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Degenerative Deformity

Conditions Treated

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Overview

Degenerative deformity is abnormal spinal curvature that develops due to age-related wear and tear of the spine. It can occur in the lumbar, thoracic or cervical regions and may cause back or neck pain, loss of height or difficulty with balance. Management depends on symptoms and degree of deformity.

Symptoms

  • Back or neck pain, often worsening with certain activities or prolonged standing.
  • Progressive loss of height or stooped posture.
  • Difficulty standing upright; sense of imbalance.
  • Leg pain or numbness if nerves are compressed.
  • Reduced mobility and functional limitations.
  • Visible spinal curvature (kyphosis in thoracic region, scoliosis or kyphosis in lumbar region).

Causes

  • Degenerative disc disease: loss of disc height, disc bulging and collapse.
  • Vertebral body changes: bone loss, fractures or wedging of vertebrae.
  • Facet joint and ligament degeneration: contributing to instability and curvature change.
  • Cumulative mechanical stress: years of spinal loading leading to structural changes.
  • Age-related bone loss: osteoporosis increasing fracture risk and deformity.

Diagnosis

  • Physical examination: posture assessment, gait analysis, neurological testing.
  • X-rays: assess curvature magnitude, vertebral alignment and bone quality.
  • CT or MRI: detailed evaluation of bone, disc and nerve involvement; assess cord or nerve compression.
  • Functional tests: assess impact on walking, balance and activities of daily living.
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Non‑surgical treatment

For mild to moderate deformity without significant pain or neurological deficit, conservative care may suffice.

  • Physiotherapy: core strengthening, postural training and balance exercises.
  • Pain management: NSAIDs, muscle relaxants and targeted pain medication.
  • Spinal supports or bracing: temporary support during activities; may improve symptoms and confidence.
  • Activity modification: pacing activities, avoiding heavy lifting, ergonomic adjustments.
  • Calcium and vitamin D: bone health support, particularly if osteoporosis is present.

Regular monitoring and follow-up imaging may help track progression.

Surgical treatment

Degenerative deformity surgery involves complex spinal reconstruction and is reserved for cases with severe functional impairment, significant pain, nerve compression or progressive instability. These procedures require advanced surgical expertise and planning.

  • Decompression and fusion: stabilisation of affected spine segments to relieve nerve pressure, correct alignment and prevent further deformity progression.
  • Osteotomy: bone realignment procedures to restore normal spinal curvature in severe cases.
  • Instrumentation: use of rods, screws and plates to maintain correction and long-term stability.
  • Two-consultant surgery: complex reconstructive cases are commonly performed as a two-consultant operation — the gold standard for major spinal reconstruction — allowing simultaneous anterior and posterior approaches and reducing operative time and risk.
  • Advanced surgical techniques: these cases utilise neuronavigation (computer-guided imaging for precise implant placement) and intraoperative spinal cord monitoring to maximise safety and accuracy throughout the procedure.

Surgery aims to relieve pain, restore spinal balance, decompress neural structures and prevent further neurological deterioration.