Spinal deformity fundamentals
Scoliosis and Kyphosis
Scoliosis and kyphosis are curvatures of the spine. Although most common in young teenagers, these deformities affect children as well as adults. In most patients these deformities of the spine are non-progressive; however in some patients, scoliosis and kyphosis continue to slowly progress throughout life, resulting in cosmetic issues, functional issues and occasionally painful and sometimes dangerous curvatures that must be addressed through spine stabilization surgery. The goals of treating any deformity of the spine are to stop progression, normalize spinal function, minimize any associated painful problems. For adolescent patients with severe curves, and for adults with curves that continue to worsen, or are painful, surgical treatment can reduce and halt the progression of the spine's deformity.
Spondylolisthesis is another deformity of the spine where one vertebrae (a spinal bone) slips forward in relation to the one below. This can commonly result from a defect or stress fracture in the arch component of the spine's vertebrae. On rare circumstances the slippage of the vertebrae can cause spinal nerve irritation by compression resulting in pain down the leg or even more rare numbness and or muscle weakness. If painful and progressive, spondylolisthesis may require a fusion of the spine in order to prevent further slippage or to relieve low back pain and nerve irritation.
What causes the Scoliosis and Kyphosis? What causes Spondylolisthesis?
Scoliosis and Kyphosis
In most cases, the cause behind scoliosis and kyphosis is unknown. The cause of both scoliosis and kyphosis is thought to be a combination of factors including abnormal development of the bones, soft ligaments or weak muscles, or abnormalities with the inner ear and balance functions. The resulting curvature of the spine affects all of the muscles in the back, as well as the alignment of the hip. The commonly noted symptoms of the curved-spine condition include:
- Uneven shoulders or waistline
- One or both shoulder blades sticking out
- Leaning slightly to one side
- A hump on one side of the back
Spondylolisthesis is typically caused by a developmental defect of the arch of the vertebrae. It can also be caused by an injury or repetitive trauma. The slippage of the vertebra may or may not worsen over time. Symptoms of spondylolisthesis include:
- Low back pain
- Muscle spasms
- Thigh or leg pain
What are my treatment options?
Scoliosis and kyphosis treatment methods depend on your age, how much more you are likely to grow, the degree and pattern of your spine's curve, the extent of pain, functional limitation and cosmetic appearance of the spine. Bracing may be used to temporarily halt the worsening of the curve during a growth spurt. There are many brace varieties and depending on the above issues the most appropriate brace will be prescribed and the duration of usage and wearing time will be determined.
For deformities of the spine approaching or greater than 45 degrees, associated with pain, functional impairment or severe cosmetic deformity, your doctor may recommend spine stabilization surgery. The goal of stabilization surgery is to straighten and hold the spine straight in the safest fashion possible. To accomplish this the surgeon fuses the bones of the spine (vertebrae) together with the help of bone grafts, and uses metallic implants to hold everything together till the fusion matures.
In certain cases, Cleveland Clinic spine surgeons are able to use a less invasive technique in spine stabilization surgery. Guided by a thin, telescope-like instrument called an endoscope, they can place metal implants and bone grafts in the spine through small incisions in the abdomen and chest. With this approach, the incision is shorter, recovery is easier, and most patients can leave the hospital sooner.
Bracing after spine stabilization surgery is usually not necessary. Since the surgery immediately makes the spine straighter and stiffens the spine, scoliosis and kyphosis patients quickly begin recovery.
- Non-operative Treatment
To ease pain and muscle spasm, your doctor may prescribe muscle relaxants, acetaminophen, or anti-inflammatory agents. Physical therapy, non-aerobic exercise, and stretching may be used to improve flexibility of the trunk muscles. Other non-operative treatments may include a custom-made brace or corset designed to reduce pressure on the lower back. Corsets are made of soft fabric with rigid supports. They are typically worn throughout the day and removed before you go to bed. Braces are made of plastic and can be either customized or ready-made.
Spine stabilization surgery is recommended when the spondylolisthesis irritates a nerve and results in numbness or weakness of the leg or, very rarely, incontinence. The goals of stabilization surgery are to eliminate pressure on spinal nerves and to stabilize the spine. Spinal fusion – uniting one vertebra to the next – and spinal instrumentation – using implants to secure the fusion – are both used during spine stabilization surgery.
To achieve a spinal fusion the surgeon uses the patient’s own bone harvested from the pelvis, although donor bone is also an option. Spinal instrumentation includes specially designed implants, such as screws, cages, hooks, wires and rods. The implants secure the bones of the spine, enabling fusion to take place.
What are the risks of spine stabilization surgery? Is the surgery safe?
As with any surgical procedure, there are general risks and procedure specific risks with spine stabilization surgery. The more common general risks of surgery include the risk of adverse reactions to the anesthetic, post-operative pneumonia, blood clots in the legs (deep vein thrombosis)that may travel to the lungs (pulmonary embolus), infection at the site of surgery and blood loss during surgery requiring a transfusion. The specific risks of spinal deformity surgery include the risk of injury to the nerves or spinal cord resulting in pain or even paralysis, (the estimated risk of paralysis for major spinal reconstructions is somewhere around 1 in 10,000), the instrumentation breaking, dislodging or irritating the surrounding tissues, and pain from the surgery itself.
Risks of spine stabilization surgery are dependent on the individual, please discuss your risk level with your surgeon, prior to surgery.
How do I prepare for spine stabilization surgery?
To prepare for spine stabilization surgery, quit smoking if you smoke, exercise on a regular basis to improve your recovery rate, stop taking any non-essential medications and any herbal remedies which may react with anesthetics or other medications and ask your surgeon all the questions you may have.
What are the Cleveland Clinic physician credentials?
- All doctors at Cleveland Clinic's Center for Spine Health are fellowship-trained and board-certified or board-eligible in orthopaedic surgery or neurosurgery. In addition, our surgeons have subspecialty training and years of experience in spine surgery.
- All Cleveland Clinic staff radiologists are board-certified or board-eligible in radiology or have the international equivalent.
- All Cleveland Clinic staff rehabilitation specialists are board-certified or board-eligible in physical medicine and rehabilitation, or have the international equivalent.
- All Cleveland Clinic staff pain management specialists are board-certified or board-eligible in pain management or have the international equivalent.
How do I make an appointment?
Call 216.636.5860 or toll free 866.588.2264, Monday through Friday, 8:00 a.m. to 5:00 p.m. (Eastern Standard Time).
What clinical trials and orthopaedic research are being conducted at Cleveland Clinic on the procedure?
Researchers at the Cleveland Clinic are involved in ongoing studies that investigate new drugs and treatment approaches for managing diseases or deformities like scoliosis or spondylolisthesis. Participants in these clinical trials can play a more active role in their own health care, gain access to new research treatments before they are widely available, and help others by contributing to medical research. There are currently more than 1,700 active clinical studies underway.
Are there other resources that I can go to for more information on spine stabilization surgery?
Patients can go to the following resources for more information on spine stabilization surgery:
- Cleveland Clinic Health Information Center
- American Academy of Orthopaedic Surgeons
- North American Spine Society
- Scoliosis Research Society
- Spine Universe Website
Why should I seek a second opinion regarding treatment for my spine disorder?
As modern medical care grows more complex, patients can feel overwhelmed. The opportunity to consult a recognized authority about a particular diagnosis and treatment can bring peace of mind at an emotionally difficult time. A second opinion may be beneficial when:
- You are uncertain about having surgery.
- You still have questions or concerns about your current treatment.
- A controversial or experimental treatment is recommended.
- You have multiple medical problems.
- You have choices to make about treatment.
A convenient way to obtain a second opinion is e-Cleveland Clinic, a contemporary adaptation of The Cleveland Clinic’s 80-year tradition as a nationally designated referral center. An easy-to-use, secure, from-home second opinion service, e-Cleveland Clinic utilizes sophisticated Internet technology to make the skills of some of our specialists available to patients and their physicians, anytime, anywhere. With e-Cleveland Clinic’s personalized access, no patient need ever to feel unsure or uninformed when faced with what could potentially be one of the most important decisions of their life.