Spinal Deformities – Comprehensive Diagnosis and Treatment
Scoliosis, kyphosis, spondylolisthesis, and congenital spinal defects. Precise diagnosis based on the Cobb angle and the Meyering classification, along with individually tailored treatment—ranging from specialized physical therapy to advanced spinal surgery.
What are spinal deformities?
Spinal deformity is a three-dimensional distortion of the spine’s natural shape, affecting the frontal, sagittal, and transverse planes simultaneously. It affects not only the appearance of the body but also—depending on its severity—the functioning of the respiratory, nervous, and musculoskeletal systems.
The most common spinal deformities include: idiopathic scoliosis (approximately 80% of all scoliosis cases), congenital scoliosis, neuromuscular scoliosis, spondylolisthesis, kyphosis (including Scheuermann’s disease), and rare caudal regression. Each has a different underlying cause, but all require early diagnosis and individually tailored treatment.
Spinal Deformities
Reasons
Spinal deformities can be idiopathic (the most common type, accounting for about 80% of scoliosis cases—cause unknown), congenital (abnormal development of the vertebrae during fetal life, e.g., hemivertebrae), or secondary—associated with neuromuscular disorders, congenital anomalies, or injuries. These disorders include, among others, scoliosis, kyphosis, spondylolisthesis, and the rare condition known as caudal regression.
Symptoms
The symptoms of spinal deformity are often visible to the naked eye: a rib or lumbar hump, asymmetry in the waistline, uneven shoulder height, a protruding hip on one side, and asymmetry of the shoulder blades. In more advanced cases, pain, limited mobility, and even neurological symptoms—such as numbness, tingling, or weakness in the lower limbs—may occur.
Diagnostics
The diagnosis is based on a clinical examination (including the Adams test) and imaging studies—standing X-rays—which are used to assess the Cobb angle (scoliosis) or the degree of slippage according to the Meyerding classification (spondylolisthesis). In justified cases, the diagnosis is supplemented with computed tomography (CT), magnetic resonance imaging (MRI), or electromyography (EMG).
Paley European Institute: The Global Standard in Poland for the Treatment of Spinal Deformities
2–3% of children and adolescents aged 10–16 are affected by idiopathic scoliosis
3.1% of Poles have been diagnosed with spondylolisthesis
23 hours a day – the recommended duration for wearing a corrective corset to achieve the best results
Every patient at the Paley European Institute is cared for by a multidisciplinary team that develops a comprehensive treatment plan tailored to the individual needs of the child and family.
The team consists of: a pediatric orthopedist , a neurologist, a physical therapist, and a psychologist.
Diagnostics – When and at What Age Should You Seek Care?
During pregnancy
Abnormalities detected during a prenatal ultrasound—such as hemivertebrae or signs of caudal regression—are an indication for an orthopedic consultation after the baby is born. Early diagnosis allows for the planning of care by a team of specialists even before delivery.
After birth (newborns and infants)
Visible spinal deformity, trunk asymmetry, or abnormal spinal alignment are signs that require urgent evaluation. In newborns with congenital scoliosis, additional evaluation of the kidneys and bladder is recommended, as this condition is sometimes associated with abnormalities of the urinary tract.
School-age children (ages 6–10)
School screenings and regular monitoring of posture can help detect idiopathic scoliosis and minor deformities early, before the curvature begins to progress. It is especially important to remain vigilant if there is a family history of the condition.
Adolescence (ages 10–16)
Uneven shoulders, waist asymmetry, a rib hump, worsening back pain, or difficulty with physical activity—this is the peak period for the onset of idiopathic scoliosis, spondylolisthesis, and Scheuermann’s kyphosis, during which the deformity progresses most rapidly. These symptoms may indicate a progressive deformity requiring conservative or surgical treatment.
Idiopathic scoliosis
The most common type of scoliosis, accounting for approximately 80% of all cases. It is a three-dimensional deformity of the spine of unknown cause, affecting 2–3% of children and adolescents aged 10–16, particularly girls during puberty.
Causes of
The cause remains unknown despite thorough diagnostic testing. The condition manifests in healthy children during their developmental years, most often during the growth spurt that accompanies puberty.
Symptoms
Uneven shoulder height, asymmetry in the waistline, a protruding hip on one side, and a rib hump, most clearly visible during the Adams test (forward bend). The symptoms can be subtle and easy to overlook.
Diagnosis
An X-ray of the spine taken in the standing position, in an anteroposterior and lateral view. The Cobb angle is key—a diagnosis is made at 10° or greater. In addition, spinal rotation is assessed, as well as the Risser test, which determines skeletal maturity.
Treatment
For curvatures of 10–24°—specific physical therapy (Schroth method, Dobosiewicz method). For curvatures of 25–40°—treatment with a Cheneau brace, worn up to 23 hours a day. For curvatures exceeding 45–50° or in cases of rapid progression—surgical treatment (spinal instrumentation and fusion).
Congenital scoliosis
Congenital scoliosis is a spinal deformity present from the moment of birth, unlike idiopathic scoliosis, which develops only during puberty. It is rare, occurring in about 1 in 10,000 births.
Causes of
Abnormal development of the vertebrae during the fetal period—incomplete formation of a vertebra, failure of adjacent vertebrae to separate, or a combination of both mechanisms (the most severe form). The condition may co-occur with other congenital defects, particularly involving the kidneys and bladder.
Symptoms
A spinal deformity visible even in a newborn or infant. As the child grows, the abnormally developed section of the spine prevents symmetrical growth on both sides, leading to progressive curvature.
Diagnosis
The diagnosis is often made prenatally (during prenatal ultrasound) or through newborn screening. The diagnosis is supplemented by X-rays and, if necessary, computed tomography (CT) or magnetic resonance imaging (MRI), which allow for an assessment of the structure of the vertebrae and help rule out associated defects of internal organs.
Treatment of
The most severe, combined forms usually require early surgical intervention before significant spinal displacement occurs. Milder forms may be managed with regular monitoring and the use of a brace, although the effectiveness of conservative methods is usually limited in these cases due to the structural nature of the deformity.
Neuromuscular scoliosis
Neuromuscular scoliosis develops as a result of conditions that impair a child’s ability to control and maintain proper spinal posture.
Causes of
The most common causes include muscular dystrophy, cerebral palsy, and spina bifida. Not all children with neuromuscular disorders will develop scoliosis, but it is a fairly common condition—children who use wheelchairs are particularly at risk.
Symptoms of
In children who retain the ability to move independently, the symptoms resemble those of idiopathic scoliosis—asymmetry of the shoulders and waist, and a rib hump—but they are usually more severe and progress more rapidly.
Diagnostics
An orthopedic evaluation combined with a neurological consultation, X-rays of the spine, and an assessment of the patient’s neuromuscular function.
Treatment
This requires a multidisciplinary team. The risk of postoperative complications is higher than with other types of scoliosis, so the surgical team’s experience in treating neuromuscular disorders is crucial.
Spondylolisthesis
Spinal subluxation is a condition in which one vertebra is displaced relative to another; it affects approximately 3.1% of Poles. It most commonly occurs in the lower lumbar region, between the L5 and S1 vertebrae.
Causes of
Congenital – spina bifida, spinal malformations, abnormalities in the alignment of the articular processes. Acquired (in adults) – degeneration of the intervertebral discs, mechanical injuries, stress fractures, weakness of the muscles that stabilize the spine.
Symptoms of
Acute or chronic lower back pain that worsens with sitting and movement, radiating to the buttocks and legs. Morning stiffness and limited mobility. In advanced cases—numbness, weakness in the lower limbs, and even bladder and bowel dysfunction.
Diagnosis
Standing X-ray with assessment of the degree of slippage according to the Meyerding classification (5 degrees). If necessary, computed tomography (CT), magnetic resonance imaging (MRI), or electromyography (EMG).
Treatment of
For slippage of up to 50% (Grades I–II) – conservative treatment: physical therapy to strengthen the core muscles, orthopedic braces, and pain medication. For slippage exceeding 50% (Grade III–IV) or in cases of severe neurological symptoms—surgical treatment, specifically spondylodesis (spinal fusion).
Kyphosis
Kyphosis is an excessive backward curvature of the spine, most commonly affecting the thoracic region. The normal angle of curvature ranges from 20° to 40°, and values above 50° are considered pathological.
Causes of
Metabolic disorders, neuromuscular diseases, spina bifida, osteoporotic fractures, injuries, or herniated discs. A distinction is made between congenital kyphosis (present from birth) and Scheuermann’s disease (developing after birth).
Symptoms of
Changes in the appearance of the back and body shape, back pain, and in advanced cases—compression of the spinal cord and nerve roots, manifesting as weakness in the limbs, as well as respiratory problems associated with chest deformity.
Diagnosis
Family history and medical history, assessment of spinal mobility, muscle strength, and sensation, as well as imaging studies—X-rays, CT scans, or MRI.
Treatment of
Conservative – rehabilitation, home exercises, braces, and, in cases of osteoporosis, additional vitamin D and calcium supplementation, as well as hormone therapy. Surgical – used only for severe deformities that do not respond to treatment.
Caudal Regression Syndrome
A rare congenital developmental disorder characterized by incomplete development of the lower, caudal portion of the spine and spinal cord.
Causes of
A disorder affecting the growth and development of the caudal end of the embryo during the first trimester of pregnancy. Risk factors include, among others, maternal diabetes.
Symptoms
The severity of symptoms varies widely—from mild symptoms that allow the patient to move around with the aid of orthoses, to severe lower limb deformities, spinal abnormalities, and bladder and bowel dysfunction.
Diagnosis
The diagnosis is usually made prenatally or shortly after birth, based on imaging tests such as MRI or CT.
Treatment of
It requires a multidisciplinary approach—a team consisting of an orthopedist, a neurosurgeon, and a urologist. It includes physical therapy, medication, and surgical procedures to correct structural defects.
Your most frequently asked questions
That is, What you as a parent should know before making a decision.
The postural defect is functional in nature—the child is able to straighten their posture on their own. Scoliosis is a structural, three-dimensional deformity of the spine, which also involves vertebral rotation, and cannot be corrected by willpower alone or through a temporary adjustment of posture.
In children and adolescents, scoliosis rarely causes pain—this is one of the reasons why it is sometimes detected late. Pain occurs more frequently in untreated cases in adulthood, as a result of strain and degenerative changes.
According to the Scoliosis Research Society criteria, scoliosis is diagnosed when the Cobb angle is at least 10 degrees.
Yes, in the vast majority of cases, physical activity is recommended. Symmetrical sports—such as swimming, cycling, and Nordic walking—are particularly recommended. The corset should be removed during exercise, and physical activity complements, but does not replace, specialized physical therapy.
For best results, wear the brace for up to 23 hours a day until bone growth is complete—which is generally estimated to occur around age 14 for girls and age 16 for boys.
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Your most frequently asked questions
That is, What you as a parent should know before making a decision.
The postural defect is functional in nature—the child is able to straighten their posture on their own. Scoliosis is a structural, three-dimensional deformity of the spine, which also involves vertebral rotation, and cannot be corrected by willpower alone or through a temporary adjustment of posture.
In children and adolescents, scoliosis rarely causes pain—this is one of the reasons why it is sometimes detected late. Pain occurs more frequently in untreated cases in adulthood, as a result of strain and degenerative changes.
According to the Scoliosis Research Society criteria, scoliosis is diagnosed when the Cobb angle is at least 10 degrees.
Yes, in the vast majority of cases, physical activity is recommended. Symmetrical sports—such as swimming, cycling, and Nordic walking—are particularly recommended. The corset should be removed during exercise, and physical activity complements, but does not replace, specialized physical therapy.
For best results, wear the brace for up to 23 hours a day until bone growth is complete—which is generally estimated to occur around age 14 for girls and age 16 for boys.
Surgical treatment is usually considered for curvatures exceeding 45–50 degrees or in cases of documented, rapid progression of the deformity despite conservative treatment.
Congenital scoliosis is present from birth and results from abnormal vertebral development during fetal life. Idiopathic scoliosis develops only during a child’s growth period, and its cause remains unknown.