Scoliosis and Kyphosis

Two words which often go together are scoliosis and kyphosis. Kyphosis is a word we have met already in the page in Spine - Anatomy and Mechanics. It is normal for the thoracic spine to have a kyphotic curve. Excessive kyphosis however is a disabling condition. Advanced degeneration in the lumbar or cervical spine can turn an otherwise lordotic curve into a kyphotic deformity. Scoliosis is a deformity of the spine in the coronal plane. Front on, in the coronal plane, the spine should be pretty straight. A scoliotic deformity is often also associated with rotation of the vertebrae resulting in a very complex 3- dimensional problem. Traditional surgery to fix this problem really is a huge ordeal both for the patient and the surgeon. It used to be said that 2 intensive care beds need to be booked, one for the patient and one for the surgeon! Modern, minimally invasive techniques allow now for very good, if not better, reconstruction of scoliotic and kyphotic spines than traditional methods and patients who would otherwise have been sent off to chronic pain clinics can now be treated.

On the right is a patient with a deformity in the coronal and sagittal plane. There is degeneration everywhere with a curved spine front-on and loss of lumbar lordosis viewed from the side. This patient has pain as a result of all the mechanisms discussed in the page on back pain but especially because of mechanical instability. This patient is 84 years old and the energy he has to expend to keep his spine from collapsing whenever he stands up is considerable. These patients fatigue very easily and providing simple mechanical stability to the spine using minimally invasive techniques is very effective in controlling a lot of the pain. One feature these patients all have in common is the ability to get rid of all or most of their pain simply by lying down in bed or on a recliner. In other words, mechanically unloading their spine, temporarily stabilises it and takes away their pain. Successful surgery accomplishes the same goal by mechanically stabilising the spine allowing the patient to keep this stable position whilst upright.

More severe is the scoliosis curve to the left which is a result of aggressive decompressive surgery many years prior. This kind of curve is extremely mechanically unstable. The spine essentially fails whenever it is loaded. In this case the collapse is so bad that the rib cage actually sinks in to the pelvis and so every breath causes bone-on-bone pain. Respiratory function is often compromised in these individuals as a result of this and this condition has a mortality associated with it because of this.

Childhood scoliosis is a very different situation. There are many causes for childhood scoliosis. In the past it was called idiopathic scoliosis (idiopathic essentially means 'cause unknown') but we now know for certain that the cause is genetic and certain gene mutations are responsible. Girls are more frequently affected than boys and it is probable that in the future DNA analysis will determine of a child is at risk for developing this condition and preventative measures can be taken. Curves that are not extreme are often braced until growth stops. The dangerous curves are the ones that are already measureable before any real growth in the child has occurred as these can spiral - literally - out of control. Childhood scoliosis does not form a big part of my practice except to make a diagnosis and refer appropriately to surgeons who specialise in this field.

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