Post-Surgical Malalignment | Scoliosis Research Society
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Post-Surgical Malalignment

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Post-Surgical Malalignment

Patients who have undergone spinal fusions surgery (either for scoliosis or for degenerative low back conditions) are at risk for developing post-surgical malalignment. Types of post-surgical malalignment are described below; both result in an imbalance of the spine from the side (sagittal imbalance) and lead to progressive low back pain and stiffness.

  • Flat Back Syndrome: Experienced by patients who have had long fusions of the spine. The spine loses its normal inward curvature (known as lordosis); patients are unable to stand upright and are usually "pitched" forward. For more information, review Fixed Sagittal Imbalance.
  • Junctional Kyphosis: An sharp curvature that develops just above or below a previous spinal fusion. For more information on Proximal Junctional Kyphosis, click here.
  • Post-Laminectomy Curvature: Occurs, rarely, after a common procedure used to treat spinal stenosis (pinched nerves) in adults – especially if many levels are decompressed. The curvature takes on the form of scoliosis (front curve) or kyphosis (forward bend).
  • Adjacent-Level Disease: Results from a spinal fusion that places additional stress on the neighboring segments to the fused vertebrae, possibly contributing to accelerated arthritis. The body may lean to the side or forward. Significant spinal curvature typically does not occur; however, symptomatic curves can develop.
  • Post-surgical Instability: Results when a spine loses the ability to support itself after extensive low back surgery. Symptoms are similar to adjacent-level disease, but may occur within the operated levels themselves. Also, every fusion procedure has a risk that the bones will not join together.
  • Failed Fusion: Happens when the bones in a fusion procedure will not join, possibly leading to further collapse of the spine. The risk for failed fusion increases as the number of vertebra fused increases.

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