CHAPTER 77 - Spinal deformity: Recognition and intervention

Abstract

Spinal Deformity is as much a process as a clinical outcome. The static structure depends on the force resistant distribution of bone and collagen, The pathobiology can be a response to force, inflammation, habit, or metastasis. Sagittal plane alignment directly influences functional status and health-related quality of life. Imbalance in pelvis angulation and spinal alignment can have insidious onset, relentless progression, and deadly resolution. Combined Hip/Knee flexion, cervical hyperextension (crane neck) and pelvic retroversion are pathognomonic for anterior sagittal malalignment. Recognition and treatment require interdisciplinary collaboration, multimodal imaging (X-Ray, MRI, CT), and electrodiagnostic characterization of neuromuscular dysfunction to complement a detailed history and physical examination. Large curves with limited pain typify Adolescent Idiopathic Scoliosis (AIS); while significant pain and reduced function define Adult Spinal Deformity (ASD). Spinal bracing reduces spinal pain intensity and disability in spinal deformity. Degenerative spinal stenosis is a synchronous process. Any lumbar presentation (e.g.: neurogenic claudication) requires cervical surveillance for latent pathology. Vitamin B12 deficiency surveillance complements MRI imaging and electrodiagnostic evaluation of spinal impingement. Spinal tumors metastasized from breast, prostate, and lung (80%) instigate pathologic fractures, kyphotic deformity, and neural impingement. Bowel/bladder dysfunction and peroneal numbness are hallmarks for Cauda Equina syndrome (CES). Surgical decompression within hours is required to prevent permanent “saddle anesthesia” and paralysis.