Spinal alignment is evaluated in several directions.
From the front, the spine should appear relatively straight. From the side, it should have balanced curves in the neck, upper back, and lower back.
Please review the Lumbosacral spine anatomy section for more information.
A deformity may involve:
- Sideways curvature
- Abnormal forward bending
- Loss of normal lumbar curvature
- Rotation of the vertebrae
- Forward or sideways imbalance
- Collapse above or below a previous fusion
Major Diagnosis Types
Below are the major types we see in our clinic. Click on available links to learn about our approach to the problems.
Adult Degenerative Deformity
Adult degenerative scoliosis is a sideways curvature that develops as the discs and facet joints wear unevenly over time.
It most commonly affects the lumbar spine and may be associated with:
- Disc collapse
- Facet arthritis
- Vertebral rotation
- Spinal stenosis
- Foraminal narrowing
- Spondylolisthesis
Some patients primarily experience back pain, while others develop leg pain, weakness, or difficulty walking because the deformity compresses the spinal nerves.
Minor Diagnosis Types
These terms are often encountered, but are either less often treated or described within one of the above diagnoses.
Adult Idiopathic Scoliosis
Adult idiopathic scoliosis is a spinal curvature that began during adolescence and remains present into adulthood.
The curve may remain stable for many years or gradually progress as age-related degeneration develops.
Symptoms may result from the curve itself, muscular fatigue, imbalance, disc degeneration, or nerve compression.
Coronal Imbalance
Coronal imbalance occurs when the head and trunk shift to one side relative to the pelvis.
This may accompany scoliosis and can make standing or walking feel uneven or unstable.
Degenerative Lumbar Scoliosis
Degenerative lumbar scoliosis specifically refers to an age-related curvature involving the lower spine.
The vertebrae may rotate and shift sideways as the discs and facet joints deteriorate unevenly.
This may narrow the spinal canal or neural foramina and cause pain that travels into one or both legs.
Flatback Syndrome
Flatback syndrome occurs when the normal inward curve of the lumbar spine is reduced.
Without adequate lumbar curvature, the trunk may shift forward and require increased muscular effort to remain upright.
Patients may experience:
- Back fatigue
- Difficulty standing upright
- Hip or knee flexion while standing
- Pain that worsens later in the day
- Difficulty looking straight ahead
- Reduced walking tolerance
Flatback syndrome may develop from degeneration or after a previous spinal fusion performed with inadequate alignment.
Junctional Failure
Junctional failure is a more severe structural problem near the end of a spinal fusion.
It may involve:
- Vertebral fracture
- Ligament disruption
- Implant failure
- Vertebral slippage
- Progressive deformity
- Nerve or spinal cord compression
Junctional failure may require urgent evaluation, particularly when it causes severe pain, weakness, or loss of alignment.
Junctional Kyphosis
Junctional kyphosis is an abnormal forward curve that develops near the end of a spinal fusion.
It may occur gradually as the discs, joints, and ligaments next to the fusion experience increased stress.
Not every case causes symptoms or requires additional treatment.
Lumbar Kyphosis
The lumbar spine normally curves inward. Lumbar kyphosis occurs when this inward curve is lost or reversed, causing the lower spine to bend forward.
Lumbar kyphosis may result from:
- Severe disc degeneration
- Vertebral fractures
- Previous spine surgery
- Infection
- Tumor
- Neuromuscular disease
Patients may have difficulty standing upright and may compensate by bending the hips or knees.
Sagittal Imbalance
Sagittal imbalance refers to abnormal alignment when the spine is viewed from the side.
A patient with positive sagittal imbalance has the head and upper body positioned too far forward relative to the pelvis.
The body may compensate by:
- Tilting the pelvis backward
- Bending the knees
- Extending the hips
- Hyperextending unaffected spinal levels
These compensatory mechanisms may eventually cause pain and fatigue.