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.

What is Scoliosis?

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.

What Causes 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.

Types of Scoliosis

  • Degenerative scoliosis – This type of scoliosis is associated with arthritis and degeneration of the spine. It typically gets worse as you age.
  • Congenital scoliosis – This type is defined as a curvature of the spine that is the result of malformations of the vertebral elements. The fact that the spine and spinal column ever form correctly is amazing given the complexity of the process from an embryological standpoint. Most of this development happens during the third to sixth week in utero (after conception). In spite of the opportunities for error, congenital malformations are extremely rare.
  • Adolescent idiopathic scoliosis – This type of scoliosis is the most common form in North America, affecting up to an estimated 5.2% of the population.1 It’s often seen during or after an adolescent growth spurt. In order for a physician to diagnose and treat idiopathic scoliosis, he or she must first rule out all other causes of scoliosis. Most idiopathic curves present in adolescence are painless, gradual, have a typical curve pattern (e.g., a right thoracic curve), and the neurological exam is normal. Idiopathic scoliosis is much more common in females.
  • Neuromuscular scoliosis – This term is used to describe curvature of the spine in children with any disorder of the neurological system. Common categories include cerebral palsy, spina bifida, muscular dystrophies, spinal cord injuries, and so forth.

What Are the Symptoms of Scoliosis?

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:

  • Your shoulders are different heights (one shoulder blade is more prominent than the other)
  • Your head is not centered directly above your pelvis
  • You have a raised, prominent hip
  • Your rib cages are at different heights
  • You have an uneven waist
  • You notice changes in the appearance or texture of the skin overlying the spine
  • Your entire body leans to one side

How is Scoliosis Diagnosed?

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.

How is Scoliosis Treated?

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.

What is Kyphosis?

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.

What Causes Kyphosis?

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.

Other Types of Kyphosis

Aside from age-related kyphosis, there are two common forms of kyphosis that are typically seen in children and teenagers:

  • Scheueremann’s kyphosis – This type of kyphosis is most common in teenage boys. It is characterized by a short, sharp kyphosis in the middle part of the upper spine, and may be associated with aching back pain. The kyphosis tends to be rigid (not flexible) when examined. A mild degree of scoliosis is common in teenagers with Scheueremann’s kyphosis.
  • Postural roundback – This type of kyphosis is noted by a smooth, flexible kyphosis that is not typically associated with pain. The curve is easily corrected by asking the child to stand up straight. These curves tend to be mild in severity and extend over a longer number of vertebral segments compared to Scheueremann’s kyphosis.

What Are the Symptoms of Kyphosis?

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.

How is Kyphosis Diagnosed?

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.

How is Kyphosis Treated?

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.

What is Hyperlordosis?

Hyperlordosis (also known as “swayback”) refers to an exaggerated inward curve of the lumbar spine (just above the buttocks).

What Causes Hyperlordosis?

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.

What Are the Symptoms?

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.

How is Hyperlordosis Diagnosed?

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.

How is Hyperlordosis Treated?

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.

References

  1. Konieczny MR, Senyurt H, Krauspe R. J Child Orthop. 2013 Feb;7(1):3-9. Epub 2012 Dec 11. Epidemiology of adolescent idiopathic scoliosis.