Spinal Deformities | Most Common Treatments

Spine deformities are abnormal curvatures of the spine that can cause pain, neurological symptoms, and other issues that reduce quality of life. Fortunately, a variety of non-surgical and surgical treatment options are available. 

Introduction

Spine deformities develop for numerous reasons – genetics, poor posture over time, arthritis, previous trauma, and sometimes the underlying cause is unknown. While minor cases may only need monitoring, moderate to severe spinal abnormalities often greatly impact daily life.

As curvatures progress, they contribute to breathing difficulty, cardiovascular problems, constant pain, and mobility restrictions. The good news is appropriate treatment can effectively stabilize worsening and provide relief.

Both non-surgical and surgical approaches are utilized depending on factors like the patient’s age, comorbidities, lifestyle, and deformity severity. Treatment aims to straighten abnormal spinal curves, restore alignment, decompress compressed nerves, and improve physical function.

Non-Surgical Treatments

Non-surgical interventions focus on controlling symptoms and preventing further spinal deviation in mild to moderate cases without neurological deficits.

Lifestyle Modifications

Correcting posture, developing core/back strength, weight management and regular exercise help minimize deformity-related symptoms. Yoga, Pilates and targeted conditioning routines enhance postural mechanics and back muscle function within pain limits.

Medications

Oral and injectable medications reduce inflammation driving pain. Common options include:

• NSAIDs (ibuprofen, naproxen) – Decrease swelling
• Muscle relaxants – Alleviate spasms
• Nerve pain agents – Block/relieve neuropathic symptoms
• Steroid injections – Deliver anti-inflammatory medication directly to painful spinal levels

Medications facilitate engaging in rehabilitative exercises. Some patients may require a narcotic for severe pain but these present addiction risks with long-term use.

Braces

Rigid and soft braces offer external spinal support and help prevent curve progression. Bracing is a common early treatment for juvenile and adolescent idiopathic scoliosis. Wearing a brace won’t reverse existing curves but can halt worsening, especially during developmental growth spurts.

The most effective braces are worn upwards of 18 hours per day until skeletal maturity. Poor compliance decreases success. Potential complications include skin irritation, restricted activity and muscle atrophy. Still, bracing remains a mainstay for conservative management.

For pain relief and postural support, soft braces allow greater mobility with less restriction. These are used for mild scoliosis and in adults with back pain related to spinal deformities.

Physical Therapy

Physical therapy alleviates pain through core strengthening exercises, postural retraining, flexibility improvement and conditioning routines tailored to each patient’s functional status.

While physical therapy doesn’t change abnormal curvature magnitudes, optimized muscle function reduces deformity-related symptoms. Stretching tight pelvic/leg musculature alleviates nerve tension another source of discomfort associated with progressive scoliosis. Patients learn proper body mechanics for everyday activities.

Alternative Medicine

Some patients benefit from complementary treatments like chiropractic adjustments, massage therapy and acupuncture. Such modalities provide short-term relief by addressing muscle tension and nerve irritation related to progressive deformity. They don’t correct actual skeletal curvatures by themselves but can enhance other conservative treatments when used together.

If adequate symptom control and deformity stabilization aren’t achieved non-surgically, surgery may become necessary. Surgery focuses on realigning and fusing spinal segments.

Surgical Treatments

Surgical correction is considered for curvatures >45-70° with intractable pain or neurological deficits indicating spinal cord/nerve impingement requiring decompression. Surgery may also be recommended if non-operative measures fail and deformities continue to worsen over time.

Goals of surgery include:

• Straightening abnormal spinal alignment
• Halting deformity progression
• Reducing pain/discomfort
• Restoring mobility and function
• Preventing progression-related complications

Factors like patient age, comorbidities, lung/cardiac status, curve types/locations and surgical goals dictate the approach.

Spinal Fusion

This procedure promotes long-term stabilization using bone grafts to stimulate fusion between individual vertebrae into one solid segment. Instrumentation like rods/screws internally splint the area.

Eliminating motion through targeted fusion provides a rigid column preventing deformity advancement. Fusion redirects forces to stabilize while healing progresses over 3-12 months depending on patient factors.

Osteotomies

These realign vertebrae by purposefully cutting bone and closing wedge-shaped defects. Different osteotomy types exist for precise correction.

• Posterior column osteotomy – Partial posterior wedge removal for gradual curves
• Pedicle subtraction – Removes pedicles/portion of vertebral body

Meticulously executed, substantial realignment is achievable through these tissue-sparing approaches without excess fusion levels. Pedicle subtraction offers ~30° per segment. Osteotomies improve coronal/sagittal balance in rigid angular deformities.

Laminectomy

This surgery removes select vertebral lamina overgrowths pressing on the spinal cord/nerves. Decompression alleviates associated leg pain, numbness and weakness not responsive to non-surgical measures. Laminectomies require a fusion to prevent post-decompression

Vertebral Column Resection (VCR)

VCR completely removes an entire vertebral body and disc for the most severe, sharp rigid curves >80° unresponsive to other corrective techniques. After resection, closing the gap straightens the spine which is then reconstructed using instrumentation.

Due to technical demands, VCR risks higher complications but successfully achieves substantial realignment when indicated. Integrating advanced imaging helps ensure safe, precise execution protecting the cord.

Conclusion

In summary, spine deformities are complex progressive conditions requiring customized treatment plans based on deformity type/severity, symptoms, progression risk and prior response to interventions tried. While conservative treatments like bracing, physical therapy and anti-inflammatory medications often successfully manage mild to moderate cases, surgery is reliably needed for those failing non-operative management or with rigid, angular curves over 45 degrees with intractable pain or neurological deficits indicating impingement requiring decompression. As techniques and technology continue advancing, both non-surgical and surgical options improve – from biologics enhancing fusion rates to minimal access approaches reducing tissue disruption. Understanding all the available treatment options and how they work empowers patients to make informed decisions while navigating their care.