Spine Deformities

The spine has naturally occurring curves that position the head over the pelvis and function as shock absorbers with movement. When these curves are exaggerated or pronounced problems can occur such as back pain, breathing difficulties, and fatigue. To understand Spine Deformities it is helpful to first learn about normal spine anatomy.

Normal Spine Anatomy

The spine, also called the back bone, is designed to give us stability, smooth movement, as well as providing a corridor of protection for the delicate spinal cord. It is made up of bony segments called vertebrae and fibrous tissue called intervertebral discs. The vertebrae and discs form a column from your head to your pelvis providing symmetry and support to the body. The spine can be divided into 4 parts. The uppermost is the cervical region, consisting of 7 small vertebrae that form the neck.

As we move down the body, the next 12 vertebrae make up the thoracic region or mid back from which the ribs are hinged. The 5 lumbar vertebrae are the largest of the mobile vertebrae and supports 2/3 of the body’s weight.

The lowest region of the spine is the sacrum and coccyx. The sacrum is a triangular plate made up of 5 fused vertebral segments while the 4 coccyxes terminate the bony spine.

Vertebra

A single vertebra is made up of two parts; the front portion is called the body, cylindrical in shape, and is strong and stable. The back portion of the vertebra is referred to as the vertebral or neural arch and is made up of many parts. The strong 2 pedicles join the vertebral arch to the front body.

The laminae form the arch itself while the transverse process spread out from the side of the pedicles like wings to help anchor the vertebral arch to surrounding muscle. The spinous process forms a steeple at the apex of the laminae, and is the part of our spine that is felt directly under the skin.

Laminae

The laminae of the vertebra can be described as a pair of flat arched bones that form a component of the vertebral arch.

Spinal Canal

This canal is formed by the placement of single vertebral foramina, one on top of the other, to form a canal. The purpose of the canal is to create a bony casing from the head to the lower back through which the spinal cord passes.

Pars Inter Articularis

Known as the Pars, it is the part of the vertebral arch where the pedicle, transverse process, and articular process transect.

Intervertebral Disc

The intervertebral disc sits between the weight bearing vertebral bodies, servicing the spine as shock absorbers. The disc has fibrous outer rings called the annulus fibrosus with a watery jelly filled nucleus called the Nucleus Pulposis.

Spinal Cord

The spinal cord is the means by which the nervous system communicates the electrical signals between the brain and the body. It begins at the brain stem and is held within the spinal canal until it reaches the beginning of the lumbar vertebrae. At L1 the spinal cord resolves down to a grouping of nerves that supply the lower body.

Facet Joint

Facets joints are the paired articular processes of the vertebral arch. These synovial joints give the spine it’s flexibility by sliding on the articular processes of the vertebrae below.

Spine Deformities: Scoliosis

Scoliosis is a condition where the spine or back bone is curved sideways instead of appearing in a straight line. The most common type of scoliosis is adolescent idiopathic scoliosis which occurs after age 10 and is seen more frequently in girls than boys. Scoliosis can occur at any age, however, and the cause is not known in 80% of cases. This is referred to as idiopathic scoliosis. Your physician will investigate other possible causes before diagnosing you with idiopathic scoliosis.

Causes of Scoliosis

Scoliosis causes are categorized into two groups:

• Non-Structural Scoliosis: This type of scoliosis presents as a structurally normal spine with a temporary or changing curve.
  Causes include:
  • Differences in leg lengths
  • Muscle Spasms
  • Inflammatory conditions such as appendicitis
• Structural Scoliosis: This type of scoliosis presents with a fixed curve in the spine.
  Causes include:
  • Birth defects
  • Injury to the spine
  • Infections
  • Neuromuscular diseases such as cerebral palsy and muscular dystrophy
  • Tumors
  • Connective Tissue Disorders
  • Rheumatic Diseases

Scoliosis Treatments

Treatment of Scoliosis is based on the physician’s assessment of the spinal curve, its cause, the age of the patient, and how much more the patient may grow. Treatment options include:

• Observation: Your physician may want to see you every 4-6 months to monitor the curve if your scoliosis is mild with a curve of less than 25 degrees.
• Bracing: Your physician may recommend wearing a brace to prevent the curve from worsening while the patient is still growing or if your curve is greater than 30 degrees.
• Surgery: If the patient is still growing and the curve is over 40 degrees, or is worsening, surgery may be recommended. The most common surgical procedure for Scoliosis is correction, stabilization, and fusion of the curve.

Spine Deformities: Lordosis

Lordosis is a condition where the natural inward curve of the spine in the lumbar region, just above the buttocks, is abnormally increased or pronounced. Lordosis is sometimes referred to as swayback.

Causes of Lordosis

Causes of Lordosis include:

• Spondylolisthesis: this condition occurs when one vertebra slips forward in relation to an adjacent vertebra causing misalignment and potential entrapment of the spinal nerves. This condition can be congenital (present at birth) or can develop in childhood or adulthood.
• Discitis: Inflammation of the intervertebral disk or disk space.
• Achondroplasia: a bone growth disorder causing the most common type of dwarfism.

Lordosis Treatments

The goal of treatment for Lordosis is to stop the progression of the curve and prevent deformity from occurring. Treatment for Lordosis is dependent on the severity of the condition, the patient’s age, and if there are any neurological deficits present. Treatment options include the following:

• Observation: Your physician may want to see you every 4-6 months to monitor the curve if your Lordosis is mild.
• Physical Therapy: Your physician may recommend referral to a Physical therapist to instruct you on a home exercise program to increase your range of motion, flexibility, and strength.
• Analgesics and Anti-inflammatory Medications: Medications to relieve pain and reduce inflammation may be prescribed by your physician.
• Bracing: Your physician may recommend wearing a brace to prevent the curve from worsening while the patient is still growing.
• Surgery: If the Lordosis is severe, neurological involvement is present, and no relief from non-surgical treatment is obtained, surgery may be recommended.

Spine Deformities: Kyphosis

Kyphosis is an abnormal curving of the spine usually occurring in the thoracic region resulting in a roundback or hunchback appearance. Kyphosis can also occur in the cervical and lumbar regions although this is less frequent.

Causes of Kyphosis include:

• Osteoporosis: Compression fractures can occur in the vertebrae as a result of osteoporosis leading to Kyphosis.
• Scheuermann’s Disease: Also referred to as adolescent Kyphosis, this disease causes adjacent vertebra to wedge together leading to Kyphosis.
• Spondylolisthesis: This condition occurs when one vertebra slips forward in relation to an adjacent vertebra causing misalignment and potential entrapment of the spinal nerves. This condition can be congenital (present at birth) or can develop in childhood or adulthood.
• Arthritis
• Disc Degeneration: As people age, vertebral discs can lose moisture and shrink leading to Kyphosis.
• Injury to the spine
• Infections such as tuberculosis and polio.
• Birth Defects such as Spina Bifida.
• Inherited Disorders such as muscular dystrophy and neurofibromatosis.

Kyphosis Treatments

Treatment for Kyphosis will depend on the cause of the condition.

Treatment options include:

• Bracing: If the cause of Kyphosis is Scheuermann’s disease, your physician may recommend wearing a brace to prevent the curve from worsening while the patient is still growing.
• Physical Therapy: Your physician may recommend referral to a Physical therapist to instruct you on a home exercise program to increase your range of motion, flexibility, and strength.
• Medications: If the cause of Kyphosis is osteoporosis, your physician may recommend medications to prevent future compression fractures. Kyphosis caused by infections or tumors will also require medications for treatment.
• Surgery: Your physician may recommend surgery if your Kyphosis is debilitating and painful and does not respond to conservative treatment methods. Congenital Kyphosis, occurring at birth, usually will require surgery at an early age. Patients with Scheuermann’s disease with a large, painful curve over 60 degrees may also require surgery.