Déformation de la colonne vertébrale

Spinal deformity means the spine has an abnormal curve or shape (for example, scoliosis, kyphosis, or a combination), so the head and body are not lined up in a straight, balanced way. It can be mild and mostly a cosmetic issue, or severe enough to cause pain, nerve problems, and trouble standing or walking upright.​

1) What is this condition?

  • Common patterns include:

    • Scoliosis: side‑to‑side “S” or “C” curve.​

    • Kyphosis: excessive forward bend of the upper or mid‑back (hunched posture).​

    • Kyphoscoliosis: a mix of sideways and forward curves.​

  • It can be present from birth, develop during growth, or appear later from arthritis, osteoporosis, prior surgery, fractures, or neuromuscular conditions.​

2) How serious is it?

  • Many mild deformities cause little or no symptoms and are just monitored.​

  • More severe curves can lead to:

    • Chronic back pain.

    • Pinched nerves (leg or arm pain, numbness, weakness).

    • Trouble standing upright, fatigue, and in extreme cases breathing or heart strain.​

3) Non‑surgical treatments

  • Targeted physical therapy and exercise: scoliosis‑ or kyphosis‑specific programs to improve posture, strengthen core and back muscles, and reduce pain.​

  • Pain management: anti‑inflammatory medicines, activity modification, weight control, and sometimes injections (facet or epidural) for associated stenosis.​

  • Bracing:

    • In growing children/teens, braces can help prevent curves from worsening.​

    • In adults, bracing is used more short‑term for pain or support, as long‑term bracing can weaken core muscles.​

4) Types of surgery that may be necessary

  • Spinal fusion with deformity correction: placing screws and rods along several vertebrae to straighten the curve and then fusing them with bone graft.​

  • Osteotomies (bone cuts) in severe, stiff deformities to allow more powerful straightening before fusion.​

  • In children with significant growth remaining, growth‑friendly systems (growing rods, guided‑growth devices) may be used.​

5) Goals of surgery vs non‑surgical care

  • Non‑surgical goals:

    • Control pain, improve posture and function, and slow or prevent curve progression without major surgery.​

    • Maintain flexibility and daily independence as long as possible.​

  • Surgery goals:

    • Restore more normal alignment and balance of the spine and trunk.​

    • Relieve nerve pressure, improve ability to stand and walk upright, and reduce disabling pain or breathing compromise.​

6) How surgery can “fix” the problem

  • Screws are placed into multiple vertebrae and connected by rods; the rods are contoured and gradually straightened to correct the curve.​

  • Bone graft is added so the treated segments fuse into a solid block over time, holding the new, straighter shape.​

  • When deformity is very stiff or severe, wedge‑shaped pieces of bone are removed (osteotomy) to allow the spine to be realigned before fusion.​

7) Risks of surgery (general and specific)

  • General risks: bleeding (often substantial in long fusions), infection, blood clots, lung or heart complications, and anesthesia risks.​

  • Deformity‑specific:

    • Nerve or spinal cord injury causing new weakness, numbness, or bowel/bladder problems (reported neurologic complication rates up to about 0.3–35% depending on complexity).​

    • Hardware failure, non‑union, or loss of correction over time, especially in long constructs or with osteoporosis.​

8) Chances this surgery will work

  • Adult deformity surgery typically improves pain, posture, and health‑related quality of life in a majority of well‑selected patients, especially when sagittal (front‑to‑side) balance is restored.​

  • However, overall complication rates around 30–40% and re‑operation rates around 20–30% are reported in large adult series, reflecting the complexity of these procedures.​

9) Possible complications from the surgery

  • Systemic: heart or lung complications, blood transfusion needs, and prolonged ICU stays in older or frail patients.​

  • Local: infection, poor wound healing, nerve injury, rod breakage, screw loosening, pseudarthrosis (non‑fusion), and adjacent‑segment breakdown requiring further surgery.​

  • Long term: reduced spinal flexibility and some lifestyle limitations due to fused segments.​

10) Typical recovery from the condition

  • Without surgery, many people live for years with mild‑to‑moderate deformity using exercise, pain control, and activity adjustments.​

  • In progressive adult deformity, curves and forward stooping can slowly worsen, increasing pain, fatigue, and nerve symptoms, and sometimes reducing lung function.​

11) Typical recovery after surgery

  • Hospital stay includes pain control, early walking with assistance, and sometimes a brace; activity restrictions on bending, lifting, and twisting are common for weeks to months.​

  • Outpatient physical therapy focuses on safe movement, endurance, and adapting to reduced motion; bone fusion and remodeling continue for 6–12 months or more.​

  • Many patients report better posture and pain relief by 6–12 months, though some stiffness and residual discomfort are common.​

12) How long in the hospital

  • Typical stays after multi‑level deformity fusion are 3–7 days, longer with extensive osteotomies or complications.​

  • Some patients, especially older adults or those with other medical problems, transition to inpatient rehab before going home.​

13) Long‑term outlook

  • For mild deformities managed non‑surgically, outlook is often good with ongoing exercise, posture care, and monitoring.​

  • After successful deformity surgery, many adults enjoy lasting improvements in pain and function, but must accept a stiffer spine and the risk of future adjacent‑level issues.​

  • Underlying problems like osteoporosis or neuromuscular disease still need long‑term management to protect the rest of the spine.​

14) Need for outpatient follow‑up

  • Non‑surgical: periodic visits for curve measurement, symptom review, and adjustment of therapy, bracing (in youth), and exercise programs.​

  • Post‑surgery: scheduled follow‑up and imaging (X‑rays, sometimes CT) to monitor fusion, hardware, and alignment, especially in the first 2–3 years.​

  • Long‑term: ongoing monitoring for bone health, adjacent‑segment problems, and late neurologic or balance changes, with early reassessment if new pain, weakness, or breathing issues occur.