Normally the reverse c-shaped curve of the thoracic part of the spine helps to maintain the upright posture of the body. A curving of the spine is called kyphosis. When the curvature becomes excessive of more than 45 degrees it is called hyperkyphosis, although the term “kyphosis” usually refers to the abnormal curvature of the spine.
Causes and risk factors
Commonly kyphosis occurs during adolescence and is associated with the poor posture. This type of kyphosis is called postural. Kyphosis may also be caused by degenerative diseases such as osteoporosis, arthritis, scoliosis, and weakness of the spine muscles. Gibbus deformity is the result of tuberculosis If the person experienced severe traumatic injury to the spinal column, but hadn’t treated it effectively later is likely to develop post-traumatic kyphosis. Nutrition is crucial for the development of the bones, so the nutritional deficiencies during childhood may lead to the deformity of the bones and the spine curvature causing so-called nutritional kyphosis.
Types of kyphosis
The most common types of kyphosis are postural, congenital and Schuermann’s kyphosis.
Postural kyphosis is usually described as poor posture or slouching. This condition may be reversed by correcting muscular imbalance. This type of deformity doesn’t progress and isn’t causing any other problems except the abnormal posture. This kyphosis more frequently affects girls.
Congenital kyphosis is visible right after the birth of the child. This abnormality is the result of the disturbed development of the spinal column during the growth of the baby in the uterus. Probably the vertebrae are not formed right or are fused together. Sometimes congenital kyphosis appear during teenage years when it is associated with neurologic disorders (commonly cerebral palsy).
Scheuermann’s kyphosis is a form of spinal osteochondrosis characteristic for teenage boys. Vertebrae are of wedge shape due to the greater posterior angle than the anterior. This condition may involve different parts of the spine and causes worse deformity than the postural kyphosis. The curvature has an apex usually located in the thoracic vertebrae. This apex is quite rigid. Affected person feel discomfort and pain in this area that worsens after the long period of standing or sitting or may be provoked by the physical activity.On the x-ray the vartebrae appear herniated and deformed.
Minor and mild kyphosis usually are asymptomatic. The main problem is the changed posture. Severe cases are associated with discomfort, spine stiffness and back pain, excessive tiredness and disfiguring. The flexibility and mobility of the spine may be altered to different extent. As the deformity progresses internal organs may be involved causing breathing difficulties.
In some cases the compression of the spinal cord and spinal nerves may occur. This condition causes pain, numbness, and weakness in the lower parts of the body.
X-ray examination of the spinal column is required.
Kyphosis can be graded by the measurement of the Cobb angle. This angle is formed by the intersect of the lines drawn along the endplates on both sides of the curvature.
The sagittal balance is measured as well as the horizontal distance between the center of the vertebra C7 and the superior-posterior border of the endplate of vertebra S1 on a lateral radiograph.
Severe deformity of the spine demands pulmonary function tests to estimate the function of the lungs.
Commonly postural kyphosis is an indication for the nonsurgical treatment. Congenital kyphosis and severe Scheuermann’s kyphosis require surgical treatment.
Nonsurgical treatment includes:
– Physical therapy to strengthen the muscles of the back and alleviate the discomfort in the back, Scheuermann’s disease and lumbar kyphosis may be treated by the Schroth method;
– Posture re-education (in case of posture kyphosis);
– Body braces are especially recommended for children and teens before their skeleton stops developing. The severity of kyphosis determines the type of the brace and the number of hours per day it should be worn by the affected person;
– NSAIDs such as ibuprofen are recommended to lessen pain;
Kyphoplasty or spinal fusion (spondylodesis or spondylosyndesis) are the surgical options to correct the spinal deformity.