KYPHOSIS - Watsons Health

KYPHOSIS

  • When seen from the side, the spine has a series of normal curves that help absorb loads applied to it. The neck (cervical) and lower back (lumbar) areas have normal inward curvatures referred as “lordosis.” The upper back (thoracic) has a normal outward curvature that is termed kyphosis or the “kyphotic” curve . For purposes of this section, “kyphosis” will be used to denote abnormal kyphosis.
  • The normal spinal curvatures enable the head to be balanced directly over the pelvis. If one or more of these curves is either too great or too small, the head may not be properly balanced over the pelvis.
    • May lead to back pain, stiffness, and an altered gait or walking pattern.

Most common symptoms:

  • appearance of poor posture with a hump appearance of the back or “hunchback”
  • back painmuscle fatigue, back stiffness
    • remain fairly constant and do not progress over time

In more severe situations, progression of symptoms may be noted:

  • Progression of kyphosis – exaggeration of hunchback
    • May lead to spinal cord compression with neurologic symptoms
      • Weakness, loss of sensation, loss of bowel and bladder control
    • May lead to limitation in chest space
      • Causing shortness of breath, chest pain, eventually leading to pulmonary/heart failure

Three main types: postural kyphosis, Scheuermann’s kyphosis, and congenital kyphosis.

  • Postural kyphosis: most common
    • more common in girls than in boys
      • Noticed during adolescence
    • Due to poor posture and weakening of the muscles and ligamental structures of the back
    • The vertebrae are typically shaped normally
    • Develops slowly and usually does not continue to become progressively worse with time
    • Individuals may experience pain and muscle fatigue
    • Does not lead to a severe curve and there is little risk of neurologic, cardiac, or pulmonary problems
  • Scheuermann’s kyphosis
    • Noticed during adolescence
    • Due to a structural deformity of the vertebrae
    • It is more common to develop scoliosis (kyphoscoliosis) with this condition than with the other types of kyphosis
    • X-ray diagnosis is required to show a wedge of at least 5 degrees at the front of at least three neighboring vertebral bodies
      • Reason for this abnormal wedging of the vertebrae is not well understood
  • Congenital kyphosis: least common
    • Due to an abnormal development of the vertebrae during development prior to birth
      • Can lead to several vertebrae fusing in kyphosis

Other conditions can lead to kyphosis such as:

  • Multiple compression fractures of vertebrae – most common
    • Due to osteoporosis
  • Degenerative arthritis, ankylosing spondylitis, spine infections, spine tumors

DIAGNOSIS

Physician may do/request:

  • History & Physical Exam
  • Imaging tests
    • X-ray
    • MRI

 

RECOMMENDED MEDICATIONS

  • Postural kyphosis
    • Physical therapy for muscle strengthening and postural correction
    • Medication for pain and inflammation
    • Surgery not needed
  • Scheuermann’s kyphosis
    • Physical therapy for muscle strengthening and postural correction
    • Medication for pain and inflammation
    • Brace
      • For growing patients with curvese of at least 45 degrees
      • Not usually recommended for adults who are no longer growing
    • Surgery
      • For a curve greater than 75 degrees, uncontrolled pain, and neurologic, cardiac, or pulmonary complaints
    • Congenital kyphosis
      • Surgery when patient is still an infant
  • Kyphosis due to osteoporosis
    • Kyphoplasty – insertion of a balloon in affected vertebra and filled with methylmethacrylate for restoration of vertebral height
      • Last resort; only after failure of conservative treatment

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