Division Lead: Thomas J Buell, MD
Deformity Surgeons:
David Okonkwo, MD, Hong Joo Moon, MD
Expert Care for Complex Spinal Conditions
Whether you have recently been diagnosed with scoliosis or have lived with a spinal deformity for years, our multidisciplinary team specializes in the evaluation and treatment of simple to the most complex spinal conditions. We provide personalized treatment plans ranging from observation and physical therapy to advanced minimally invasive techniques and complex reconstructive surgery.
Our expertise includes:
- Adult scoliosis
- Adolescent idiopathic scoliosis
- Congenital scoliosis
- Degenerative scoliosis
- Kyphosis
- Flat Back Syndrome
- Chin-on-Chest Deformity
- Sagittal imbalance
- Coronal imbalance
- Revision deformity surgery
- Spinal osteotomies
- Minimally invasive deformity correction
Understanding Spinal Deformities
The healthy spine has gentle curves that help maintain balance and absorb the forces of everyday movement. When these curves become exaggerated or abnormal, patients may develop pain, nerve compression, difficulty standing upright, impaired walking, or cosmetic concerns.
Spinal deformities may develop during childhood, occur as part of aging, result from previous surgery, trauma, infection, or neurological disorders.
Conditions We Treat
Adolescent Idiopathic Scoliosis (AIS)
The most common form of scoliosis, idiopathic scoliosis develops during adolescence without a known cause. Although many curves remain mild, progressive curves can continue to worsen during growth and occasionally into adulthood
Common symptoms
- Uneven shoulders
- Prominent shoulder blade
- Uneven waistline
- Rib prominence/hump
- Visible spinal curvature
Treatment options
- Observation
- Bracing
- Physical therapy
- Schroth Physical Therapy
- Posterior spinal fusion
Adult Degenerative Scoliosis
As we age, the discs and joints of the spine gradually wear down. Occasionally, this can be caused by a leg length discrepancy. Uneven degeneration can cause the spine to curve, leading to scoliosis, spinal stenosis, nerve compression, and loss of normal posture.
Common symptoms
- Low back pain
- Leg pain or sciatica
- Difficulty standing upright
- Numbness or weakness
- Progressive leaning
Treatment options
- Physical therapy
- Schroth Physical Therapy
- Pain management
- Injections
- Minimally invasive decompression
- Complex deformity reconstruction
Congenital Scoliosis
Congenital scoliosis results from abnormal spinal development before birth. Because the vertebrae do not form normally, curves may progress as children grow.
Common symptoms
- Visible spinal curve
- Uneven shoulders
- Rib asymmetry
- Associated congenital abnormalities
Treatment options
- Observation
- Physical therapy
- Schroth Physical Therapy
- Bracing
- Corrective deformity surgery
Kyphosis
Kyphosis is an excessive forward curvature of the thoracic spine, producing a rounded or hunched appearance. Some patients experience only cosmetic changes, while others develop pain, neurological symptoms, or progressive sagittal imbalance. This can be caused by degenerative changes, trauma, infection, osteoporosis, or Scheuermann's disease.
Common Symptoms
- Rounded upper back
- Fatigue
- Difficulty standing upright
- Back pain
- Neurological symptoms
Treatment Options
- Physical Therapy
- Schroth Physical Therapy
- Injections
- Pain Management
- Corrective deformity surgery
Flat Back Syndrome
Flat Back Syndrome occurs when the natural lumbar lordosis is lost, making it difficult to stand upright without bending the knees or hips. Patients often report worsening posture throughout the day because their muscles become fatigued trying to maintain balance.
Common symptoms
- Leaning forward, bending knees
- Difficulty standing for long periods
- Fatigue
- Low back pain
- Walking intolerance
Treatment options
- Physical therapy
- Injections
- Pain management
- Corrective deformity surgery
- Revision spinal reconstruction
Chin-on-Chest Deformity
Chin-on-Chest Deformity is a severe cervical deformity in which the head progressively falls forward, limiting forward vision and affecting swallowing, breathing, and quality of life. This may occur from cervical kyphosis, ankylosing spondylitis, neuromuscular disorders, prior cervical surgery, or infection.
Symptoms
- Inability to look forward
- Neck pain
- Difficulty swallowing
- Difficulty eating
- Balance problems
Treatment
- Physical therapy
- Injections
- Pain management
- Corrective deformity surgery
Complex cervical reconstruction is designed to restore horizontal gaze and spinal alignment.
Sagittal Imbalance
Sagittal imbalance occurs when the spine loses its normal front-to-back alignment, causing patients to lean forward. This may result from degenerative changes or prior surgery.
Symptoms
- Difficulty walking
- Fatigue
- Inability to stand upright
- Back and leg pain
Treatment
- Physical therapy
- Injections
- Pain management
- Corrective deformity surgery
Coronal Imbalance
Coronal imbalance occurs when the body shifts to one side rather than remaining centered over the pelvis. This can result from progressive scoliosis, leg length discrepancies, degenerative changes, or prior surgery.
Symptoms
- Leaning to one side
- Uneven shoulders or hips
- Difficulty walking
- Back and leg pain
Treatment
- Physical therapy
- Injections
- Pain management
- Corrective deformity surgery
Revision Spinal Deformity Surgery
Some patients require revision surgery because of:
- Failed prior fusion
- Hardware complications
- Adjacent segment disease
- Persistent deformity
- Nonunion (pseudoarthrosis)
- Proximal Junctional Failure
- Distal Junctional Failure
How We Diagnose Spinal Deformities
Evaluation includes:
- Physical examination
- Standing full-length spine x-rays
- Flexion/Extension x-rays
- EOS® low-dose imaging (full body scan)
- CT
- MRI
- Bone density testing (DEXA)
- Patient-reported outcome measures
Our specialists evaluate your spinal and pelvic alignment, parameters, and angles. We look at changes over time. It is important to match your imaging findings with symptoms and a physical exam.
Treatment Options
Every patient receives an individualized treatment plan based on symptoms, alignment, overall health, and personal goals.
Non-Surgical Care
- Physical therapy
- Schroth Physical Therapy
- Water-based Physical Therapy
- Physical Medicine and Rehab: Spine Health Program
- Medication management: Pain Management
- Osteoporosis/ bone health: Endocrine Management
- Injections/Ablations/Selective Nerve Root Blocks: Interventional Neuroradiology
Surgical Care
Our surgeons specialize in:
- Minimally invasive deformity surgery
- Posterior spinal fusion
- Anterior/posterior reconstruction
- Spinal osteotomies
- Cervical deformity correction
- Revision spine surgery
- Navigation and robotic-assisted surgery
Why Choose Our Center?
Our multidisciplinary team provides comprehensive care for patients with spinal deformity using the latest surgical techniques and evidence-based treatment strategies.
Our program offers:
- Fellowship-trained spinal deformity surgeons
- Expertise in adult and pediatric deformity
- Minimally invasive approaches when appropriate
- Advanced imaging and surgical planning
- Multidisciplinary Approach Pre-Operation and Post-Operation
- Personalized treatment plans
- Participation in clinical research and innovation
Schroth Physical Therapy:
The Schroth method is a specialized physical therapy technique designed to treat scoliosis. This method was developed by Katarina Schroth, a German physiotherapist in the 1920s, and requires specific training. This method is patient specific. Schroth physical therapists review your x-rays and assess your curvature. The goal of therapy is to prevent further progression of the curve, improve posture stabilization in all three planes, increase chest mobility and lung function, and help with trunk symmetry.
UPMC has Schroth certified physical therapists at multiple locations, lead by director of the program, Lauren Martino PT, DPT. A video demonstrating this type of physical therapy is being developed.