Spinal deformities can often be clearly visible. However, to establish both the cause and extent of a spinal deformity, a doctor will begin with getting a complete medical history, including any previous X-rays for comparison, in addition to watching a person move in various positions and learning about the following:
- Changes in a person’s height
- Bowel or bladder dysfunction, which may indicate nerve damage
- Family history, since some types of spinal deformities tend to run in families
- Onset of symptoms, or when spinal deformity was first noticed
- Pain, what intensifies it, and if any pain radiates from the spine itself, as well as tingling, numbness, impaired reflexes, and muscle weakness, indicating compression of nerves
- Past surgeries, as spinal deformities can be a result of previous back surgeries. Iatrogenic kyphosis (caused by prior medical treatment) — such as when a spinal fusion does not heal properly and the ligaments are not strong enough to support the spine, which causes the vertebrae to collapse — often requires a second, revision surgery to correct. For example, a very common cause of kyphosis in the cervical spine, or neck, is iatrogenic.
Spinal deformities like scoliosis, kyphosis, and spondylolisthesis (spinal dislocation or slippage) can be visualized with X-rays.
- X-rays from different angles can check for changes from past X-rays and determine progression of the curve or visualize any other bony abnormalities, fractures, and disc issues.
- Front-view full-length X-rays of the spinal column are taken as the individual stands with arms extended forward while keeping the head erect.
- Lateral-bend X-rays may be taken from the side while an individual is standing or bending sideways or backwards to see wedging of the vertebrae and determine flexibility.
- Traction-film X-rays, which are ordered only occasionally, are taken while an individual’s spine is pulled and held in a particular position.
These other tests may be ordered to diagnosis spinal deformities and determine their severity and cause:
- Blood may be tested for the HLA-B27 gene, which is carried by more than 95 percent of those with ankylosing spondylitis, a form of arthritis in which chronic inflammation causes stiffness and pain in the spine.
- Computerized tomography (CT) is a noninvasive procedure that uses X-rays to produce a three-dimensional image of the spine. A CT shows more details than an X-ray and can reveal the nerves, spinal cord, and any possible damage to them.
- Electromyogram and nerve-conduction studies (EMG/NCS) measure the electrical activity in the nerves and muscles. They may identify nerve damage or nerve compression.
- Magnetic resonance imaging (MRI) uses magnetic fields and radio-frequency waves to create an image of the spine that reveals the discs, nerves, spinal canal, and other details that can’t normally be seen on an X-ray. An MRI may also check for spinal cord compression. Sometimes a contrast agent is injected into a vein in the hand or arm during the test, which highlights certain tissues and structures to make details even clearer.
- Myelograms involve a dye that is injected directly into the spinal column and are used in conjunction with CT scans.
- Pulmonary function tests may be ordered to determine if lung function is restricted due to compression in the chest from the spinal deformity.
Some mild deformities may be treated with pain medications, physical therapy (including gait and posture training), and certain braces. Other cases require corrective surgery.
