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All spines have curves. Some curvature in the neck, upper trunk, and lower trunk is normal. We need these spinal curves to help our upper body maintain proper balance and alignment over the pelvis. However, when there are abnormal curves in the spinal column, we refer to these as scoliosis, kyphosis, and hyperlordosis—depending on the direction of the curvature.
Scoliosis is not a disease—it is a descriptive term. It refers to an abnormal side-to-side (lateral) curve in the spinal column. When viewed from the back, the vertebrae of a healthy spine should form a straight line, but in someone with scoliosis, the spine looks more like an “S” or a “C” than an “I”. There may be additional rotation with this scoliosis.
There are many causes of scoliosis, including congenital spine deformities (those present at birth, either inherited or caused by the environment), genetic conditions, neuromuscular problems, unequal limb lengths, and osteoporosis. Scoliosis can also occur in adults due to age-related wear and tear. Other causes of scoliosis include cerebral palsy, spina bifida, muscular dystrophy, spinal muscular atrophy, and tumors. More than 80% of scoliosis cases, however, have no known cause.
There are several symptoms to look for to help determine if you or someone you love has scoliosis.
If you notice any of these signs, you should schedule an exam with your doctor:
Once suspected, scoliosis can be confirmed with a diagnostic exam such as an x-ray, spinal radiograph, CT scan, or magnetic resonance imaging (MRI) of the spine. The curve is then measured and is discussed in terms of degrees. Generally, a curve is considered significant if it is greater than 25 to 30 degrees. Curves exceeding 45 to 50 degrees are considered more severe.
Treating scoliosis depends on your curve, your age, and other factors. If the curve needs to be corrected, a brace is usually the first option. Most scoliosis curves never progress to the point where surgery is necessary. However, some people have scoliosis so severe that it requires surgery. Thanks to advancements in technologies, spinal fusion is much easier than it used to be and may give you the freedom to resume normal activities.
Spinal fusion is the most common surgery to correct severe scoliosis. It is typically used to correct curves in the spine that are greater than 45 degrees or for spinal curves that haven’t responded to bracing. There are really two goals for scoliosis surgery: to stop a curve from worsening and to correct spinal deformities.
Kyphosis (a forward spinal curvature or “hunched back”) is normal in the thoracic (upper) spine. It can occur in the cervical and lumbar spine as well. When a doctor measures it on an x-ray, the normal range for kyphosis is quite broad, between 20-50 degrees. However, when kyphosis is greater than 50 degrees, it becomes easy to see and is considered abnormal. Kyphosis is most commonly seen in older women, as a result of osteoporosis.
Kyphosis occurs when the vertebrae in the upper back become wedge-shaped. This deformity can be caused by a variety of conditions including age-related degenerative diseases like osteoporosis, spinal fractures, and degenerative disc disease, among others.
Aside from age-related kyphosis, there are two common forms of kyphosis that are typically seen in children and teenagers:
Besides causing a “hunched back,” kyphosis can also lead to back pain and stiffness and in severe cases, it can even affect your lungs, nerves, and other organs. Mild cases, however, may produce no noticeable signs or symptoms.
Kyphosis is typically diagnosed through a physical exam and x-rays. If more detail is required, your doctor may order a CT scan as well. In some cases, your doctor may also request an MRI of your spine if he or she suspects an underlying cause such as a tumor or infection that could be causing the curvature.
Treatment decisions regarding kyphosis are based upon the cause of the curvature, the degree of deformity, the risk of progression during and after growth (in children and adolescents), and the severity of symptoms associated with the kyphosis.
Treatment options for kyphosis include observation, medications, bracing, or surgery. Kyphosis below 50 degrees usually requires no treatment. Kyphosis between 50 and 75 degrees, where there is significant growth remaining or persistent back pain, may be managed by a brace.
When kyphosis is caused by a vertebral compression fracture due to osteoporosis or cancer, a minimally invasive procedure called kyphoplasty is a common treatment. Surgeries, such as spinal fusion, are usually reserved for curves greater than 75 degrees, where there is concern that there will be gradual progression after the completion of growth or in late adult life when there is a progressive loss of bone mass. Surgical treatment consists of both a correction of the deformity using spinal instrumentation and fusion of the involved portion of the spine to prevent progression later in life.
Hyperlordosis (also known as “swayback”) refers to an exaggerated inward curve of the lumbar spine (just above the buttocks).
Hyperlordosis may be caused by achondroplasia (a common cause of dwarfism), spondylolisthesis, benign juvenile lordosis (which is not medically significant), and osteoporosis, among other conditions.
Hyperlordosis tends to make the buttocks appear more pronounced. In people who have significant hyperlordosis, a large gap will be visible beneath their lower back when lying on a hard surface. Other symptoms include back pain and discomfort, as well as difficulty moving certain ways.
If hyperlordosis is suspected, the curvature will be examined to see if it seems flexible or rigid. If the curvature seems rigid (not flexible), the doctor may order x-rays to determine the diagnosis.
If the lordotic curve is flexible, treatment isn’t typically needed and the lordosis won’t progress or cause problems down the road. In some cases, especially if the curve is rigid, the curvature may require the use of a back brace or back surgery, such as spinal fusion.