Spinal Deformities - Symptoms, Diagnosis, Treatment, and Risks

Introduction:

The spine consists of a stack of vertebrae and discs, which appear straight from the frontal view and curved from the lateral view to maintain erect body posture. An abnormal spine curve is known as a spinal deformity and can affect its ability to do its job, leading to pain, neurological problems, and mobility challenges. Spinal deformities can occur for many reasons, including congenital disabilities, aging, degenerative diseases, or traumatic injuries. A deformed spine facilitates a reaction from the rest of the body. As a result, muscles strain, lungs pump more arduously, and simple functions (such as walking) become difficult. Spinal alignment and curvature are altered in many ways. They can occur due to a congenital disability, a child's growth, aging, injury, or previous spine surgery.

What Are Spinal Deformities?

All spinal deformities involve problems with the curve or rotation of the spine. Adult spinal deformities are classified and termed as follows;

1. Kyphosis: Involves the upper back curving forward which creates the form of a hump. A spinal malformation that gives the appearance of a hunchback due to an excessive outward curvature of the spine. sometimes referred to as hyperkyphosis to distinguish it from thoracic spine normal kyphosis.

2. Lordosis: Also known as swayback, is a deformity where the lower back curves inward instead of outward. An uncommon spinal malformation characterized by an abnormally inward curve of the lower back and also referred to as hyperlordosis to distinguish it from the typical lumbar spine lordosis. To make up for hyperkyphosis elsewhere, hyperlordosis may develop.

3. Scoliosis: A frontal deformity in which the spine, when viewed straight on, curves to the left or the right. This curving ordinarily ends when the skeleton stops growing, but in adulthood, the angle can still progress slightly, often resulting from disk degeneration. Scoliosis: a lateral curvature of the vertebrae. Among the classifications are

• Congenital: scoliosis that is present from birth

• Infantile: scoliosis affecting patients under three years of age

• Juvenile: Patients with scoliosis that is considered juvenile 4–10 years old

• Adolescent: patients with scoliosis between the ages of 11 and 18

• Adult: The cause of adult scoliosis may be either degenerative or idiopathic.

1. Spondylolisthesis: It occurs when one vertebra dislocates onto the vertebra below, pressuring the disk and a nerve.

What Are the Symptoms of Spinal Deformity?

Different symptoms are seen depending on the type of deformity. However, they may take the form of

• Pain may occur in the upper spine and the ribs in scoliosis.

• Loss of balance or difficulty walking or standing.

• Visible curve or hunched-over appearance.

• Asymptomatic.

These spinal deformities may lead to pain or affect the ability to perform daily activities. In addition, spinal cord dysfunction or its nerve roots may also occur. Thus a treatment, either surgical or non-surgical, may be required.

How Are Spinal Deformities Diagnosed?

• X-rays: X-rays are the first line of medical imaging to identify any disorders in the bones. The spine is a bony column of vertebrae; it is no exception to this.

• Magnetic Resonance Imaging (MRI) Scans:MRI scans are done to view the soft tissue in and around the spine to locate whether any nerve root or the spinal cord has been damaged or affected in any way.

• Computed Tomography (CT) Scans: These provide a three-dimensional image of the affected area, thus allowing minute analyses before a treatment modality is opted for.

What Is the Treatment Plan Available for Spinal Deformities?

• Severe pain cannot be relieved by physical therapy, bracing, and pain medications.

• Progressive spinal deformity.

• A painful physical deformity.

• The disease has caused compression of the spinal cord or nerve roots.

• Deformation of the spine resulting from fractures.

• A deformity that is likely to progress post-skeletal growth completion.

A non-surgical approach is the first line of treatment for almost all forms of spinal deformity. However, in certain conditions where the rigidity of the spine disallows such procedures, or the fragility of the bone requires the placement of inert implant materials for both corrective alignment and stabilization, surgical procedures have to be opted for. Surgery aims to relieve symptoms by alignment and stabilization of the spine.

However, since spinal deformities vary from patient to patient, no two surgical treatments are ever the same. These complex procedures involve the spine being aligned and must be achieved from all angles keeping the spine in its stable position. This requires implants such as screws and rods. If deformities result in the spinal cord or spinal nerve compression, decompression surgery may be performed. A common type of decompression surgery is called a laminectomy, where a section of bone called the lamina at the back of the vertebra is surgically removed, providing extra space for the spinal cord and allowing it to function correctly.

What Are the Potential Postoperative Risks?

The patients are informed of the risks before opting for the procedure. The potential postoperative risk factors may include the following;

• Infection.

• Postoperative clotting and hematomas that require drainage.

• Strokes.

• Seizures.

• Clotting in lower limbs.

• Embolism and dissemination to lungs.

• Improper surgery requires future corrective surgeries.

• Damage to spinal nerves or spinal cord.

• Leakage of cerebrospinal fluid during or after the procedure.

• Injury to the meninges.

How Do Treatment Modalities Differ for Adults and Children?

Treatments vary for children and adults. Children with spinal deformities are treated with non-surgical treatments as their bone development is incomplete. A child's growing spine can be guided into proper alignment by using braces. The same treatment would be less effective in adults as the spine is rigid. If the underlying cause of the deformity is attributed to osteoporosis in aging adults, calcium, hormone replacement therapy, or weight-bearing exercises may be prescribed. Bracing is another non-surgical option for adults that does not change the spine's position but may ease the pressure. If the legs are affected by spinal deformities, orthotics or shoe inserts can also help reduce back pain.

Conclusion:

Spinal alignment and curvature can be altered in many ways. They can occur due to a congenital disability, growth, aging, injury, or traumatic spine surgery. The first line of treatment for practically all types of spinal deformity is a non-surgical method. Adults and children receive different treatments. With braces, a growing child's spine can be helped into the right position. Adults' spines are stiff; therefore, the same treatment would be less successful for them. Calcium, hormone replacement treatment, or weight-bearing exercises may be chosen if osteoporosis in older adults is the underlying cause of the deformity. When such spinal malformations impact the legs, orthotics or shoe inserts may also be beneficial. Several postoperative risks and complications may arise, and the patients are informed before any procedure is conducted.