Kyphosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
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Kyphosis (Greek - kyphos, a hump), in general terms, is a curvature of the upper spine. It can be either the result of bad posture or a structural anomaly in the spine.
Many radiologists will detect kyphosis with a scolie or an AP-Lateral — two types of X-ray. A scolie (pictured to the right) is an X-ray taken from the rear. An AP-Lateral is taken from the side, where the X-ray machine is programmed to show the spine with high definition.
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. Symptoms of kyphosis, that may be present or not, depending on the type and extent of the deformity, include mild back pain, fatigue, appearance of round back and breathing difficulties. Severe cases can cause great discomfort and even lead to death.
Classification
There are several kinds of kyphosis (ICD-10 codes are provided):
Postural kyphosis (M40.0)
The most common type, normally attributed to slouching, can occur in both the old[1] 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 hyperkyphosis or dowager’s hump. About one third of cases have vertebral fractures.[2] Otherwise, the aging body tends towards a loss of musculoskeletal integrity[3], and kyphosis can develop due to aging alone.[4][2]
Scheuermann's kyphosis (M42.0)
Scheuermann's kyphosis is significantly worse cosmetically and can cause pain. It is considered a form of juvenile osteochondrosis 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[5]. The apex of the curve, located in the thoracic vertebrae, 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 seems to run in families.
Congenital kyphosis (Q76.4)
Congenital kyphosis 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. [6]. 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.
Treatments
Physiotherapy
Treatment for kyphosis may involve anti-inflammatory drugs as well as exercises to strengthen the abdominal and hamstring muscles. John Albert Odom, Jr., M.D. states that;
While physical therapy (PT) doesn't help in severe cases of scoliosis and kyphosis, it is still the mainstay of treatment for minor scoliosis and kyphosis, The sooner physical therapy is started, the more likely the child will not end up with a humpback. We recommend that PT be started as early as age 10. At age 15 PT is considered too late to start, at this point bracing or surgery are the two most viable treatments especially if the curve is progressive and/or is accompanied by C-spine deformity.[7]
Orthosis (brace)
Body braces showed benefit in a randomized controlled trial.[8]
Surgery
Surgical treatment can be used in severe cases. Surgical treatment also has greater risk involved than a brace, for example as in any surgery there is a risk of infection, which could be potentially serious in the current situation of multiple drug resistant bacteria such as MRSA. In patients with progressive kyphotic deformity due to vertebral collapse, a procedure called a kyphoplasty may arrest the deformity and relieve the pain. The procedure is serious and consists of fusion of the abnormal vertebrae[9].
References
- ↑ Annals of Human Biology, Volume 1, Number 3 / July 1974.
- ↑ 2.0 2.1 Kado DM, Prenovost K, Crandall C (2007). "Narrative review: hyperkyphosis in older persons". Ann. Intern. Med. 147 (5): 330–8. PMID 17785488.
- ↑ Keller TS, Harrison DE, Colloca CJ, Harrison DD, Janik TJ (2003). "Prediction of osteoporotic spinal deformity". Spine. 28 (5): 455–62. doi:10.1097/01.BRS.0000048651.92777.30. PMID 12616157.
- ↑ Osteopathy: A Complete Health Care System, by Leon Chaitow N.D., D.O., M.R.O.
- ↑ http://www.back.com/causes-developmental-scheuermann.html and http://www.emedicine.com/pmr/topic129.htm
- ↑ http://www.ejbjs.org/cgi/content/abstract/81/10/1367
- ↑ Spinal Deformities: Benefits of Early Screening and Treatment, by John Albert Odom, Jr., M.D.
- ↑ 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. PMID 15043351.
- ↑ http://www.spineuniversity.com/public/spinesub.asp?id=48
See also
External links
- Kyphosis: Description and Diagnosis
- Kyphosis bracing
- Kyphosis (Curvature of the spine)
- Scheuermann's Kyphosis (Scheuermann's Disease): Abnormal Curvature of the Spine
- Effects of a postural gymnastics programme on individuals with lumbar disk hernia
- Genetic Studies On Scheuermann's Disease
Template:Diseases of the musculoskeletal system and connective tissue Template:SIB
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