Adult Spinal Deformity: Scoliosis, Kyphosis, Spondylolisthesis
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 3 through 5 below.
Figure 3a. Three Months Post-operative
X-Ray (Radiograph) Scoliosis: Standing AP
Figure 3b. Three Months Post-operative
X-Ray (Radiograph) Scoliosis: Lateral
Figure 4. Scoliosis visualized on
an AP/coronal radiograph
Figure 5. Spondylolisthesis is represented
on this lateral/sagittal radiograph
Spinal deformities that develop to the point requiring surgical treatment can be further divided into primary and revision cases. Revision cases are most commonly performed to treat failed fusion (pseudarthrosis) or breakdown, progression of the deformity, or spinal stenosis occurring below the level of the spine previously operated on.
Lumbar deformities can be divided into idiopathic (cause unknown) with superimposed degenerative changes and de novo degenerative scoliosis where the deformity starts at age 40. The latter means the scoliosis may have resulted from osteoporosis and/or age-related disc changes. These deformities can be divided into thoracic curves, lumbar curves, or a combination. Treatment for the lumbar pathology is more common.