Spinal curvature
| Spinal curvature | |
|---|---|
| Classification and external resources | |
 Different regions (curvatures) of the vertebral column | |
| ICD-10 | M40-M41, Q76.3-Q76.4 |
| ICD-9 | 737, 756.1 |
| MeSH | D013121 |
Although spinal curvature (or curvature of spine) can refer to the normal concave and convex curvature of the spine, in clinical contexts, the phrase usually refers to deviations from the expected curvature, even when that difference is a reduction in curvature.
Types include kyphosis (Deviating outwards from the body), lordosis (Deviating Inwards to the body), and scoliosis (Curving to the side, e.g., a 'C' or 'S' shape).
The terms can be used to explain an increase in curvature as well. E.g., the curve of the lumbar region is called a lordosis, but if it is curving drastically inwards, it can be referred to as an excessive or hyper-lordosis.
The thoracic and sacral (pelvic) curves develop in the fetus. Around 6 months after birth the cervical curve appears which helps hold the head up. Around one year of age the lumbar curve develops which helps with balance and walking. The cervical and lumbar curves are considered secondary curves whereas the thoracic and sacral curves are primary.
Diagnosis
A diagnosis of kyphosis or lordosis is generally made through observation and measurement. Idiopathic causes of these spinal curvatures, such as vertebral wedging or other abnormalities, can be confirmed through X-ray. Osteoporosis, a potential cause of kyphosis, can be confirmed with a bone density scan.A plumb line centered at vertical midline of the back can help identify both subtle and obvious scoliosis. Idiopathic scoliosis may also be detected when an individual with scoliosis bends forward with hands joined and arms hanging down. Individuals with scoliosis show asymmetries in the two sides of the back when bending forward. An X-ray can confirm scoliosis and help monitor its progression. An MRI may be necessary if the individual presents with neurological signs.Practicing good posture is the best way to prevent postural disorders of the spinal column. Postural scoliosis related to back pain is best resolved by treating the source of back pain, possibly nerve root impingement or other inflammatory conditions. Postural thoracic kyphosis can often be treated with posture reeducation and focused strengthening exercises.Idiopathic thoracic kyphosis due to vertebral wedging,fractures, or vertebral abnormalities is more difficult to manage, since assuming a correct posture may not be possible with structural changes in the vertebrae.Children who have not completed their growth may show long-lasting improvements with bracing. Exercises may be prescribed to alleviate discomfort associated with overstretched back muscles. A variety of gravity-assisted positions or gentle traction can minimize pain associated with nerve root impingement. Surgery may be recommended for severe idiopathic kyphosis. Treatment for idiopathic scoliosis depends upon the severity of the curvature, the spine’s potential for further growth, and the risk that the curvature will progress. Mild scoliosis (less than 30 degrees deviation) may simply be monitored and treated with exercise. Moderately severe scoliosis (30–45 degrees) in a child who is still growing may require bracing. Severe curvatures that rapidly progress may be treated surgically with spinal rod placement. Bracing may prevent a progressive curvature, but evidence is not strong infavor of correction with brace wear. In all cases, early intervention offers the best results.
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