Abnormal Curvature of the Spine


Abnormal Curvature of the SpineIn a normal spine a gradual curvature is present in the cervical, thoracic and lumbar regions. This anatomical architecture is designed to protect the spinal cord from injury by increasing the strength of the spine, assisting in maintaining balance when the body is in the upright position and assisting in the absorption of the mechanical shock of body movement, e.g., walking or running.

More than seven million Americans have an abnormal curvature of the spine. There are three primary types of abnormal spine curvature: kyphosis, lordosis and scoliosis:

Kyphosis: also referred to as humpback or hunchback, is an exaggerated (greater than 50 degrees) outward curvature or rounding of the thoracic and/or cervical spine. There are three categories of kyphosis: (1) congenital kyphosis (CK) occurs when the fetal spinal column fails to develop properly due to the fusing of several vertebrae or an abnormality in vertebral bone formation. CK may progress as the child develops; (2) Scheuermann’s kyphosis (SK) is a more severe form of kyphosis that usually becomes noticeable when the individual is a teenager; and (3) postural kyphosis (PK), which is the most common form of kyphosis, usually occurs during an individual’s adolescent years. It is more common in girls than boys and is usually not associated with pain. PK is generally considered to be caused by poor posture, e.g., slouching, hunching over, etc.

Mild kyphosis, such as postural kyphosis, can be treated with physical therapy and/or non-steroidal anti-inflammatory or pain relief medications. In the case of Scheuermann’s kyphosis surgery may be considered if the patient experiences intense chronic pain, the spinal curve is greater than 75 degrees, or other neurologic, pulmonary or cardiac complaints are present.

Lordosis: also referred to as swayback, is a condition most usually found in the lumbar spine, although it can appear in the cervical region. It is caused by an exaggerated inward curvature of the low back/lumbar spine. If the lordosis is pronounced it can cause pain with movement. Kyphosis, obesity, osteoporosis, spondylolisthesis or dwarfism (achondroplasia) can contribute to the development of this condition. If the condition becomes severe as a result of age-related progression it can result in low back pain, muscle spasm, muscle weakness, etc. When conservative treatment fails to provide relief to the patient, surgery may be performed to apply spinal instrumentation, kyphoplasty (to restore vertebral height), or full or partial artificial disc replacement.

Scoliosis: is an abnormal lateral curvature of the spine in the shape of an S or a C that is greater than 10 degrees distance from a normal spine. It is most usually found in the upper thoracic spine and to a considerably lesser extent in the lumbar spine of young girls. The condition affects more than seven million Americans. The cause of the great majority (80%) of scoliosis cases is unknown (idiopathic). The remaining 20% of scoliosis cases may have been caused by (1) failure of the fetal spine to form correctly; (2) neurological system disorders, e.g., spina bifida, spine tumors, spinal cysts or other neurological deficits; or, (3) neuromuscular disorders such as muscular dystrophy, Marfan’s disease (a condition that affects the body’s connective tissue), etc.

The classification of idiopathic scoliosis is based on the age at which it first develops: congenital scoliosis (develops in the womb); infantile idiopathic scoliosis (child is less than 3 years of age – more prevalent in boys than girls – usually recognized in the first six months); juvenile idiopathic scoliosis (3 to 10 years of age – more prevalent in girls than boys); adolescent idiopathic scoliosis (11 to 18 years of age – more prevalent in girls than boys); and, adult scoliosis (presence of scoliosis past the age of 18 years or skeletal maturity). Adult scoliosis usually originates at an early age and has continued into adulthood. However, there are instances when scoliosis can first develop during the adult years. This condition is known as adult degenerative scoliosis and can be caused by osteopenia (low bone density), osteoporosis of the spine, wear and tear on the spine due to the aging process, advanced disc degeneration, etc.

In a future blog a discussion of the treatment alternatives for the various forms of spinal abnormalities will be presented.

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