Adult Congenital Malformations of the Thoracic and Lumbar Spine

Various congenital abnormalities that affect the thoracic and lumbar spine can arise from errors during development, including embryogenesis, neurulation, and neurogenesis. The principal congenital problems manifesting in the adult include congenital kyphosis, scoliosis, lordosis, sacral dysgenesis, and closed or occult spinal dysraphism, also known as spina bifida occulta. The seven types of closed spinal dysraphism are lipomyelomeningocele, intradural lipoma, fatty filum terminale, split cord malformations, meningocele manqué, dermal sinus tract, neurenteric cyst, and dermoid. Despite being caused by errors in development, each abnormality requires distinct regimens of surgical and nonsurgical treatments to maximize the benefit in the adult patient. This chapter highlights the main abnormalities affecting the adult thoracolumbar spine and various treatment methods to improve patient outcomes for each specific defect.