative approaches. If the condition is severe and conservative treatments are ineffective, surgery will likely be recommended. Unless there is a concern for serious neurological impairment, conservative care will usually be tried for at least 3 to 6 months before surgery is considered.

What will the surgery recovery be like?

The details of your recovery will vary depending on the surgical technique chosen. Patients may be able to return home on the day of the surgery or within a few days. Typically, some pain and stiffness are common during recovery but will subside as the tissues heal. More details will be provided for you based on your surgical plan.

What are the risks of surgery for adult spinal deformity?

All surgeries carry some risks. These include but are not limited to reactions to anesthesia, nerve injury, reduced movement, discomfort, failure to alleviate symptoms, pneumonia, blood clot, fracturing of the internal surgical hardware used to align the spine, pseudoarthrosis (failure of fusion to occur), and others. Modern techniques and careful monitoring of the patient during the procedure help to ensure a successful surgery and minimize these risks. All potential risks and benefits will be discussed with you in detail when you are evaluated in clinic.

What are the long-term implications of adult spinal deformity?

Adult spinal deformity may worsen over time. Conservative therapy can often significantly improve quality of life and may prevent the condition from worsening or causing nerve damage. For severe cases, surgery can prevent irreversible nerve damage and provide a much healthier long-term prognosis. If you have an adult spinal deformity, and especially if you have any of the symptoms listed above, it is important to see your doctor for an evaluation right away to get an accurate diagnosis and begin your treatment plan.

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