Spine Curvature Disorders

Overview of spine curvature disorders

The vertebral column is the most essential structure of a human body, which helps maintain an erect posture. Any irregularities in the structure of the vertebra or any disorders of the spine can lead to serious deformities and interfere with healthy living. Spinal curvature disorders are common in elderly people especially in men above 65 years old. Women, young adults, and children are also found to suffer from spine curvature disorders, the number of cases reported was less. According to reports by World Health Organization, each year 25,00,000 to 50,00,000 people suffer from spine injuries. Also, more than 1.7 billion people suffer from lower back and neck pain . All of these incidences are closely associated with spine curvature disorders of serious nature and must be resolved at the earliest.

What are spine curvature disorders?

Spine curvature disorders refer to the disorders caused by dislocation, degeneration or injury to any of the 33 vertebrae that constitute the vertebral column.

These are divided into few sections viz- Cervical (top 7 vertebrae), Thoracic (next 12 vertebrae), Lumbar (last 5 vertebrae) and Sacrococcygeal (9 fused vertebrae forming the sacrum and coccyx) regions.

Each of these is responsible for maintaining upright posture, bending, twisting and movements. Disorientation of any of these can lead to spine curvature disorders.

Causes of spine curvature disorders

Spine curvature disorders mainly arise due to degeneration and deformities in old age. But there are other etiological factors as well. The general causes of spinal curvature disorders are described below-

• Age: Natural degeneration of vertebral bones and discs occur with age due to the erosion of the spine, protruded discs, trapped nerves, muscular degeneration or spinal injuries.
• Anatomical problems: Abnormalities in muscles around the vertebra, the presence of abnormally high arches can lead to spine curvature disorders.
• Co-ordination problems: In few people, inherited spine disorders or co-ordination abnormalities can cause asymmetric growths in the spine. In due course of time, this may lead to spine curvature disorders.
• Proteins: Collagen is an important structural protein present in muscles and bones. Maintenance and repair of collagen are done by a particular enzyme called matrix metalloproteinase. Extremely high quantities of these enzymes can cause abnormalities in the spinal disc components causing anomalous progression of the spine curvature, leading to disc degeneration and spine curvature disorders. Again, abnormalities in another type of protein called platelet calmodulin (which binds to calcium) can also contribute to spine curvature disorders.
• Hormones: Abnormalities in the functioning of a specific hormone called “melatonin” which is associated with sleep and growth has accounted for spine curvature disorders in few reported cases.
• Birth defects: A few congenital defects such as absent or fused or deformed vertebrae can lead to abnormal spine growth and spine curvature disorders. These problems are very prominent in the growing years (8-13) of a child. During these years the spine growth in very fast and it exerts more stress on the spinal disorders already present. In few children, a defective positioning of the kidney, or presence of only one kidney is closely linked to spine curvature disorders. Birth defects such as spina bifida or myelomeningocele (Hernia of the Central Nervous System) can also cause spine curvature disorders.
• Heredity: Familial dysautonomia is a very rare variety of genetic disease which accounts for spine curvature disorders in few cases.
• Medical conditions: A few existing diseases like muscle paralysis, muscular dystrophy, cerebral palsy, polio, osteogenesis or rheumatoid arthritis can lead to spine curvature disorder at some point of time.
• Spinal tumors: Presence of spinal tumors in case of existing malignancies can give rise to spine curvature disorders.
• Non-structural causes: Spinal injuries, poor posture, long periods of standing, muscle spasms and differences in leg length are some of the non-structural causes of spine curvature disorders.

What are the main warning signs?

The symptoms of spine curvature disorders are visible at a much later stage. The common symptoms are as follows-

• Abnormal postures in a growing child such as tilted head, jutting out shoulder blades, one of the hips or shoulder blades present at a different level than the other.
• Sticking out of the rib or shoulder blade in case of spine curvature defects in the thoracic region.
• Forward protrusion of the pelvic bone due to spine curvature defects in the lumbar regions (causes one leg to appear shorter than the other).
• A tendency to lean on one side
• Muscle spasms, abnormal skeletal growths on the spine and occasional pain in the spine
• Pain and fatigue after long periods of standing or sitting

Types of spine curvature disorders

Spine curvature disorders can be classified into the following types depending on the portion of the vertebral column that is affected. These are elaborated below-

Scoliosis

Scoliosis is a collective term for deformities of the spine and rib cage. It is commonly observed in the thoracolumbar area (portion between thoracic and lumbar regions). But it may also develop only in the thoracic region (upper back) and lumbar region (lower back). Scoliosis may develop as a single C-shaped curve, an S-shaped curve (consisting of a primary curve and a compensating or secondary curve), forming a three dimensional deformity. Scoliosis may be categorized into the following types based on anatomy and postion-

Structural Scoliosis: This condition is characterized by abnormal curvature, rotation and twisting of the spine. Due to this, one half of the rib cage is pushed forward (creating large gaps between the ribs) and another half is pushed inward (causing compression of the ribs). The shoulder blade juts out causing differences in levels of the shoulders. Structural scoliosis has the following subtypes- 

• Idiopathic scoliosis: Origin or cause of this type of scoliosis is not known. 8-10 cases of scoliosis are idiopathic in nature.
• Neuromuscular scoliosis: It is mainly observed in cases of muscular dystrophy and neurofibromatosis. The abnormal curvature in this condition is an outcome of disorders of the posterior muscles and nerves. 1 out of 10 cases of scoliosis belongs to this category.
• Osteopathic scoliosis: It results due to some major bone defect(s).
• Congenital scoliosis: This type of scoliosis occurs due to abnormal spine growth of the fetus in the womb. 1 out of 10 cases of this category is reported.

Functional scoliosis: It is also called Non-structural or Postural Scoliosis. In this case, the spine curvature is actually normal but looks curved due to other factors. It occurs due to non-anatomical defects of the spine such as a difference in leg length, poor postures, muscle spasms or spinal injuries.

Thoracic scoliosis: It is caused due to abnormal curvature of the upper portion of the spine.

Lumbar scoliosis: It is caused due to abnormal curvature in the lower portion of the spine.

Fixed scoliosis: It occurs due to infections of the spine or presence of spine tumors. It is characterized by visible deformities of the bone and back.

Non-fixed scoliosis: It is a secondary form of scoliosis and occurs due to paralysis of back muscles, misaligned hip, spinal injuries, and arthritis. This type of scoliosis is curable if the causative factors are eliminated.

Kyphosis

Kyphosis refers to the abnormal curvature or bowing of the back due to the outward curvature of the lumbar spine. Kyphosis is characterized by hunchback or a slouching posture. It can be an outcome of different conditions such as arthritis of spine (damage of vertebra), osteoporosis of spine (thinning of vertebral bones) and diseases like spina bifida or myelomeningocele.

It has the following subtypes-

• •  Postural Kyphosis: It is a very common form of Kyphosis and is called Hyperkyphosis or Dowager’s Hump (in aged people). It is characterized by abnormal slouching.

• • Scheuermann’s Kyphosis: It is also called Adolescent Kyphosis and is more commonly observed in adolescents and teenagers. In this condition, a series of vertebral bones are wedged together, causing deformity and abnormal curvature of the spine.

• • Nutritional Kyphosis: It is mainly observed in children suffering from rickets and is caused due to Vitamin D deficiency.

• Post-traumatic Kyphosis: It is an outcome of spinal fractures and injuries. (e) Congenital Kyphosis: It occurs due to malformed bones during early stages of fetal development. It results in major birth defects due to spinal deformities.

Lordosis

It is also called “sway back” condition and is characterized by an extreme inward curvature of the spine. Extreme cases of Lordosis are observed in adolescence due to some existing diseases or poor postures for prolonged period. The vertebral and spinal muscles are severely affected in such cases. Mild cases of Lordosis in the lumbar and cervical regions are considered normal. Lordosis has the following subtypes- (a) Cervical Lordosis: Inward curvature of the cervical portion of the spine is observed especially in the neck region. (b) Thoracic Lordosis: Inward curvature of the thoracic portion of the spine occurs. (c) Lumbar Lordosis: In this condition, abnormal inward curvature of the lumbar (lower) portion of the spine occurs. (c) Congenital Lordosis: It is caused due to inward spine curvatures present since birth.

Diagnosis

For proper diagnosis of spine curvature disorders, a proper examination of the Angle of Trunk Rotation is necessary. Forward bend tests are recommended in the initial stages. X-rays of spines are carried out in the later stages to determine the degree of scoliosis or presence of abnormal curvatures. MRI scans or CT scans can also be performed to detect any tumours in the spine.

Treatment & Prevention

Kyphosis

The treatment of kyphosis chiefly depends on the cause and the severity of the condition. Following treatment modalities are available:

• Pain relieving medications- Prescription medications can be administered in cases where the pain cannot be managed by the regular over-the-counter medicines (such as ibuprofen, acetaminophen, and naproxen sodium).
• Bone-strengthening medications- Medications are prescribed for treating osteoporosis in order to prevent spinal fractures in future.
• Exercise- Stretching exercises are advised by a physical therapist to reduce a backache and improve spinal flexibility.
• Bracing- In certain cases, bracing can help in impeding the progression of kyphosis. For instance, wearing a body brace during the growth period might help the children who have Scheuermann’s disease.
• Surgical intervention: In severe cases, surgeries might be required to rectify the position of the spine.

Scoliosis

The treatment depends on the age of the patient and the severity of the condition. In mild cases, no treatment or surgery is required. However, in moderate to severe cases, the following treatment options may be considered:

• Scoliosis brace: It helps children during their growth years. It does not treat or reverse scoliosis but prevents its progression.
• Surgical intervention: Surgeries such as spinal fusion may be executed in order to reduce the severity of the condition and prevent worsening. Surgery might have complications such as nerve damage, bleeding, pain, infection etc.

Lordosis

• Medications: Medications are usually prescribed to control inflammation and pain.
• Physical therapy and exercise: This helps to augment muscle strength and flexibility.
• Back brace: This can help to support the spine.
• Surgical intervention: Corrective surgeries are performed in few cases.

Weight-loss is advised in case of obese patients to reduce the stress on the spine.

Prevention is mainly by maintaining a right posture and use of protective gears during driving, playing sports, cycling etc. in order to prevent accidents and trauma. Early intervention can prevent the progression of the condition.

References