Spine Deformities

Adult spinal deformity encompasses a spectrum of conditions — scoliosis (sideways curvature), kyphosis (forward rounding), flatback deformity, and sagittal imbalance — in which the spine’s normal alignment is significantly disrupted. These are not simply cosmetic concerns. Advanced spinal deformity can cause severe back pain, neurological deficits from nerve compression, and functional limitations that restrict the ability to walk, stand, or carry out daily activities. At Mountain Spine & Orthopedics, our specialists evaluate the spine’s alignment in both the frontal plane (coronal balance) and the side profile (sagittal balance), using advanced full-length imaging and a thorough neurological examination to characterize the deformity and guide treatment.

Symptoms vary by the type and severity of the deformity. Common presentations include: chronic back or neck pain that has failed to respond to conservative care; visible postural changes such as a sideways lean (scoliosis), forward stoop (kyphosis), or forward trunk shift (flatback deformity); leg pain, numbness, or weakness from nerve compression secondary to the deformity; difficulty standing upright or needing to lean on furniture for support; pain that worsens with walking and improves with sitting (neurogenic claudication from stenosis); and progressive loss of height or rounding of the upper back.

Risk factors for adult spinal deformity include: degenerative disc disease across multiple spinal levels; osteoporosis, which leads to compression fractures and progressive kyphosis; prior spinal surgery with risk of adjacent segment degeneration and flatback deformity; degenerative scoliosis from asymmetric disc collapse; systemic inflammatory conditions affecting spinal joints; and advanced age, female sex, and low bone density. Patients who have had previous spine surgery and are experiencing worsening symptoms or new-onset deformity may have adjacent segment disease — a condition in which degeneration has progressed to the levels above or below a prior fusion.

Accurate diagnosis requires more than a standard MRI. Our specialists use full-length standing scoliosis X-rays (EOS or standard) to measure the Cobb angle and assess overall spinal alignment including sagittal and coronal balance; MRI to evaluate nerve compression and disc degeneration at each level; CT scan when bony anatomy detail is needed for surgical planning; and a comprehensive neurological examination to document functional deficits. We offer a complimentary MRI review for new patients with existing imaging.

Non-surgical management aims to relieve pain and maintain function when deformity is not severely progressive. Injections — epidural steroids, facet blocks, nerve blocks — can provide significant relief for deformity-related nerve compression. When conservative care fails or when deformity is progressive and compromising neurological function, surgical correction may be recommended. Options include spinal fusion to stabilize and partially correct the deformity, multilevel fusion for complex multilevel involvement, deformity correction osteotomies for severe sagittal imbalance, and revision surgery for patients with prior failed spinal procedures. Minimally invasive approaches including OLIF and XLIF are used where appropriate to reduce muscle disruption in multilevel scoliosis correction.

Pain from adult spinal deformity has two primary sources: mechanical pain from the arthritic facet joints, discs, and fatigued paraspinal muscles; and neurological pain from nerve root or spinal cord compression as the curved, imbalanced spine narrows the spinal canal and foramina. Patients with significant neurogenic claudication — leg cramping or weakness that limits walking — typically have the most to gain from surgical decompression. Our pain management team and spine surgeons work collaboratively to ensure every appropriate option is available before any surgical decision is made.

For adults, maintaining strong core musculature, good bone health through adequate calcium and vitamin D intake, and healthy weight can slow the progression of degenerative spinal deformities. Patients with known deformity should undergo periodic monitoring with imaging to track progression, particularly if curves are above 30 degrees. Early intervention — both in terms of diagnosis and appropriate conservative care — can expand the range of treatment options and may enable less invasive surgical approaches if surgery becomes necessary.

If you are living with a known spinal deformity, progressive back pain, or worsening neurological symptoms, bring your imaging and schedule a comprehensive evaluation today. Our specialists will give you an honest assessment of your condition and every available option — from conservative management to complex deformity correction.