Alignment, Scoliosis & Posture
Adult Spinal Deformity
Adult spinal deformity includes scoliosis, kyphosis, and imbalance that alter the spine’s three-dimensional alignment. Treatment focuses on pain, neurologic function, posture, endurance, and quality of life—not the curve alone.
Overview
Spinal deformity describes abnormal alignment in the coronal, sagittal, or axial plane. Adult scoliosis may persist from adolescence or develop later as discs and joints degenerate unevenly. Kyphosis, loss of lumbar lordosis, and forward or side-to-side imbalance may coexist.
The body often compensates by tilting the pelvis, bending the hips or knees, or recruiting muscles continuously to keep the head centered. These strategies can preserve function but contribute to fatigue, pain, and difficulty standing or walking for long periods.
Degenerative collapse and rotation can also narrow the central canal or foramina, producing radiculopathy or claudication. Osteoporosis, prior fusion, vertebral fractures, leg-length differences, and neuromuscular conditions may influence the pattern.
Curve magnitude is only one part of the diagnosis. Symptoms, balance, neurologic findings, progression, bone health, overall fitness, and the activities the patient hopes to regain guide treatment.
Symptoms
Symptoms reflect both local tissue stress and the effort required to remain upright. Some patients have visible deformity with little pain, while others experience major functional loss.
Back pain & fatigue
Muscles may tire from continuously supporting an imbalanced spine. Aching often increases later in the day or with prolonged standing.
Postural change
Patients may notice leaning forward or to one side, uneven shoulders or waist, rib prominence, or difficulty standing upright.
Standing & walking limits
Balance demands and stenosis can reduce endurance, require frequent sitting, or make assistive devices necessary.
Leg symptoms
Foraminal or canal narrowing may cause radiating pain, numbness, tingling, heaviness, or weakness in one or both legs.
Appearance & daily function
Clothing fit, reaching, household tasks, travel, sleep, and self-image may be affected alongside physical symptoms.
Progression
Some curves remain stable; others progress with asymmetric degeneration, fracture, or junctional breakdown. Change over time matters.
Evaluation
Evaluation measures three-dimensional alignment and connects it to pain, neurologic symptoms, balance, bone health, and overall function. Full-length standing imaging is essential.
History
Reviews curve history, progression, posture, standing tolerance, leg symptoms, prior surgery, and health goals.
Physical examination
Assesses global posture, shoulder and pelvic balance, strength, sensation, reflexes, gait, hips, and compensatory mechanics.
Standing full-length X-rays
Measure scoliosis, kyphosis, lordosis, pelvic parameters, and overall coronal and sagittal balance.
MRI
Evaluates nerves, stenosis, discs, and soft tissues when neurologic symptoms are present.
CT
Defines bone anatomy, fusion status, rotational deformity, or prior implants when needed for planning.
Bone-health assessment
May include bone density and laboratory evaluation because fixation and fracture risk depend on bone quality.
Treatment
Treatment is based on symptom burden and function rather than curve size alone. Many patients improve without reconstruction; major surgery is reserved for carefully selected deformity with substantial disability or neurologic compromise.
Nonoperative treatment
Care aims to improve endurance, manage pain, protect bone, and reduce the effort required for daily activity even when the curve itself cannot be corrected without surgery.
Conditioning & therapy
Individualized strength, aerobic conditioning, balance work, and movement strategies can improve capacity and confidence.
Medication & targeted injections
Appropriate medication or injections may address facet, sacroiliac, or nerve-related pain generators.
Bone health & support
Osteoporosis treatment, nutrition, fall prevention, weight optimization, and selective bracing may be important.
Operative treatment
Reconstruction may be considered when progressive deformity, neurologic compression, disabling imbalance, or severe pain persists despite comprehensive care and the expected benefit justifies the magnitude of surgery.
Neural decompression
Compressed nerves may require targeted decompression, usually coordinated with the stability and alignment plan.
Realignment & fusion
Osteotomies, interbody techniques, rods, screws, and fusion may restore balance and stabilize painful or progressive segments.
Staged or limited strategies
Some patients benefit from a focused operation, while complex rigid deformity may require staged anterior, lateral, and posterior reconstruction.
Risk optimization
Bone density, nutrition, medical health, frailty, goals, and recovery support are addressed before major deformity surgery.
When to seek prompt evaluation
Progressive weakness or loss of balance deserves prompt evaluation.
Seek timely care for increasing leg weakness, new bowel or bladder symptoms, saddle numbness, repeated falls, rapidly worsening posture, or severe pain after a minor injury.
Mission Viejo · Orange County
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Schedule an individualized spine evaluation with Omid Jalali, MD.