When viewed from the side, the spine forms a S shaped curve.
A forward, exaggerated rounding of the back is called Kyphosis. This most commonly occurs in older individuals due to osteoporosis, but can also occur in infants and teens.
Infants may be born with and abnormal spine segment (Congenital Kyphosis). They may usually look ok at birth but the spine deformity gets manifested as the baby grows.
Scheuremann’s kyphosis is condition seen in adolescent boys wherein the vertebrae become wedge-shaped.
Surgery allows significant correction to be achieved, usually without needing post-operative bracing. Pedicle screws are inserted and connected with two rods, which allows gentle straightening of the spine.
Normal Spine when viewed from front forms a straight line. An abnormal lateral or sideways curvature of the spine is called scoliosis. Most of the times it occurs in adolescent age group and the cause is unknown (Adolescent Idiopathic Scoliosis). Other causes of scoliosis can be congenital or neuromuscular.
Treatment of scoliosis depends on the severity of the curve and its possibility of getting worse. Treatment options range from observation to bracing and sometimes surgical correction in the form of deformity correction and instrumented fusion
© Dr. Mayur Kardile
Occurs when one vertebra slips forward onto the vertebra below it. This leads to pinching of the spinal nerves causing numbness or pain in the back or legs.
Out of several types of spondylisthesis, the most common types are Lytic listhesis and Degenerative listhesis.
Depending on the type and severity of listhesis, treatment would range from minimally invasive decompression to fusing the two involved vertebrae. These kind of fusion surgeries are best done through the anterior approach (Anterior Lumbar Interbody Fusion- ALIF
Forward posture usually due to a flattened lumbar spine from postoperative or degenerative changes. When viewed from the side, the patient’s head may be several centimeters in front of their hips.
The lower back has lost its normal inward curvature or lordosis. As a result, patients with this condition are unable to stand upright and usually tilt forward.
This occurs in patients who had previously undergone spinal surgery either for scoliosis or for degenerative low back conditions.
Surgical remedies include anterior osteotomies, posterior fusion and instrumentation to restore normal curvature of the lower back, enabling a patient to stand upright.
Degenerative Conditions of The Spine
Herniated disc (Slip Disc)
Intervertebral Disc is a soft cushion like structure between two vertebra. Sometimes, disc material may come out of its normal boundaries and irritate the spinal nerves causing pain and numbness.
Most of the times, disc herniations can be treated with non operative treatment. A few patients with disc herniation may require surgery in the form of Microdiscectomy
Lumbar Canal Stenosis
As the one progress in life, several degenerative changes may happen in the spine. This degeneration is a part of normal physiological process. A few subset of patient may suffer from pinching of nerves in the lumbar spine. This condition is called as Lumbar Canal Stenosis. Such patients develop symptoms of pain, claudication (gripping pain in legs on walking) and weakness.
Treatment options may range from pain block injection and physiotherapy to structure sparing minimally invasive decompressions to spinal fusion surgery.
Cervical Disc Herniation
The cushion like structure between the two vertebrae in the neck may sometimes creep out of its boundaries and press on the spinal cord or nerves passing through the cervical spine.
Such patients may have symptoms of radiating pain in one or both upper extremities, weakness or gait imbalance.
Depending on the severity of symptoms, treatment options may range from pain block injection and physiotherapy to anterior cervical discectomy and fusion (ACDF). Over the recent years, motion preserving Cervical disc Replacement (CDR) has been providing promising results in patients with this condition.
Occurs when a disease or degenerative process in the spine causes compression of the spinal cord leading to neurological symptoms. Such patients complains of unsteadiness while walking, spasticity in lower limbs and sometimes loss of precision in movement of fingers.
There is not much role of non operative management in compressive myelopathies and treatment is usually in the form of surgical decompression of the spinal cord
Spine Fractures and dislocations
With the increasing pace of life, high velocity accidents have become common. With this, incidence of spinal injuries has also increased. Spine injuries like fractures and dislocations can lead to catastrophic neurological deficits like quadriplegia and paraplegia and at times can even be life threatening.
Timely intervention with various modalities of spinal stabilization techniques and aggressive rehabilitation can help these patients to get back to normal life.
Patients with osteoporosis (weakening of bones) may suffer from vertebral fractures with minimal or no trauma at all. These fractures can lead to chronic pain, spinal deformity and decrease the quality of life.
Osteoporotic fractures need a multimodal treatment aimed at increasing the strength in bones and stabilization of the spine.
Minimally invasive treatment options like vertebroplasty, kyphoplasty and percutaneous pedicle screw or cement augmented pedicle screw fixation can lead to good pain relief in such patients.
Tuberculosis of the Spine
Contrary to the popular belief tuberculosis not only affects the lungs but can affect almost any organ system. Spine is the most common site for bone and joint tuberculosis. The tubercular bacilli destroy the spinal bones and cause pain, instability and deformity. The infective material can press over the spinal cord and nerves leading to weakness and pain.
Treatment involves multi-drug antitubercular therapy. At times, these patients may also need surgery to clear the infection, decompress never structures and restore spinal stability
Pyogenic and fungal infections of the Spine
Spine may be a site of infection in patients with chronic diabetes, chronic steroid use, chronic renal failure, cancer chemotherapy and radiotherapy and immunocompromised status like HIV. Patients may present with fever, back ache and neurodeficits.
Treatment involves accurate diagnosis with percutaneous biopsy, culture directed antibiotics. At times, these patients may also need surgery to clear the infection, decompress never structures and restore spinal stability
Metastatic and Primary Spine Tumors
With increasing longevity of life, incidence of various cancers has increased. Spine is one of the most common site for metastatic (spread of cancer through blood stream) cancer disease. Some of the most common cancers spreading to the spine are that of Breast, Prostate, Lung, Kidney, Colon, Cervix and uterus. Sometimes, spine metastasis can even be the first manifestation of such occult cancers.
Primary bone tumors like Myeloma, Osteosarcoma, Ewings Sarcoma, Lymphoma, Hemagioma etc can also affect the spine.
Patients may present with trivial back ache or frank neurodeficits like weakness and loss of bowel and bladder control.
Spine tumors need a multidisciplinary management which involves Spine Surgeon, Intervention Radiologists, Chemotherapists, Radiotherapists, Physicians and so on. Primary spine tumors may need t be managed with highly specialized surgeries like EnBlock Resections and Reconstructions. With modern modalities of treatment, patients with Spine tumors can even get back to normal lifestyle.