Spinal deformity is a permanent state when the spine is visibly out of its normal alignment, so much so that it does not go back to normal in any position change. Single level deformities include spondylolisthesis, spondylolysis, or a focal scoliosis, while more extensive conditions include various forms of scoliosis, including hyperlordosis, rotatory scoliosis, and kyphoscoliosis. This state affects a large number of people, and is increasing with age due to degenerative conditions, arthritis, and osteoporotic compression fractures. Spinal deformities can be caused by many different problems, including trauma, arthritis, congenital anomalies, neurological problems, tumors, infections, or by the unintended consequences of radiation or surgical treatments.
One increasingly common problem is flat back syndrome, often caused by surgery to correct one problem, but after the operation the spine is no longer in its normal lordosis, and is instead “flat” or too straight. How does this happen? It is usually inadvertent, and in some cases likely related to the type of OR table or the lack of proper instrumentation as used by the first surgeon. Depending on how the surgeon performs a fusion procedure, they may not put the spine back into the normal position when they finish, and this then results in more problems at the adjacent levels as they try to compensate for the new abnormal condition of the spine. While the fusion may (but not always) be “well healed”, it has “healed” in a sub-optimal position, relatively kyphotic for the normal curve at that level, leading the patient to worsening back problems (because the surgeon didn’t understand or believe that this needed to be taken into account, they aren’t looking for this problem post-operatively, and the patient’s worsening back problems can not explained by the initial surgeon. All he or she sees is the “perfectly good surgery”, and not the problem they likely caused or failed to prevent.
Any spinal deformity problem can result in asymmetric wear on the spine, can result in more pressure on nerves and spinal cord due to changes in the local anatomy of the spine, as well as other impact on the rest of the body. Deformities in one part of the body will result in compensation in other parts including the spine, the hips and pelvis, the neck, and even knees and shoulders.
Some deformities are mild and stable over time, while others will get worse if untreated. The impact on the spine of an untreated spinal deformity is worsening arthritis, damage to disks and even bones of the spine, weakening of muscles that are overstretched or contracted, among others. In some cases, a deformity can result in spinal stenosis, disk herniation, or synovial cyst pinching nerves or the spinal cord, resulting in more deformity as well as neurological symptoms. Extreme cases of spinal deformity can result in impairment of breathing or compression on the abdomen causing difficulty eating. They can result in not being able to look straight ahead or forward due to the back and/or neck being tipped so far forward they can’t look up.
When the deformity of the spine impacts on the person’s quality of life to the point where they cannot do the things they need to do to be happy or healthy, then surgery should be considered to correct the deformity. Many people have concerns about surgery, and consequences like reduced range of motion. In most cases, the range of motion after surgery is not very different from before surgery because many of the deformities are already fixed and the person doesn’t move those joints anyway, and the deformity results in the person not getting around enough to use those joints any more. Another concern is for risks of the surgery itself, and these are important to discuss with someone skilled and familiar with the range of treatments, as well as their potential complications. Most risks can be minimized and managed depending on the procedure and the condition of the patient. Deformity correction can be a life-changing procedure, and can benefit people of all ages. In most cases, the deformity does not need to be corrected 100%, but rather to within certain stable parameters:
- C7 balanced over sacrum
- Curve at least 50% corrected, preferably to less than 30 degrees
- less than 20 degrees if under 18,
- less than 15 degrees if under 15 years old)
- reasonably normal alignment of spine and pelvis and head position
Surgical treatments range from minimally invasive spinal fusions, open short segments stabilization and fusion, to extensive deformity corrections that require multiple large operations. Dr. Jenkins is on the forefront of developing minimally invasive treatments to reduce the risk to the patient but still achieve the goals of providing relief from the progression of the deformity.