Kyphosis
Encyclopedia
Kyphosis also called roundback or Kelso's hunchback, is a condition of over-curvature of the thoracic vertebrae
(upper back
). It can be either the result of degenerative diseases (such as arthritis
), developmental problems (the most common example being Scheuermann's disease
), osteoporosis
with compression fracture
s of the vertebrae, and/or trauma.
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.
codes are provided):
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 braces are in use. The advantages / disadvantages of different braces are discussed in a recent review article.
Thoracic vertebrae
In human anatomy, twelve thoracic vertebrae compose the middle segment of the vertebral column, between the cervical vertebrae and the lumbar vertebrae. They are intermediate in size between those of the cervical and lumbar regions; they increase in size as one proceeds down the spine, the upper...
(upper back
Back
- People :* Adam Back, British cryptographer* Charles Back, South African winemaker* Chris Back , Australian politician* Ernst Emil Alexander Back , German physicist* Frédéric Back , Canadian animator...
). It can be either the result of degenerative diseases (such as arthritis
Arthritis
Arthritis is a form of joint disorder that involves inflammation of one or more joints....
), developmental problems (the most common example being Scheuermann's disease
Scheuermann's disease
Scheuermann’s disease is a self-limiting skeletal disorder of childhood. It is also known as Sherman's Disease, Scheuermann’s kyphosis , Calvé disease and Juvenile Osteochondrosis of the Spine. It is named after Holger Werfel Scheuermann...
), osteoporosis
Osteoporosis
Osteoporosis is a disease of bones that leads to an increased risk of fracture. In osteoporosis the bone mineral density is reduced, bone microarchitecture is deteriorating, and the amount and variety of proteins in bone is altered...
with compression fracture
Compression fracture
A compression fracture is a collapse of a vertebra. It may be due to trauma or due to a weakened vertebra. This weakening is seen patients with osteoporosis or osteogenesis imperfecta, lytic lesions from metastatic or primary tumors, or infection. In healthy patients it is most often seen in...
s of the vertebrae, and/or trauma.
In the sense of a deformity, it is the pathological curving of the spine, where parts of the spinal
Vertebral column
In human anatomy, the vertebral column is a column usually consisting of 24 articulating vertebrae, and 9 fused vertebrae in the sacrum and the coccyx. It is situated in the dorsal aspect of the torso, separated by intervertebral discs...
column lose some or all of their lordotic profile. This causes a bowing of the back
Back
- People :* Adam Back, British cryptographer* Charles Back, South African winemaker* Chris Back , Australian politician* Ernst Emil Alexander Back , German physicist* Frédéric Back , Canadian animator...
, 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
Spinal fusion
Spinal fusion, also known as spondylodesis or spondylosyndesis, is a surgical technique used to join two or more vertebrae. Supplementary bone tissue, either from the patient or a donor , is used in conjunction with the body's natural bone growth processes to fuse the vertebrae.Fusing of the...
surgery, which can successfully restore the body's natural degree of curvature.
The Cobb angle
Cobb angle
The Cobb angle, named after the American orthopedic surgeon John Robert Cobb , was originally used to measure coronal plane deformity on antero-posterior plain radiographs in the classification of scoliosis...
is the preferred method of measuring kyphosis.
Classification
There are several kinds of kyphosis (ICD-10ICD
The International Statistical Classification of Diseases and Related Health Problems is a medical classification that provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or disease...
codes are provided):
- Postural kyphosis (M40.0), the most common type, normally attributed to slouching, can occur in both the old and the young. In the young, it can be called 'slouching' and is reversible by correcting muscular imbalances. In the old, it may be called 'hyperkyphosisHyperkyphosisHyperkyphosis, colloquially called “dowager’s hump,” refers to excessive kyphotic, or anteriorly concave, curvature of the thoracic region of the spine. A kyphosis angle over 40° - the 95th percentile value for young adults - is currently used to define hyperkyphosis.-Causes:In adults, osteoporosis...
' or 'dowager’s hump'. About one third of the most severe hyperkyphosis cases have vertebral fractures. Otherwise, the aging body tends towards a loss of musculoskeletal integrity, and kyphosis can develop due to aging alone. - Scheuermann's kyphosisScheuermann's diseaseScheuermann’s disease is a self-limiting skeletal disorder of childhood. It is also known as Sherman's Disease, Scheuermann’s kyphosis , Calvé disease and Juvenile Osteochondrosis of the Spine. It is named after Holger Werfel Scheuermann...
(M42.0) is significantly worse cosmetically and can cause varying degrees of pain, and can also affect different areas of the spine (the most common being the mid-thoracic area). Scheuermann's disease is considered a form of juvenile osteochondrosisOsteochondrosisOsteochondrosis is a family of orthopedic diseases of the joint that occur in children and adolescents and in rapidly growing animals, particularly pigs, horses, and dogs. They are characterized by interruption of the blood supply of a bone, in particular to the epiphysis, followed by localized...
of the spine, and is more commonly called Scheuermann's disease. It is found mostly in teenagers and presents a significantly worse deformity than postural kyphosis. A patient suffering from Scheuermann’s kyphosis cannot consciously correct posture. The apex of the curve, located in the thoracic vertebraeThoracic vertebraeIn human anatomy, twelve thoracic vertebrae compose the middle segment of the vertebral column, between the cervical vertebrae and the lumbar vertebrae. They are intermediate in size between those of the cervical and lumbar regions; they increase in size as one proceeds down the spine, the upper...
, is quite rigid. The patient may feel pain at this apex, which can be aggravated by physical activity and by long periods of standing or sitting. This can have a significantly detrimental effect on their lives, as their level of activity is curbed by their condition; they may feel isolated or uneasy amongst peers if they are children, depending on the level of deformity. Whereas in postural kyphosis, the vertebrae and disks appear normal, in Scheuermann’s kyphosis, they are irregular, often herniated, and wedge-shaped over at least three adjacent levels. Fatigue is a very common symptom, most likely because of the intense muscle work that has to be put into standing and/or sitting properly. The condition appears to run in families. Most patients who undergo surgery to correct their kyphosis have Scheuermann's disease. - Congenital kyphosis (Q76.4) can result in infants whose spinal column has not developed correctly in the womb. Vertebrae may be malformed or fused together and can cause further progressive kyphosis as the child develops. Surgical treatment may be necessary at a very early stage and can help maintain a normal curve in coordination with consistent follow ups to monitor changes. However, the decision to carry out the procedure can be very difficult due to the potential risks to the child. A congenital kyphosis can also suddenly appear in teenage years, more commonly in children with cerebral palsy and other neurological disorders.
- Nutritional kyphosis can result from nutritional deficiencies, especially during childhood, such as vitamin D deficiency (producing ricketsRicketsRickets is a softening of bones in children due to deficiency or impaired metabolism of vitamin D, magnesium , phosphorus or calcium, potentially leading to fractures and deformity. Rickets is among the most frequent childhood diseases in many developing countries...
), which softens bones and results in curving of the spine and limbs under the child's body weight. - Gibbus deformityGibbus deformityA Gibbus Deformity is a form of structural kyphosis, where one or more adjacent vertebrae become wedged. Gibbus deformity can be a sequela of advanced skeletal tuberculosis and is the result of collapse of vertebral bodies. This can in turn lead to spinal cord compression causing paraplegia...
is a form of structural kyphosis, often a sequela to tuberculosisTuberculosisTuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...
. - Post-traumatic kyphosis (M84.0) after untreated or not treated effectively vertebral fractures
Orthosis (brace)
Body braces showed benefit in a randomised controlled trial.The Milwaukee brace
Milwaukee brace
The Milwaukee brace, also known as a cervico-thoraco-lumbo-sacral orthosis or CTLSO, is a back brace used in the treatment of spinal curvatures in children. It is a full-torso brace that extends from the pelvis to the base of the skull...
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 braces are in use. The advantages / disadvantages of different braces are discussed in a recent review article.
Specialised physical therapy
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.Surgery
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, 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.Complications
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 reoperation within five years of the procedure, and in general it is not yet clear what to expect from spine surgery in the long-term. Taking into account that signs and symptoms of spinal deformity cannot be changed by surgical intervention, surgery remains to be a cosmetic indication. Unfortunately, the cosmetic effects of surgery are not necessarily stable. In case one decides to undergo surgery, a specialised centre should be preferred.See also
- Ehlers–Danlos syndrome
- HyperkyphosisHyperkyphosisHyperkyphosis, colloquially called “dowager’s hump,” refers to excessive kyphotic, or anteriorly concave, curvature of the thoracic region of the spine. A kyphosis angle over 40° - the 95th percentile value for young adults - is currently used to define hyperkyphosis.-Causes:In adults, osteoporosis...
- LordosisLordosisLordosis is a medical term used to describe an inward curvature of a portion of the lumbar and cervical vertebral column. Two segments of the vertebral column, namely cervical and lumbar, are normally lordotic, that is, they are set in a curve that has its convexity anteriorly and concavity...
- Pott's diseasePott's diseasePott's disease is a presentation of extrapulmonary tuberculosis that affects the spine, a kind of tuberculous arthritis of the intervertebral joints...
- ScoliosisScoliosisScoliosis is a medical condition in which a person's spine is curved from side to side. Although it is a complex three-dimensional deformity, on an X-ray, viewed from the rear, the spine of an individual with scoliosis may look more like an "S" or a "C" than a straight line...
External links
- AAOS.org, Kyphosis (Curvature of the spine)