Spinal deformities such as scoliosis, kyphosis, or spondylolisthesis occur when the natural alignment of the spine is altered, leading to curvature, imbalance, or instability.
These conditions may be congenital, adolescent (idiopathic), or degenerative in adults. Mild curvatures can often be managed with observation or bracing, but progressive or symptomatic deformities require surgical correction to restore spinal balance, protect the spinal cord, and relieve pain.
Types of Spinal Deformities
1. Idiopathic Scoliosis
The most common type, often appearing during adolescence, usually without an identifiable cause. Detected by uneven shoulders, rib hump, or waist asymmetry. Early detection and monitoring prevent progression during growth.
2. Congenital Scoliosis
A developmental deformity present at birth, caused by failure of vertebral formation (such as hemivertebra) or failure of segmentation (incomplete separation between vertebrae).
These abnormalities develop during the first six weeks of embryonic life.
Symptoms: visible spinal curvature, asymmetry of the chest or waist, sometimes associated with rib fusion or other organ anomalies (kidney or heart).
Treatment:
- Mild curves are observed with regular imaging to track growth.
- Progressive deformities may require hemivertebra excision or short-segment fusion to prevent severe deformity and preserve motion in unaffected segments.
- Early surgical correction offers the best long-term spinal balance and growth potential.
3. Kyphosis
An excessive forward curvature of the thoracic spine, which may result from Scheuermann’s disease, postural imbalance, or trauma.
Severe kyphosis can cause chronic pain, deformity, or breathing difficulty.
Surgical correction (posterior fusion or osteotomy) restores normal alignment and relieves symptoms.
4. Spondylolisthesis
A forward slip of one vertebra over another, typically in the lumbar region.
Can be congenital, isthmic, or degenerative.
Symptoms: low back pain, leg weakness, or numbness due to nerve compression.
Treatment: stabilization with spinal fusion and decompression if conservative therapy fails.
Symptoms
- Visible spinal curvature or shoulder/hip asymmetry
- Back pain or fatigue
- Numbness or tingling in legs from nerve compression
- Difficulty standing upright or walking long distances
- Cosmetic concerns (especially in adolescents)
- In severe thoracic deformities: shortness of breath or restricted lung capacity
Diagnosis
Diagnosis includes:
- Standing full-spine X-rays to measure curve angle (Cobb angle)
- MRI for spinal cord and soft tissue assessment
- CT or 3D reconstruction for complex congenital deformities
- EOS imaging (if available) for precise spinal balance analysis with minimal radiation
In children, growth and progression risk are evaluated using Risser score and skeletal maturity.
Treatment Options
1. Non-Surgical Management
- Observation and follow-up X-rays for mild curves
- Bracing (Boston, TLSO) for adolescents with curves between 25°–45°
- Physiotherapy and core exercises for posture and muscle balance
2. Surgical Correction and Stabilization
For progressive or severe curves (>45°):
- Posterior spinal fusion with instrumentation is the standard.
- Modern systems allow three-dimensional correction with shorter fusion segments.
- Intraoperative neuromonitoring (MEP, SSEP) ensures spinal cord safety.
- Minimally invasive fusion techniques reduce recovery time and blood loss.
3. Growth-Preserving and Pediatric Techniques
In younger children:
- Expandable growing rods or magnetically controlled rods allow spinal growth while maintaining correction.
- Vertebral body tethering (VBT) is an alternative to fusion that preserves mobility.
4. Osteotomies and Complex Reconstruction
For rigid deformities or post-traumatic kyphosis, spinal osteotomies (e.g., pedicle subtraction osteotomy) correct alignment and restore balance.
Recovery & Follow-Up
Hospital stay is usually 5–7 days.
Patients begin walking with physiotherapist support within a few days.
Most return to normal activities in 2–3 months.
Follow-up includes X-rays at 6 weeks, 3 months, and annually to assess fusion and alignment.
For children, long-term follow-up tracks spinal growth and compensatory changes in adjacent levels.
When to See a Spine Specialist
Consult a neurosurgeon if you or your child show spinal curvature, asymmetry, back pain, or growth-related imbalance.
Early evaluation can prevent curve progression and allow less invasive treatment options.