Scoliosis and Kyphosis
Scoliosis refers to an S-shaped or C-shaped spinal deformity in the coronal plane when looking directly at the person.
Kyphosis is used to describe the condition of increased forward spinal angulation in the sagittal plane when looking at someone from the side.
Patients may develop scoliosis or kyphosis spinal deformities in adulthood, or the deformity may have been present since childhood and become progressively worse. Generally, a mild scoliosis and/or kyphotic curvature does not cause significant pain or disability. However, when the deformity is progressive and/or associated with other spinal conditions, it may cause significant pain and disability and require extensive treatment.
How is it diagnosed?
The diagnosis of scoliosis and/or kyphosis may be suspected, particularly if the above-mentioned physical findings are present. An x-ray is required to confirm the diagnosis, as well as to evaluate the severity of the deformity and curvature. Occasionally, patients may have another musculoskeletal abnormality, such as pelvic obliquity or a leg length discrepancy that is the underlying cause of the spinal deformity, and care must be taken to identify these other causes so as to render treatment appropriately.
What are the treatment options?
The treatment of adult patients with scoliosis and/or kyphosis depends on the severity of the pain, nerve compression and spinal deformity. A patient’s age and general medical condition also is an important consideration, since the surgical treatments are often large operations. Nearly all patients are recommended for conservative treatment initially unless there is a severe neurologic deficit such as leg weakness and numbness. Physical therapy, chiropractic care and oral medications are frequently prescribed. Epidural steroid injections and/or nerve root blocks may also be utilized for severe pain or moderate pain that is no longer responding to other conservative measures. Patients who do not benefit from these conservative measures are usually candidates for surgical intervention.
A critical aspect of surgical decision-making is to determine what is causing the patient’s pain and disability. Sometimes, a scoliosis patient may have one focal region of nerve compression or stenosis, which may be relieved by a small microscopic decompression surgery without correction of the spinal deformity. However, if there is significant spinal imbalance causing difficulty walking and standing, a deformity correction should be performed so as to address this problem. The surgical treatment of adult scoliosis and/or kyphosis is spinal fusion with metal rods and screws. A correction of the deformity is necessary if there is spinal imbalance or uncompensated curvature in either the coronal or sagittal plane. To put it simply, the patient’s head should be balanced over the sacrum and pelvis when looking at the patient from the front view and the side view. The spinal curvature in the adult is rarely as flexible as that of a child or adolescent, therefore an anterior discectomy and release or a posterior osteotomy must be performed to facilitate adequate correction of the deformity.