Spinal deformations in adults

1 Progressive deformation during adulthood: Though not commonly recognized, lumbar and thoracoscoliosis can progress during adulthood, This slow, insi dious evolution concerns not only the anatomic configuration of the spinal curatures (three dimensional angular deformation) but also spinal function (development or aggravation of spinal or radicular pain and/or impaired equ ilibrium), This fact emphasizes the importance of regular prolonged surveil lance of ail patients with spinal deformations. 2 Radiological changes: Three anatomic elements affecting function are evid enced on serial x-rays: development of rotational dislocation, stiffening o f the main curvature, especially in the lumbosacral spine, and progressive installation of thoracolumbar kyphosis. 3 Treatment: Three types of treatment can be proposed: physical therapy, or thopedic treatment, surgery. physical therapy and orthopedic treatment can relieve pain acid improve equilibrium but cannot change the progressive pat tern of the spinal deviation. Surgery also provides effective symptom relie f and has the advantage of definitively stopping the progression of the def ormation. 4 Indications: indications are much more complex than simply determining an angle of deformation beyond which surgery is needed. For each case, indica tions are established on knowledge of the type of deformation, its extent, potential or ongoing modifications in the main curvatures, and compensatory curvatures, the patient's age, as well as the functional impairment and th e patient's general status.