Spinal deformity means abnormality in the curves of the spine. All spines have certain curves, and we expect them to. Scoliosis is a lateral or sideways curvature of the spine. Kyphosis means "humpback." Scoliosis and kyphosis can occur together.Home | More Health Articles | Men | Women | Stress | Sexuality
Scoliosis
Scoliosis, which tends to run in families and is more common in females than males, usually first appears in late childhood or during the early teens. While there are many different causes for scoliosis, including polio, in the vast majority of cases there is no known cause. Doctors call this "idiopathic" scoliosis. Over 90% of the curves in scoliosis curve to the right.
Scoliosis can often be slowed or arrested by wearing a brace, but if the angle of the spinal curvature goes beyond 40 degrees in childhood, it will become even more pronounced in adulthood.
Since the spine and the rib cage are connected, a severe scoliosis affects the position of the ribs and can affect surrounding organs as well. Severe scoliosis not only hurts the individual's appearance, but it can also compromise his or her health and ability to function. Health risks from this severe spine curvature include neurological problems from pressure on nerves, arthritis, and even lung and heart problems. A curve in the lower spine can make participation in sports or athletic activities difficult.
If the curve remains under 40 degrees, it probably won't get worse in adulthood, and can be watched by x-rays on a yearly basis.
Treatment for scoliosis
For small curves, exercise and bracing can be helpful. Bracing should start as soon as the curve reaches 24 degrees or more. Even with braces, however, at least half of patients will end up with curves that progress and, in spite of the bracing, will still require surgery.
If surgery is required, it's best to do it while the patient is young. Younger patients heal more rapidly and easily than adults, and generally have better cosmetic results from the surgery than someone older with an advanced curve who already has a severe deformity.
How we straighten the spine
To help the patient with a severe curve, the whole area of the curve must be stiffened. This is done to prevent a more severe curve from developing as the patient grows older.
During surgery, we insert special rods called "internal instrumentation" to hold the spine in the best possible position while the individual segments of spine "fuse" or come together. Afterward, the spine is permanently straightened. (The rods, incidentally, can be removed later if the patient desires, but this is unnecessary, unless they cause a problem).
Following surgery, almost all patients can return to school or work two to three weeks after leaving the hospital. In the past, patients were placed in body casts for six months, but this technique is rarely used nowadays. Instead, we use plastic braces, which patients can take off when they shower or sleep. Strenuous exercise such as bicycle riding is not recommended for the first few months, but people can get around quite well.
Thanks to the advanced techniques used in spinal fusion surgery today, our success rate exceeds 95%. Most patients who undergo this surgery have little disability and can live healthy, functional lives with no fear of adult curve progression or disability.
Treatment for kyphosis
While physical therapy (PT) doesn't help in severe cases of scoliosis, it is the mainstay of treatment for kyphosis. The sooner physical therapy is started, the more likely the child will not end up with a humpback. We recommend that PT be started as early as age 10.
In a young patient with kyphosis, a PT exercise program alone can improve the chance that his or her curve will return to normal. All of us have kyphosis to some extent, and curves of 20 to 40 degrees are considered normal.
For curves over 40 degrees, an exercise program is essential. We usually do not perform surgery to correct kyphosis unless the curve goes beyond 75 degrees.
The goal is to discover the kyphosis while the individual is still young, start him or her on exercise program, and hopefully avoid surgery. If exercises don't work, then a brace will be used. Bracing can be very effective for kyphosis and most of these patients will not go on to surgery.
Is it bad posture or kyphosis?
"Postural kyphosis" isn't really a spinal deformity. This condition is often seen in adolescent girls who assume a round-shouldered slouch to hide their growing breasts, about which they're sometimes embarrassed, especially if they are tall for their age.
Early screening can make a difference.
If there is a history of any spinal deformity in your family, your child should be examined at age 12 or 13 and followed closely to make sure a curve doesn't develop.
Scoliosis patients should have physical examinations every other year during their entire adult lives; if curve progression is noted, treatment should be instituted at once.
If we see a patient early enough, then wearing a brace or an exercise program may help stop the curve from getting worse and make surgery unnecessary.
Parents should be aware of both scoliosis and kyphosis so problems in their children can be identified, and treatments can be started, thereby preventing more serious problems in many cases.
Editor's note: Dr. Odom played a key role in instituting spinal deformity screening programs throughout the Public School System in Denver, Colorado. He is an orthopaedic surgeon with The Colorado Spine Center, Aurora, Colorado. This medical group has a national reputation for success with anterior and posterior spinal fusion surgery. For more information about spinal fusion surgery for scoliosis or kyphosis, contact Dr. Odom, The Colorado Spine Center, P.C., 1455 South Potomac Street, Suite 307, Aurora, Colorado 80012 U.S.A.,