Conditions Treated

Adult Spinal Deformity

Adult spinal deformity refers to abnormal curvatures of the spine in patients who have completed their growth. It is typically seen in both male and female patients over the age of eighteen. The age range for these patients varies widely and it is not unusual for patients to present in their sixties, seventies or even eighties. Typically patients seek out treatment for symptoms of pain and functional limitations. With increasing life expectancy along with more active lifestyles, the number of older adults requiring treatment has also gone up. I distinction to the younger patient with a spinal deformity, the older adult presents with a completely different set of problems and challenges to the treating physician.

There can be many different causes for the spinal deformity adults. The most common types of deformity include adolescent idiopathic scoliosis that was present during the patient’ s teenage years and then became worse during adulthood; spinal deformity that started in adulthood secondary to degenerative (wear and tear) changes in the spine; and deformity that developed after previous spine surgery. Other less frequent causes include spinal deformities due to weak bones (osteoporosis), previous fractures of the spine, and spondylolisthesis (slipped vertebrae). Infections and tumors are a rare cause of spinal deformity.

Adult idiopathic scoliosis:

This is a slow increase in spinal deformity that began during adolescents in an otherwise healthy individual and progressed during adult life. Some of these patients may have had brace treatment during adolescence while others may have never been diagnosed or treated. This can occur in the thoracic and lumbar spine and has the same basic appearance as that seen in teenagers. They include shoulder asymmetry, a rib hump or a prominence of the lower back on the convex side of the curvature. These curves can get worse in the older patient due to degeneration of the discs which results in settling of the vertebrae (spinal segments). Additionally, arthritis sets in the joints of the spine (facets) which leads to the formation of bone spurs. This can result in pain and stiffness of the back. In more severe cases, patients may also develop shooting pain and numbness down the legs due to pinched nerves.

Cervical disc degeneration at C4-C5 and C5-C6 resulting in spinal cord compression with signal changes in the spinal cord Post operative images of the same patient. The compression at C4-C5 and C5-C6 has been surgically removed. The signal changes in the spinal cord are still visible.
82 year old female with adult idiopathic scoliosis and advanced degenerative changes along with osteopenia. 45 year old male with adult idiopathic scoliosis. You can see degenerative changes starting to form with eccentric disc space collapse.

Adult degenerative scoliosis:

This type of spinal deformity is also called “de novo” scoliosis. This type of spinal deformity is a result of disc degeneration, arthritis of the facet joints and collapse and wedging of the disc spaces with shifting and translation of the vertebral bodies. In distinction to adult idiopathic scolsiosis, adult degenerative scoliosis by definition arises in adulthood. It is frequently seen in the lumbar spine. It is usually accompanied by straightening of the lumbar spine from the side (loss of lumbar lordosis) and spinal imbalance. Pain, stiffness, numbness and pain down the legs are seen in symptomatic patients.   Adult degenerative scoliosis 54 year old woman with “de novo” adult lumbar spine deformity. This condition results from disc degeneration and facet joint degeneration.



Post-surgical deformity:

This type of spinal deformity is found in patients who had previously undergone spinal surgery. The reason for the original surgery varies but frequently involves degenerative low back conditions. Patients that had lumbar surgery can develop a condition called “Flat Back Syndrome” where the normal lumbar lordosis (inward curvature) is lost and the spine flattens. Patients with this condition are unable to stand upright and are usually “pitching forward”. This is called a positive sagittal balance. These individuals frequently have soft tissue contractures around the knees and hips in addition to the spinal imbalance.

Another category of post-surgical deformity is “Junctional Kyphosis” which is an angular deformity (kyphosis) that develops just above or below a previous spinal fusion. Both these conditions result in an imbalance of the spine from the side (sagittal imbalance) and lead to progressive low back pain and stiffness. Multiple studies have demonstrated that patients with sagittal imbalance have worse functional outcomes that individuals with balanced spines.

  Post-surgical deformity 72 year old male who underwent multiple prior lumbar surgeries and presented with “flat back syndrome” as a result of loss of his normal lumbar lordosis (curvature).  

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