Scoliosis, Kyphosis and Spinal Deformity
Normal spinal alignment compared with scoliosis, kyphosis and other spinal curvatures.
Spinal deformity refers to abnormal curvature, rotation or alignment of the spine. It can affect posture, balance, appearance, walking ability and, in some cases, nerve function. The two most common forms of spinal deformity are scoliosis and kyphosis.
Professor Nasir Quraishi, Consultant Spinal Surgeon in Nottingham, assesses and treats spinal deformity in children, adolescents and adults, including adolescent idiopathic scoliosis, adult degenerative scoliosis, kyphosis, kyphoscoliosis and complex spinal imbalance.
Some spinal curves remain stable and require monitoring only. Others may progress over time and cause pain, neurological symptoms or difficulty standing and walking. A specialist assessment can help determine the type and severity of the deformity and whether non-surgical or surgical treatment is most appropriate.
What Is Spinal Deformity?
Spinal deformity occurs when the normal alignment of the spine changes. This may involve a sideways curve, excessive forward curvature, rotation of the spine or loss of normal spinal balance.
Spinal deformity can develop during childhood, adolescence or adult life. The impact varies widely. Some patients have no pain and only mild postural changes, while others experience back pain, leg pain, sciatica, numbness, weakness, reduced walking distance or difficulty standing upright.
Common types of spinal deformity include:
- Scoliosis
- Kyphosis
- Kyphoscoliosis
- Adult degenerative scoliosis
- Post-traumatic spinal deformity
- Deformity following previous spinal surgery
- Spinal imbalance associated with degeneration, infection, tumour or fracture
What Is Scoliosis?
Scoliosis is an abnormal side-to-side curvature of the spine. It often also involves rotation of the spine, which may cause rib prominence, uneven shoulders, waist asymmetry or a visible change in posture.
Scoliosis can affect people of any age. In children and teenagers, scoliosis is often noticed because of changes in appearance or posture. In adults, scoliosis is more commonly associated with back pain, leg pain, sciatica or symptoms caused by nerve compression.
The severity of scoliosis depends on the size of the curve, whether it is progressing, the patient’s age and whether there are associated symptoms.
Symptoms of Scoliosis
Symptoms of scoliosis vary depending on age and severity. They may include:
- Uneven shoulders
- One shoulder blade appearing more prominent
- Rib prominence, especially when bending forward
- Uneven waist or pelvis
- Leaning to one side
- Back pain
- Leg pain or sciatica
- Numbness or weakness in the legs
- Reduced walking distance
- Difficulty standing upright
- Changes in posture or balance
- Cosmetic concerns
In children and adolescents, scoliosis is often not painful. In adults, symptoms are more likely to occur when scoliosis is associated with spinal degeneration, spinal stenosis or nerve compression.
Types of Scoliosis
Infantile Scoliosis
Infantile scoliosis occurs in children under three years of age. It may be associated with congenital, neurological or developmental conditions, although some cases have no clear cause.
Assessment usually involves clinical examination and imaging to understand the curve pattern, severity and whether there are associated spinal cord or developmental abnormalities.
Treatment depends on the cause and progression of the curve. In some cases, observation or non-operative treatment may be used initially to allow continued spinal growth. Surgery may be considered in selected cases where the curve is severe or progressive.
Juvenile Scoliosis
Juvenile scoliosis affects children between three and ten years of age. Because children in this age group still have significant growth remaining, some curves have a higher risk of progression.
Treatment may include observation, bracing or surgery depending on the size of the curve, rate of progression and the child’s growth. Bracing may be recommended to help control progression while the child continues to grow.
Adolescent Idiopathic Scoliosis
Adolescent idiopathic scoliosis is the most common type of scoliosis and usually develops between the ages of ten and seventeen. “Idiopathic” means that there is no identifiable underlying cause.
This condition is often detected because of rib prominence, uneven shoulders, waist asymmetry or changes in posture. It is usually not painful and is rarely associated with neurological symptoms such as leg weakness or numbness.
Treatment decisions are based on the size of the curve, skeletal maturity and evidence of progression. Options may include observation, bracing or surgery in more severe or progressive cases.
Some curves that appear stable during adolescence may become symptomatic later in adult life due to degenerative changes, imbalance or nerve compression.
Adult Degenerative Scoliosis
Adult degenerative scoliosis develops later in life due to age-related changes in the discs, joints and supporting structures of the spine. Many patients with adult degenerative scoliosis did not have scoliosis as a child.
This condition commonly affects the lumbar spine and may be associated with spinal stenosis or nerve compression.
Symptoms may include:
- Persistent lower back pain
- Leg pain or sciatica
- Numbness or tingling
- Weakness in the legs
- Reduced walking distance
- Difficulty standing upright
- Spinal imbalance
- Worsening posture
Treatment depends on the severity of symptoms, degree of nerve compression, spinal balance and overall health. Non-surgical treatment may help many patients, while surgery may be considered where symptoms are severe, progressive or disabling.
What Is Kyphosis?
Kyphosis refers to an excessive forward curvature of the spine. Some kyphosis is normal, particularly in the thoracic spine, but excessive kyphosis can affect posture, balance and function.
Patients with kyphosis may develop a rounded upper back, forward-flexed posture or difficulty standing fully upright. In more severe cases, kyphosis may cause pain, fatigue, neurological symptoms or problems with walking and balance.
Kyphosis may be caused by:
- Scheuermann’s kyphosis
- Osteoporosis-related spinal fractures
- Trauma
- Infection
- Tumour
- Previous spinal surgery
- Age-related degeneration
- Congenital spinal abnormalities
Kyphosis can also occur together with scoliosis. This is known as kyphoscoliosis and may have a greater effect on spinal balance, posture and function.
Symptoms of Kyphosis
Symptoms of kyphosis may include:
- Rounded upper back
- Forward-flexed posture
- Difficulty standing upright
- Back pain
- Fatigue when standing or walking
- Stiffness
- Reduced walking tolerance
- Numbness or weakness in selected cases
- Loss of spinal balance
The severity of symptoms depends on the cause of the kyphosis, the degree of curvature and whether the spinal cord or nerves are affected.
How Scoliosis and Kyphosis Are Assessed
Assessment of scoliosis, kyphosis and spinal deformity usually includes a detailed medical history, physical examination and review of imaging.
Investigations may include:
- Standing spinal X-rays to assess curve size and overall balance
- MRI scan to assess the spinal cord, nerves, discs and soft tissues
- CT scan in selected cases to assess bone anatomy
- Neurological examination
- Assessment of posture, walking pattern and spinal flexibility
- Review of previous scans or surgical records where relevant
The aim is to understand the type of deformity, whether it is progressing, whether nerves are affected and whether treatment should be non-surgical or surgical.
Non-Surgical Treatment for Scoliosis and Kyphosis
Not all patients with scoliosis or kyphosis need surgery. Many patients can be managed with monitoring, physiotherapy, pain management or other non-surgical treatments.
Non-surgical treatment may include:
- Observation and repeat imaging
- Physiotherapy
- Posture and core strengthening exercises
- Pain medication
- Activity modification
- Bracing in selected children and adolescents
- Spinal injections where nerve pain or inflammation is present
- Bone health assessment and osteoporosis treatment where relevant
When Is Surgery Considered for Spinal Deformity?
Surgery may be considered when scoliosis, kyphosis or spinal deformity is severe, progressive or causing significant symptoms.
Reasons to consider surgery may include:
- Progressive scoliosis or kyphosis
- Severe back pain despite non-surgical treatment
- Leg pain or sciatica caused by nerve compression
- Numbness or weakness
- Reduced walking distance
- Difficulty standing upright
- Significant spinal imbalance
- Failure of bracing in a growing child
- Progressive deformity after previous spinal surgery
- Functional limitation affecting daily life
Second Opinion for Scoliosis or Kyphosis Surgery
Patients are often understandably cautious when surgery is recommended for scoliosis, kyphosis or adult spinal deformity. A second opinion can help clarify the diagnosis, the severity of the curve, whether surgery is necessary and whether non-surgical options remain appropriate.
A specialist second opinion may be helpful if:
- Surgery has been recommended
- Symptoms are worsening
- There is uncertainty about the diagnosis
- The spinal curve is progressing
- Previous treatment has not helped
- There has been previous spinal surgery
- The patient wants to understand the risks, benefits and alternatives
Professor Quraishi can review symptoms, examination findings and imaging to help patients make an informed decision about treatment.
Scoliosis and Kyphosis Assessment in Nottingham
Assessment by a spine surgeon in Nottingham can help determine the type and severity of spinal deformity and guide the most appropriate treatment plan.
Professor Nasir Quraishi provides specialist assessment for scoliosis, kyphosis and complex spinal deformity in children, adolescents and adults. This includes review of symptoms, neurological function, spinal alignment and imaging to help patients understand their diagnosis and treatment options.
Treatment may involve monitoring, physiotherapy, bracing, injections, pain management or surgery where appropriate.
Frequently Asked Questions
Is Scoliosis Always Painful?
No. Scoliosis in children and adolescents is often not painful. Adults with scoliosis are more likely to experience back pain, leg pain, sciatica or symptoms related to nerve compression.
Can Scoliosis Get Worse With Age?
Yes. Some curves can progress during growth or later in adult life due to degenerative changes in the spine. Adult degenerative scoliosis may worsen over time and can be associated with spinal stenosis or nerve compression.
Does Every Patient With Scoliosis Need Surgery?
No. Many patients with scoliosis are managed with observation, physiotherapy, bracing or symptom control. Surgery is usually considered only when the curve is severe, progressive or causing significant symptoms.
What Is the Difference Between Scoliosis and Kyphosis?
Scoliosis is a side-to-side curvature of the spine, often with rotation. Kyphosis is an excessive forward curvature of the spine that may cause a rounded back or forward-flexed posture.
What Is Adult Degenerative Scoliosis?
Adult degenerative scoliosis develops due to age-related changes in the spine. It commonly affects the lumbar spine and may cause back pain, leg pain, sciatica, numbness, weakness or difficulty walking.
When Should I See a Spine Surgeon for Scoliosis or Kyphosis?
Specialist assessment may be appropriate if the curve is progressing, symptoms are worsening, walking is affected, there is leg pain, numbness or weakness, or surgery has been recommended.
Can Kyphosis Be Treated Without Surgery?
Yes. Some cases of kyphosis can be managed with physiotherapy, posture work, pain management, treatment of osteoporosis or monitoring. Surgery may be considered in more severe, progressive or symptomatic cases.
What Imaging Is Needed for Spinal Deformity?
Standing spinal X-rays are commonly used to assess alignment and curve severity. MRI or CT scans may be recommended where there are neurological symptoms, complex deformity, previous surgery or concern about the spinal cord, nerves or bone anatomy.
Book a Spinal Deformity Consultation in Nottingham
If you or your child has been diagnosed with scoliosis, kyphosis or another spinal deformity, a specialist assessment can help clarify the diagnosis and treatment options. Professor Nasir Quraishi can review symptoms, examination findings and imaging to advise on appropriate non-surgical or surgical management.
This information is intended as general guidance and does not replace a consultation with a qualified medical professional. The risks and benefits of spine surgery vary between patients. Professor Quraishi will discuss your individual diagnosis, treatment options and personal risk factors during your consultation.