Spinal Deformity
Changes in spinal alignment, including selected scoliosis conditions.
General educational information is not a diagnosis or treatment recommendation for an individual.
Overview
Adult spinal deformity describes changes in spinal shape and balance. Scoliosis is a sideways curve, often with rotation; sagittal imbalance describes difficulty maintaining balanced alignment when viewed from the side. Adult deformity may represent a longstanding curve or arise with degeneration. Adult assessment differs from treatment aimed at a growing adolescent spine.
Common Symptoms
Possible concerns include back pain, fatigue while standing, an uneven waist or shoulders, or a forward-leaning posture. Some people compensate by bending their hips or knees. Associated nerve narrowing can cause leg pain, numbness, weakness, or reduced walking tolerance. The visible size of a curve does not alone describe its effect on daily life.
Causes and Risk Factors
Disc and joint degeneration can change alignment over time. A curve present earlier in life may become more symptomatic with aging. Bone health, previous spinal operations, and other medical conditions can influence posture and treatment planning. Not all adults with scoliosis develop significant disability.
Evaluation and Diagnosis
Assessment includes posture, balance, neurological function, walking, and the activities limited by symptoms. Standing full-length X-rays help assess side-to-side and front-to-back alignment. MRI may clarify nerve compression; CT can provide additional bony detail when needed. Bone health and general medical fitness matter when major reconstruction is being considered.
Nonsurgical Treatment Options
An individualized rehabilitation plan, activity adjustments, and appropriate medication can help symptoms and function. Selected injections may address associated nerve-related pain. Nonsurgical care does not necessarily correct a fixed structural deformity. Pediatric bracing recommendations should not be assumed to apply to an adult with degenerative scoliosis.
When Surgery May Be Considered
Surgical consideration depends on disability, nerve compression, balance, progression, response to appropriate nonsurgical care, and the patient’s health and goals. An operation may involve decompression, stabilization, or realignment. Extensive reconstruction is not appropriate for every curve and involves substantial individualized risk-benefit discussion. A straighter X-ray is not the only measure of a useful treatment.
When to Seek Neurosurgical Evaluation
Evaluation can help when posture-related fatigue, pain, or neurological symptoms increasingly limit standing and walking. Bring standing spine images, previous surgical information, and a description of functional goals. Complex cases may benefit from collaboration across spine specialties and attention to bone health and medical optimization.
Important Warning Signs
Rapidly worsening weakness, new inability to walk, or new bladder or bowel dysfunction with neurological changes requires urgent assessment. New groin numbness with back or leg symptoms also warrants emergency care. Gradual postural change without these features is different from an acute neurological emergency.
Questions to Ask Your Neurosurgical Clinician
Is my main problem the curve, forward imbalance, nerve compression, or a combination? What could improve function without surgery? If reconstruction is proposed, how extensive would it be, and what are its limitations? How do bone health and prior operations affect the plan?
References and Further Reading
These professional-society patient-education resources informed this draft. They are not formal clinical practice guidelines and do not endorse this website.
Preparing for Your Consultation
Bring your imaging, reports, medication list, and relevant treatment history. Describe symptoms and the activities that matter most to you. Clinical assessment combines examination and imaging with individualized discussion of options.
Medical Information Disclaimer
This article is an editorial draft requiring physician review. It provides general education, not individualized medical advice or a guarantee of treatment results. Seek qualified medical assessment for your own circumstances and emergency care for urgent symptoms. This independently maintained physician-information website is not an official website of CU Medicine, the University of Colorado, or UCHealth. References do not imply society or institutional endorsement.