Spinal Curvatures (Scoliosis, Kyphosis and Lordosis)

Your spine, or backbone, is your body’s central support structure, made up of a chain of bones (vertebrae), ligaments and discs. When viewed from the front or behind, a healthy spine will appear as perfectly straight down the middle of your back. When viewed from the side, a healthy spine has a slight S-shaped curve. This curve allows for an even distribution of weight and flexibility of movement. Sometimes this natural curvature is not aligned properly or is exaggerated, resulting in one of the following conditions:

• Kyphosis – A rounding of the spine in the upper back. It can look like you have a hump in your back.
• Lordosis – An increased curve toward the front of your body in your lower back or neck area.
• Scoliosis – The spine curves from side to side in an S-shape or C-shape rather than being straight.

Ohio State Spine Care experts in Columbus, Ohio, are able to treat all forms of spine curvature conditions.

What is scoliosis?

Scoliosis causes a sideways curvature of your spine. This condition is usually diagnosed in early childhood, just before puberty. A curve that measures more than 10 degrees on an X-ray is considered scoliosis. The curve is often S- or C-shaped. In most cases, the spine will also rotate or twist in addition to curving side to side.

Doctors use your medical and family history, a physical exam and imaging tests to diagnose scoliosis. Treatment depends on your age, how much more you’re likely to grow, how much curvature there is and whether the curve is temporary or permanent. People with mild scoliosis might only need checkups to monitor if the curve is getting worse. Others might need to wear a brace or have scoliosis surgery.

What causes scoliosis?

Certain conditions — such as cerebral palsy or muscular dystrophy — can cause scoliosis. Birth defects and other genetic conditions, such as Marfan syndrome and Down syndrome, can also lead to scoliosis. Many people who have scoliosis have a family history of the condition.

Types of scoliosis

• Idiopathic adolescent scoliosis – This is the most common type of scoliosis, affecting adolescents. It’s more common in girls than boys.
• Congenital scoliosis – This is a spinal deformity that people are born with. A bone in the spine forms improperly, which causes the spine to be off-balance and curve.
• Neuromuscular scoliosis – This develops in children with certain medical conditions including Marfan syndrome, muscular dystrophy, cerebral palsy and spina bifida.
• Adult de novo scoliosis – This type of scoliosis develops due to degeneration of the spine that comes with aging.

Scoliosis symptoms

• Mid- to low-back pain and back stiffness
• Curved posture
• Uneven shoulders or hips
• Difficulty standing or sitting
• Leaning toward one side
• One side of rib cage jutting forward

What is kyphosis?

Kyphosis, another spinal deformity, is an excessive curvature of the upper back, often with rounded shoulders. It also is called round back, hunchback or dowager’s hump. Kyphosis can occur at any age, although rarely at birth. In severe cases, it can cause pain or breathing difficulties due to pressure on the lungs. Treatment for kyphosis ranges from back exercises and physical therapy in mild cases to surgery to correct severe curvature.

Types of kyphosis

• Postural kyphosis – This is the result of poor posture, most common in adolescents and young adults. It can be corrected with proper posture and exercise.
• Scheuermann’s kyphosis – This often occurs when the front of the spine doesn’t grow as fast as the back of the spine during growth spurts such as puberty. It can be treated with stretching and anti-inflammatory medication.
• Congenital kyphosis – This birth defect occurs when a baby’s spinal column doesn’t develop properly in the womb. Treatment may focus on preventing further curving of the spine.

Causes of kyphosis include

• Degenerative diseases of the spine, such as arthritis or disc degeneration 
• Muscle weakness or poor posture
• Osteoporosis
• Spine injury
• Slipping of one vertebra (spine bone) forward on another — a condition called spondylolisthesis 
• Scheuermann’s disease (the wedging together of several spine bones in young people when a growth spurt causes uneven growth; its cause is unknown)

Kyphosis symptoms

The primary sign of kyphosis is a noticeable forward curvature in the upper part of your back — causing the appearance of rounded shoulders or a hump. Other symptoms include:

• Pain or stiffness in the back or shoulder blades
• Tight hamstring muscles
• Difference in shoulder blade height

What is lordosis?

Lordosis, also called swayback, is the forward curving of your spine in the neck (cervical) or lower back (lumbar) areas. A healthy spine naturally curves in this direction, but lordosis is when the cervical or lumbar spine curves much more than it should. Your type of lordosis depends on where the curve is in your spine:

• Cervical lordosis – The curve of your spine pushes your neck further forward than usual.
• Lumbar lordosis – Your hips and pelvis push further forward than usual. You may appear to be standing with your stomach forward or your buttocks stuck out behind you.

Lordosis is more likely to affect people over 50 years old, children during growth spurts or during puberty, and people who are pregnant.

Your doctor may recommend stretching and exercise to improve posture. Most people with lordosis don’t need additional treatment, and children with the condition often outgrow it.

Causes of lordosis

Most causes of lordosis have no known cause. However, some medical conditions can cause lordosis, including:

• Achondroplasia
• Spondylolisthesis
• Osteoporosis
• Kyphosis
• Obesity

Lordosis symptoms

Many people may not show any signs or symptoms of lordosis. Posture changes that may indicate lordosis include:

• Your head and neck leaning forward
• Hips pushed forward or buttocks being more pronounced
• A noticeable gap under your lower back while laying down
• Neck and/or low-back pain

How spinal curvatures are diagnosed

Following a thorough history and neurological exam, Ohio State Spine Care specialists may recommend imaging tests, including:

• X-rays of the spine to analyze curvature of the spine
• Computed tomography (CT) scan
• Magnetic resonance imaging (MRI) scan
• Electromyography (EMG) and electrophysiological testing

Treatment for spinal curvatures

Ohio State offers treatments ranging from physical therapy to the most complex spine surgeries. Our physicians, therapists and specialists provide you with options that increase mobility and reduce pain. Most people who come to Ohio State Spine Care don't require surgery. Some lifestyle changes may also help improve your condition.

Lifestyle changes

• Practicing correct posture
• Strengthening spine muscles through yoga or Pilates
• Quitting smoking
• Considering weight loss to reduce pressure on the spine

Nonsurgical treatments

• Physical therapy – We have experts who specialize in spine conditions
• Wearing a brace
• Medications, including anti-inflammatory
• Acupuncture
• Spinal cord stimulation

Surgical treatments

If less invasive treatments aren’t successful at treating your spinal curvature condition, there are surgeries or procedures that our spine experts can discuss with you. All spinal curvature surgeries have the same goal — to restore your spinal curvature as closely as possible to normal and prevent the condition from worsening down the road.

Reconstructive spine surgeries offered at Ohio State include:

• Pedicle subtraction osteotomy (PSO) – removal of a wedge of bone from the spinal column to reduce curvature
• Vertebral column resection (VCR) – removal of one or more vertebrae (bones of the spinal column) from the spine for proper repositioning and straightening

Other surgeries that your doctor may recommend include:

• Decompression surgery
• Spinal correction – Helpful for people with scoliosis or kyphosis, surgeons use rods, plates or screws to correct the spine’s alignment.
• Spinal fusion – It may be performed as part of another surgery. Severe scoliosis or kyphosis may require the fusion of multiple vertebrae to stabilize and straighten the spine.

We perform more than 500 complex spine reconstruction surgeries a year, far exceeding the number of cases performed by any hospital system in central Ohio.