Spinal Deformity in Adults: Common Types of Idiopathic and Degenerative Disorders

One of the leaders in the field of spinal deformity is Keith Bridwell, M.D. Although Dr. Bridwell's practice includes all aspects of spinal surgery, the emphasis is on treating spinal deformities affecting children and adults. Besides a busy practice and listed in The Best Doctors in America, Dr. Bridwell is Professor of Orthopaedic Surgery and Chief of Pediatric and Adult Spinal Surgery in the Department of Orthopaedic Surgery at Washington University School of Medicine in St. Louis, MO.

Considering Dr. Bridwell's expertise on the subject, we are pleased to feature his commentary in this article about adult spinal deformity, which includes a discussion of the causes, indications for surgical intervention, and technological advancements.

Common Types of Adult Spinal Deformity
Adult spinal deformity can be divided into problems of principally the sagittal plane versus problems of the coronal plane versus problems of both planes. The sagittal plane divides the body vertically into left and right sides. The coronal plane is also called the frontal plane and divides the body front (anterior) and back (posterior). See Figure 1 below.

Figure 1. Anatomical Planes of the Body

Scoliosis, kyphosis, and sagittal imbalance are types of spinal deformity. Scoliosis is a three-dimensional deformity that affects the coronal, sagittal, and axial planes. Most people think of it as being principally a coronal plane deformity. The coronal plane deformity is represented on Anterior/Posterior (AP) or Posterior/Anterior (PA) spine x-rays (radiographs). Kyphosis and sagittal imbalance represent the sagittal plane. Sometimes patients will have co-existent sagittal problems such as spondylolisthesis. See Figures 2 through 5.

Figure 2a. Preoperative X-Ray (Radiograph)
Scoliosis: Standing AP (coronal plane deformity)

Figure 2b. Preoperative X-Ray (Radiograph)
Kyphosis: Lateral (sagittal plane deformity)