Understanding your spine condition is the first step.
Your back is a key support for your body. When any of its components — bones, discs, nerves, or muscles — are not functioning correctly, a variety of symptoms can develop. The Hey Clinic team is experienced in diagnosing and treating all of the following conditions.
Vertebrae (Bones)
Vertebrae are individual bones stacked to form the vertebral column — 7 in the cervical spine (neck), 12 in the thoracic spine (mid-back) and 5 in the lumbar spine (low back). When these vertebrae get out of alignment, especially in a growing child, the deformity can progress causing scoliosis, kyphosis and/or spondylolisthesis. At the bottom of the spine is the sacrum, which connects to the pelvis through the sacro-iliac (SI) joint.
Discs & Facet Joints
The discs are located between the vertebrae and serve as shock absorbers, allowing spinal movement along with the two facet joints at the back of the spine. Degeneration of the discs and/or facet joints can cause pain and lead to encroachment into the spinal canal causing nerve and/or spinal cord compression — resulting in pain, numbness, weakness and/or clumsiness in the arms and/or legs.
Spinal Cord & Nerves
The spinal cord is a bundle of nerves that allows the brain to communicate with the rest of the body. It extends from the skull down to the lumbar spine, with individual nerves exiting out of the spinal canal at different levels and extending to the rest of the body. This enables the body to perceive sensation, initiate movements and maintain balance.
Muscles
There are several muscles positioned around the spine. These help keep the spine upright. With certain injuries or conditions, the muscles can be stretched, strained or injured. Weak muscles can also cause back pain and create difficulty supporting affected parts of the back, causing deformity.
Scoliosis
Scoliosis is a lateral curvature of the spine, typically forming an “S” or “C” shape. The most common type is adolescent idiopathic scoliosis which usually presents during the adolescent growth spurt. Scoliosis can also be congenital, related to a neuromuscular condition, or develop later in life as our bones and discs degenerate.
Many medical providers will screen for scoliosis using a scoliometer measurement on a forward-bend test. If the scoliometer reading is greater than 5 degrees, an x-ray is recommended to confirm the diagnosis. Any curvature of the spine measuring greater than 10 degrees on an x-ray is considered scoliosis.
Understanding your curve progression risk:
- Under 30° — Low risk of adult progression. Conservative management and monitoring.
- 30–40° — Approximately 80% chance of progression during adulthood.
- 40–50° — Approximately 76% chance of progression during adulthood.
- Over 50° — Nearly 100% chance of continued adult progression.
68% of scoliosis curves progress during adulthood — lifelong monitoring and follow-up matters at every age.Hey LA, Stanson K, et al. Acta Scientific Orthopaedics. 2022;5(8):52–55. Open access →
¹ Hey LA, Stanson K, Darroch K, Dorr V. Sharing the Truth of Scoliosis Curve Progression Risk with Patients and Families. Acta Scientific Orthopaedics. 2022;5(8):52–55. Open access.
² Hey LA. Scoliosis in the Adult. UpToDate (Wolters Kluwer). 2018–present. [Subscription required]
Types of scoliosis:
- Idiopathic Scoliosis — The most common type. “Idiopathic” means there is not a known cause. It occurs most frequently in adolescents.
- Early Onset Scoliosis — Any scoliosis present before 10 years of age.
- Congenital Scoliosis — Vertebrae are not formed correctly and may be misshapen or fused. Occurs in only 1 in 10,000 newborns.
- Neuromuscular Scoliosis — Conditions including cerebral palsy, spina bifida, and muscular dystrophy can lead to scoliosis due to impaired muscle control.
- Degenerative Scoliosis — More commonly seen in the lumbar spine of older adults from wear and tear on joints and discs.
Treatment options for scoliosis include observation, physical therapy, bracing, and surgery.
Kyphosis
Kyphosis is the forward curvature of the upper back that normally measures 30–50 degrees. If the kyphosis measures over 50 degrees, the shoulders may appear rounded with a hunched forward posture. Kyphosis affects children, adolescents, and adults. In children, the curve may straighten out or potentially progress as the child continues to grow.
Signs and symptoms include differences in shoulder and shoulder blade height, tight hamstrings, back pain, and having the head bend forward compared to the rest of the body. The earlier kyphosis is detected the more successful treatment can be.
Types of kyphosis:
- Postural Kyphosis — The most common type, defined as kyphosis greater than 50 degrees where the vertebrae are normal-shaped. Often becomes noticeable in adolescence.
- Scheuermann’s Kyphosis — When three or more vertebral bodies are wedged over 10 degrees in a row, causing the upper back to hunch forward. Found in 0.4% of the population.
- Congenital Kyphosis — Present at birth due to problems with vertebral formation. Can become more noticeable as the child grows.
Physical therapy with home exercises is often recommended to improve strength and posture. Severe cases can be corrected surgically with instrumentation and fusion.
³ Hey LA. Scoliosis in the Adult (covers kyphosis & adult spinal deformity). UpToDate (Wolters Kluwer). 2018–present. [Subscription required]
Spondylolysis & Spondylolisthesis
Spondylolysis, also known as “pars fracture”, is a fracture of the posterior elements of the spine. It is typically caused by repetitive stress and often seen in young athletes — particularly in gymnastics, football, and weight lifting. It occurs in one out of every 20 people.
While some active children and adolescents may experience symptoms, sometimes the symptoms may not surface until adulthood. The most common location is in the lumbar spine, specifically at L5. Symptoms include pain and stiffness in the lower back and occasionally weakness, tingling, or numbness in the legs.
Spondylolisthesis is a condition in which one vertebra shifts compared to the one adjacent to it, which can put pressure on a nerve causing pain, numbness, tingling, and/or weakness.
Five grades of spondylolisthesis:
- Grade 1: 1–25% slip
- Grade 2: 26–50% slip
- Grade 3: 51–75% slip
- Grade 4: 76–100% slip
- Grade 5: >100% slip
Treatment options include medication, heat/ice, rest, physical therapy, a brace, or in some cases, surgery.
Disc Herniation
Spinal discs play a critical role in your spine — absorbing shock between the vertebrae, supporting the upper body, and allowing a wide range of movement. A disc herniation occurs when the contents of the disc go beyond its normal borders, causing impingement on the spinal cord and/or nerves which can lead to pain, numbness, and/or weakness.
Herniated discs can occur in any section of the spine but are most commonly found in the lower back. Lumbar herniated discs most often affect people aged 35 to 50. Herniated discs in the neck typically result in pain in the shoulder and arm.
Reduce your risk:
- Maintain a healthy weight to keep excess pressure off your back
- Stretch often, especially if you sit for long periods
- Use proper lifting techniques — bend at your knees, not your waist
- Exercise regularly to strengthen your trunk muscles
- Avoid using any tobacco products
Treatment options include medication, rest, physical therapy, bracing, spinal injections, and surgery.
Spinal Stenosis
Your spinal canal is a tunnel formed by your vertebrae that contains your spinal cord. Spinal stenosis is the narrowing of this canal, which can cause pressure on the cord itself or on the nerves that go from the spinal cord to your muscles. Stenosis can occur in the cervical (neck), thoracic (mid-back), or lumbar (low back) spine.
While some people are born with a smaller spinal canal (congenital spinal stenosis), most cases occur from herniated discs, bony overgrowth, thickened ligaments, and other spinal injuries. Because the majority of cases occur due to gradual wear and tear, most people who develop spinal stenosis are over the age of 50.
Symptoms by region:
- Cervical stenosis: Numbness or tingling in hands and arms, weakness, neck pain, problems with walking and balance
- Thoracic stenosis: Problems with walking or balance
- Lumbar stenosis: Numbness or tingling in feet or legs, weakness, back pain, sciatica, pain after prolonged standing
While spinal stenosis cannot be completely cured, there are methods to treat and manage it including medication, physical therapy, spinal injections, and in some cases, surgery.
⁴ Hey LA. Scoliosis in the Adult (covers stenosis in the context of adult spinal deformity). UpToDate (Wolters Kluwer). 2018–present. [Subscription required]
So is every patient.
These descriptions are meant to serve as an introduction. They are not a substitute for discussing your specific situation with Dr. Hey or a PA during your appointment. We welcome second opinions.
