What is Adult Spinal Deformity?
An umbrella term for several patterns of spinal malalignment seen in adults — scoliosis (sideways curve), kyphosis (exaggerated forward curve), hyperlordosis (exaggerated inward lumbar curve), flatback syndrome (loss of lumbar lordosis), and spondylolisthesis. These often coexist, and loss of overall sagittal balance — the body’s ability to stand vertically over the pelvis — is increasingly recognised as one of the most important predictors of pain and disability, regardless of the size of the side-to-side curve.
Causes
Adult degenerative de novo scoliosis from asymmetric disc and facet wear; progression of an adolescent curve; osteoporotic vertebral compression fractures; Scheuermann’s disease; previous spinal surgery; degenerative kyphosis and flatback; spondylolisthesis with malalignment.
Symptoms
Mechanical back pain (worse with prolonged standing or activity), radiculopathy from foraminal narrowing, claudicant leg pain from canal narrowing, fatigue from holding the body upright against an unbalanced spine, leaning or stooped posture, reduced walking distance, and reduced flexibility. Emotional and quality-of-life impact is often significant.
Diagnosis
Combined history, examination of standing posture (front, back, side), shoulder, waist and pelvic symmetry, range of movement, and a full neurological examination of the legs. Treatment in adults is driven by symptoms and overall balance rather than the absolute curve size.
Imaging
Standing whole-spine X-rays for Cobb angle and sagittal balance. MRI to assess discs, nerves and any canal or foraminal compression. CT for bony detail and operative planning. DEXA scan to assess bone density, since osteoporosis can accelerate progression and influence treatment, and if considering surgery may lead to failure of the procedure.
Treatment
Non-surgical management is the cornerstone — activity, structured physiotherapy (core strengthening, postural retraining, hip and shoulder mobility, aerobic conditioning), medications (paracetamol, NSAIDs, nerve-pain agents, short courses of muscle relaxants or opioids during flares), CT-guided steroid injections for nerve pain, and lifestyle measures (weight, bone health, smoking cessation, sleep, ergonomics). Surgery is reserved for severe, persistent symptoms, progressive deformity, significant nerve compression or loss of spinal balance.