Kyphosis

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Hyperkyphosis
Classification and external resources
Scheuermanns diseasebl.jpg
A preoperative image of a 22-year-old man with Scheuermann's disease, a type of structural kyphosis
ICD-10M40.0-M40.2, M42.0, E64.3,Q76.4, M84.0, M96.2, M96.3
ICD-9732.0, 737.0, 737.1, 756.19
DiseasesDB21885
MedlinePlus001240
Patient UKKyphosis
MeSHD007738
 
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For other uses, see Kyphosis (disambiguation).
"Hunchback" redirects here. For other uses, see Hunchback (disambiguation).
Hyperkyphosis
Classification and external resources
Scheuermanns diseasebl.jpg
A preoperative image of a 22-year-old man with Scheuermann's disease, a type of structural kyphosis
ICD-10M40.0-M40.2, M42.0, E64.3,Q76.4, M84.0, M96.2, M96.3
ICD-9732.0, 737.0, 737.1, 756.19
DiseasesDB21885
MedlinePlus001240
Patient UKKyphosis
MeSHD007738

Kyphosis (from Greek κυφός kyphos, a hump) refers to the normal convex curvature of the spine as it occurs in the thoracic and sacral regions.[1][2] Inward concave curving of the cervical and lumbar regions of the spine is called lordosis. The term kyphosis can also be used to describe excessive kyphosis or overcurvature when it is also known as hyperkyphosis. Kyphosis can be called roundback or Kelso's hunchback. It can result from degenerative diseases such as arthritis; developmental problems, most commonly Scheuermann's disease; osteoporosis with compression fractures of the vertebrae, or trauma. A normal thoracic spine extends from the 1st to the 12th vertebra and should have a slight kyphosis ranging from 20° to 45°. When the "roundness" of the upper spine increases past 45° it is called "hyperkyphosis". Scheuermann's kyphosis is the most classic form of hyperkyphosis and is the result of wedged vertebrae that develop during adolescence. The cause is not currently known and the condition appears to be multifactorial and is seen more frequently in males than females.[3]

In the sense of a deformity, it is the pathological curving of the spine, where parts of the spinal column lose some or all of their lordotic profile. This causes a bowing of the back, seen as a slouching posture.

While most cases of kyphosis are mild and only require routine monitoring, serious cases can be debilitating. High degrees of kyphosis can cause severe pain and discomfort, breathing and digestion difficulties, cardiovascular irregularities, neurological compromise and, in the more severe cases, significantly shortened life spans. These types of high-end curves typically do not respond well to conservative treatment and almost always warrant spinal fusion surgery, which can successfully restore the body's natural degree of curvature. The Cobb angle is the preferred method of measuring kyphosis.

Classification[edit]

There are several kinds of kyphosis (ICD-10 codes are provided):

Treatments[edit]

A diagnosis of kyphosis is generally made through observation and measurement. Idiopathic causes, such as vertebral wedging or other abnormalities, can be confirmed through X-ray. Osteoporosis, a potential cause of kyphosis, can be confirmed with a bone density scan. Postural thoracic kyphosis can often be treated with posture reeducation and focused strengthening exercises.Idiopathic thoracic kyphosis due to vertebral wedging,fractures, or vertebral abnormalities is more difficult to manage, since assuming a correct posture may not be possible with structural changes in the vertebrae.Children who have not completed their growth may show long-lasting improvements with bracing. Exercises may be prescribed to alleviate discomfort associated with overstretched back muscles. A variety of gravity-assisted positions or gentle traction can minimize pain associated with nerve root impingement. Surgery may be recommended for severe idiopathic kyphosis.

Orthosis (brace)[edit]

Modern brace for the treatment of a thoracic kyphosis. The brace is constructed using a CAD/CAM device.[10]

Body braces showed benefit in a randomised controlled trial.[11]

The Milwaukee brace is one particular body brace that is often used to treat kyphosis in the US. Modern CAD/CAM braces are used in Europe to treat different types of kyphosis. These are much easier to wear and have better in-brace corrections than reported for the Milwaukee brace. Since there are different curve patterns (thoracic, thoracolumbar and lumbar), different types of brace are in use, with different advantages and disadvantages.[10]

Modern brace for the treatment of a lumbar or thoracolumbar kyphosis. The brace is constructed using a CAD/CAM device. Restoration of the lumbar lordosis is the main aim.[10]

Specialised physical therapy[edit]

In Germany, a standard treatment for both Scheuermann's disease and lumbar kyphosis is the Schroth method, a system of physical therapy for scoliosis and related spinal deformities.[12] It involves lying supine, placing a pillow under the scapular region and posteriorly stretching the cervical spine.

Surgery[edit]

Surgical treatment can be used in severe cases. In patients with progressive kyphotic deformity due to vertebral collapse, a procedure called a kyphoplasty may arrest the deformity and relieve the pain. Kyphoplasty is a minimally invasive procedure,[13] requiring only a small opening in the skin. The main goal is to return the damaged vertebra as close as possible to its original height.[14]

Complications[edit]

The risk of serious complications from spinal fusion surgery for kyphosis is estimated to be 5%, similar to the risks of surgery for scoliosis. Possible complications may be inflammation of the soft tissue or deep inflammatory processes, breathing impairments, bleeding, and nerve injuries. According to the latest evidence, the actual rate of complications may be substantially higher. Even among those who do not suffer serious complications, 5% of patients require re-operation within five years of the procedure, and in general it is not yet clear what to expect from spine surgery in the long-term.[15][16] Taking into account that signs and symptoms of spinal deformity cannot be changed by surgical intervention, surgery remains to be a cosmetic indication.[15][17] Unfortunately, the cosmetic effects of surgery are not necessarily stable.[15]

People[edit]

See also[edit]

References[edit]

  1. ^ Fon GT, Pitt MJ, Thies AC. Thoracic kyphosis:range in normal subjects. Am J Roentgenol. 1980;134: 979–983
  2. ^ Voutsinas SA, MacEwan GD. Sagittal profiles of the spine. Clin Orthop. 1986;210:235–242.
  3. ^ http://www.srs.org/patient_and_family/kyphosis/
  4. ^ Annals of Human Biology, Volume 1, Number 3 / July 1974.
  5. ^ a b Kado DM, Prenovost K, Crandall C (2007). "Narrative review: hyperkyphosis in older persons". Ann. Intern. Med. 147 (5): 330–8. doi:10.7326/0003-4819-147-5-200709040-00008. PMID 17785488. 
  6. ^ Keller TS, Harrison DE, Colloca CJ, Harrison DD, Janik TJ (2003). "Prediction of osteoporotic spinal deformity". Spine 28 (5): 455–62. doi:10.1097/00007632-200303010-00009. PMID 12616157. 
  7. ^ Osteopathy: A Complete Health Care System, by Leon Chaitow N.D., D.O., M.R.O.
  8. ^ Back.com and [1] Emedicine.com
  9. ^ Natural History of Congenital Kyphosis and Kyphoscoliosis. A Study of One Hundred and Twelve Patients – MCMASTER and SINGH 81 (10): 1367 – Journal of Bone no People and Joint Surgery
  10. ^ a b c Weiss HR, Turnbull D. 2010. Kyphosis (Physical and technical rehabilitation of patients with Scheuermann's disease and kyphosis). In: JH Stone, M Blouin, editors. International Encyclopedia of Rehabilitation. Available online: http://cirrie.buffalo.edu/encyclopedia/article.php?id=125&language=en
  11. ^ Pfeifer M, Begerow B, Minne HW (2004). "Effects of a new spinal orthosis on posture, trunk strength, and quality of life in women with postmenopausal osteoporosis: a randomized trial". American journal of physical medicine & rehabilitation / Association of Academic Physiatrists 83 (3): 177–86. doi:10.1097/01.PHM.0000113403.16617.93. PMID 15043351. 
  12. ^ Lehnert-Schroth, Christa (2007). Three-Dimensional Treatment for Scoliosis: A Physiotherapeutic Method for Deformities of the Spine. (Palo Alto, CA: The Martindale Press): 185-187 and passim.
  13. ^ Kyphoplasty, Minimally invasive procedure diagrams.
  14. ^ http://www.spineuniversity.com/kyphoplasty
  15. ^ a b c Hawes M. 2006. Impact of spine surgery on signs and symptoms of spinal deformity. Pediatr Rehabil. Oct-Dec;9(4):318-39.
  16. ^ Weiss HR, Goodall D: Rate of complications in scoliosis surgery – a systematic review of the Pub Med literature. Scoliosis. 2008 Aug 5;3:9.
  17. ^ Hawes MC, O'Brien JP. 2008. A century of spine surgery: What can patients expect? Disabil Rehabil. 30(10):808-17.

External links[edit]