Spinal torsion is an abnormal rotation of the spinal column along its vertical axis. This twisting should not be confused with other spinal conditions like scoliosis, which involves a side-to-side curvature, or kyphosis, a forward rounding of the back. Spinal torsion often accompanies scoliosis, resulting in a more complex, three-dimensional spinal deformity. This rotation leads to an uneven distribution of pressure throughout the spine and can affect posture, flexibility, and lead to discomfort.
Underlying Causes and Risk Factors
In the majority of cases, particularly those associated with scoliosis in adolescents, the specific cause remains unknown; this is referred to as idiopathic spinal torsion. These cases frequently become more apparent during the rapid growth spurts that occur during puberty, which is a significant risk factor for the condition’s progression.
Another category is congenital, meaning the condition is present at birth. This form of spinal torsion arises from the malformation of one or more vertebrae during fetal development, creating a structural twist in the spine from the outset.
Neuromuscular conditions are also a known cause. Disorders such as cerebral palsy or muscular dystrophy can create imbalances in the muscles that support the spine. When muscles on one side of the body are weaker or tighter than on the other, they can pull the spinal column into a rotated position over time.
Finally, degenerative changes in the spine can lead to spinal torsion in adults. As the body ages, the intervertebral discs and facet joints that connect the vertebrae can wear down. This degeneration can cause instability within the spinal column, allowing for a gradual twisting to develop.
Symptoms of Spinal Torsion
A person with this condition may exhibit noticeable asymmetries in their body. These can include having uneven shoulders, where one appears higher than the other, or a waistline that looks uneven. One of the most distinct signs is a “rib hump,” which is a protrusion on one side of the back that becomes more obvious when the individual bends forward. This hump is caused by the rotated vertebrae pulling the attached ribs out of their normal alignment.
Individuals with spinal torsion often experience persistent back pain localized to the area of the twist. Muscle stiffness and fatigue are also common, as the body’s muscles work harder to compensate for the imbalanced spinal structure. This constant strain can lead to chronic discomfort and reduced flexibility.
In some cases, the twisting of the spine can affect the spinal nerves. If the rotation becomes severe enough to compress or irritate these nerves, neurological symptoms may arise. These can include pain that radiates from the back into the legs, as well as feelings of numbness, tingling, or weakness in the lower extremities.
How Spinal Torsion is Diagnosed
A diagnosis of spinal torsion begins with a physical examination. A primary component of this assessment is the Adam’s forward bend test, where the patient bends forward at the waist, allowing the examiner to view the back for any asymmetry. This position accentuates rotational deformities like a rib hump, and the examination also includes an evaluation of the patient’s overall posture, gait, and range of motion.
Following the physical examination, imaging studies are used to confirm the diagnosis and determine the extent of the spinal rotation. X-rays are the most common imaging tool, providing clear images of the vertebrae. This allows a physician to measure the precise degree of both the spinal curve and the rotational deformity to classify the condition’s severity and plan treatment.
More advanced imaging like a CT scan or an MRI scan may be necessary to create a detailed, three-dimensional picture of the spine. These scans are useful for assessing the spinal cord and nerves, especially when neurological symptoms are present or surgery is being considered.
Treatment and Management Strategies
Treating spinal torsion depends on the rotation’s severity and the patient’s age. For mild to moderate cases, non-surgical management is the first course of action, aiming to alleviate pain, improve function, and prevent worsening. Physical therapy is a large part of this, with exercises to strengthen core muscles, increase flexibility, and promote better posture.
In growing adolescents, a custom-fitted spinal brace may be recommended to halt the twist’s progression during rapid growth. The brace must be worn for a specified number of hours each day to be effective. Pain management techniques, such as over-the-counter pain relievers, may also be used to address discomfort.
Surgery is reserved for severe cases or when rotation progresses rapidly despite non-surgical treatments. The most common procedure is spinal fusion. A surgeon uses instrumentation like metal rods and screws to de-rotate the twisted portion of the spine and stabilize it in a more correct alignment.
After the correction, bone grafts are placed along the treated section of the spine. Over time, these grafts fuse with the existing vertebrae, creating a single, solid bone segment. This fusion permanently stabilizes the spine, preventing further twisting and correcting the deformity to improve the individual’s quality of life.