What Is Adult Spinal Deformity?
Adult spinal deformity is a three-dimensional curvature of the spine in a person who has finished skeletal growth. The most common type is degenerative deformity that develops over time with age-related wear (decreasing disc height, facet joint arthrosis, osteoporotic fractures). In some patients, childhood scoliosis progresses into adulthood. Unlike adolescent scoliosis, here the priority is not appearance but pain and loss of function.
Why Is Sagittal Balance Important?
The most important concept determining functional outcomes in adult deformity is sagittal (side-view) balance. For the spine to stand upright, the natural curve of the lower back (lordosis) must be preserved. When this balance is disturbed, the patient compensates by bending the hips and knees to stand upright; this leads to rapid fatigue and a forward-leaning posture. In assessment, full-spine X-rays taken while standing and spino-pelvic parameters measure this balance; the decision is made by looking not only at the curve angle but also at the balance.
Symptoms
The most frequent complaint is low-back and mid-back pain that worsens with standing and walking and eases partly with rest. With sagittal imbalance the patient is drawn into a forward-leaning, easily tiring posture. With accompanying canal stenosis, leg pain and leg fatigue on walking (neurogenic claudication) can occur. A change in appearance (hunching, trunk asymmetry, loss of height) and a reduced quality of life often accompany it.
Non-Surgical Treatment First
In patients with mild-to-moderate symptoms and no marked imbalance, the approach is conservative: exercise and physiotherapy, core strengthening, pain management, treatment of osteoporosis if present and injections in selected cases. The aim is to control pain and preserve function. Because adult deformity surgery is a major undertaking, non-surgical options are evaluated first in suitable patients.
Surgery: A Major Decision
Surgery is considered for progressing deformity, marked sagittal imbalance, pain unresponsive to non-surgical treatment and neurological loss. The aim is to re-establish balance and lumbar lordosis together with decompression that makes room for the nerve; techniques include fusion and instrumentation, osteotomies when needed, and minimally invasive approaches in suitable cases. This surgery is a major undertaking and the risk of complications can be higher, especially in older patients or those with osteoporosis; therefore patient selection and planning are done with great care. No outcome is guaranteed; expectations and risks are discussed openly from the start.