What Causes Adult Spinal Deformity?

For instance, in a lumbar curve -- quite commonly the majority of the lumbar deformity will exist between the 11th thoracic and 3rd lumbar vertebrae (T11-L3). If the patient had a surgery as a teenager, the surgery would probably have been an anterior fusion and instrumentation from T11 to L3. Left untreated, by age 45 or so the lumbar curve would develop a rotatory subluxation (one vertebra slides off another vertebra in both the coronal and axial planes) at L3-L4 with degenerative changes, a fixed tilt at L4-L5, and degenerative changes at L5-S1. The surgery often requires fusion down to the sacrum.

Figure 6. Spinal Column

Indications for Spine Surgery
Progressive deformity, increased back and leg pain or particular concern about the magnitude of the deformity is the tidemark for surgical treatment. Certain developments trigger surgical treatment intervention such as sagittal or coronal imbalance, spinal stenosis, or increased pain.

Adult scoliosis differs from teenage scoliosis. With adult scoliosis, decisions about surgical treatment are based on a combination of factors that are considered by both the surgeon and the patient. In teenage scoliosis, the severity of the curve (degree of abnormal curvature) is often the determining factor.