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Home > Adult Spinal Deformities (ASDs) – Part III – Symptoms and Diagnosis

Adult Spinal Deformities (ASDs) – Part III – Symptoms and Diagnosis

Jeffrey R. Carlson, MD, CPE, FAAOS

Jeffrey R. Carlson, MD, MBA, CPE, FAAOS

In the first two installments of this series, I discussed the normal anatomical structure of the spine, and the different ways that the spine can be deformed by disease, injury, aging, congenital and iatrogenic issues.  In this article, I will review the symptoms and characteristics of ASDs and how I diagnose them.

Adult Spinal Deformity Symptoms – this list is not all encompassing but includes the most commonly seen issues:

  1. Persistent, chronic, often debilitating back pain is a hallmark symptom of ASD, which results from mechanical stress on spinal structures and nerve compression. Stiffness may also be a problem.
  2. Progressive curvature of the spine may continue for the lifetime of the patient. This may manifest in scoliosis, kyphosis, and/or trunk asymmetry or any combination, and may occur rapidly or very slowly in the patient.
  3. Radiculopathy and Neurological Deficits: Compression of spinal nerve roots or the spinal cord leads to radicular pain (pain down limbs), numbness, weakness, and gait disturbances. Neurogenic claudication, aka, pseudostenosis, is intermittent leg pain, numbness or weakness caused by compression of the lumbar nerves, mimics the pain of lumbar spinal stenosis.
  4. Reduced Mobility and Functional Impairment: Spinal deformities can limit a person’s range of motion, impair balance, and interfere with activities of daily living, diminishing a patient’s functional capacity in all areas of their life.
  5. Psychosocial Impact: ASDs can significantly affect patients’ emotional well-being, leading to depression, anxiety, isolation, and decreased quality of life.

How is ASD Diagnosed?

When a patient comes to my office for a diagnostic evaluation, I will order x-rays, complete a thorough physical examination, review any past radiographic imaging that the patient may provide (such as an MR scan) if any, and perform functional assessments.

X-rays will provide a wealth of information including anterior, posterior, lateral, and oblique views, showing spinal alignment, curvature, and any degenerative changes. I routinely review these with the patient during this office visit and point out any areas of concern.

The physical examination may reveal spinal curvature, pelvic misalignment, and neurological deficits. I perform certain tests to ascertain how well the patient can function and move, including gait analysis, to help me quantify the impact of their spinal deformities on their daily activities.

Advanced imaging modalities such as magnetic resonance imaging (MRI) and computed tomography (CT) scans provide detailed information regarding neural compression, spinal canal stenosis, and soft tissue abnormalities.  MR scanning uses a large electric magnet to capture images of the body: CT scanning uses x-ray technology (radiographs) taken in rapid succession to provide a complete image of the area of the body being studied. I typically use CT scanning when the patient is not able to have an MR scan due to certain types of metal in their body (implant, bullet, metallic shards in the eye from welding, implanted medication pumps, etc.)

If the patient has not had an MR scan, I will order one to get a very detailed set of images of not only their spinal column, but also their soft tissues, which includes the spinal cord, nerves, spinal discs, muscles, ligaments, tendons, etc.   The MR scan will confirm where structural deformity may be causing radiculopathy or provide evidence that something else may be the cause of pain and dysfunction. This will greatly assist me in creating a specific treatment plan for the patient moving forward.

In my next article, I will review both conservative and surgical treatment plans and how these can be adapted to cover the patient as they grow and mature throughout their lifetime.

 

 

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