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Kyphosis

Definition


Disease: Kyphosis Kyphosis
Category: Bones, joints, muscles diseases

Disease Definition:

The forward rounding of the upper back is called kyphosis, round back or hunchback. Some rounding of the back is normal. But an exaggerated rounding, more than 40 to 45 degrees is referred to as kyphosis.

 

Kyphosis can affect everyone from children to adolescents to adults. Trauma to the spine, developmental problems, osteoporosis with compression fractures of the vertebrae, and degenerative diseases, such as arthritis of the spine, are some of the diseases that could end up causing kyphosis. In this condition, the spine could either look normal, or it could develop a hump.

 

Only few problems are caused by mild cases, however, pain and other problems could be caused by severe cases, which affect the lungs, nerves, in addition to other tissues and organs. Based on the cause of the curvature and its effects, treatment will be determined.

 

Work Group:


Symptoms, Causes

Symptoms:

Some of the signs and symptoms of kyphosis may include:

 

  • Fatigue
  • Mild back pain
  • Hunchback or slouching posture
  • Spinal stiffness or tenderness

 

This condition may not cause any signs or symptoms in its mild forms.

 

Causes:

The vertebral column, also known as the spine, is made up of vertebrae (bones), held together with ligaments, which are tough, fibrous bands. Seven cervical vertebrae in the neck, twelve thoracic vertebrae in the middle back and five lumbar vertebrae in the lower back make up the vertebral column. Most of the body's weight is carried by the lumbar vertebrae, which are the largest. The tailbone (coccyx) is made up of the last three tiny vertebrae, which are also fused together.

 

The forward rounding of the vertebrae in the thoracic spine is called kyphosis. The ribs are connected to the vertebrae in the thoracic spine.

 

CHILDREN AND ADOLESCENTS:

Usually, the cause of kyphosis depends on its type. Some of the common types of kyphosis in children and adolescents include:

Scheuermann kyphosis:

This type appears in adolescence while the bones are still growing, usually between the ages of 10 and 15, and is more common in boys than in girls. Also called Scheuermann disease, this type of kyphosis may deform the vertebrae so that they appear wedge shaped on X-rays, rather than rectangular. On the affected vertebrae, there could be another finding, known as Schmorl nodes. When the cushion or disks between the vertebrae push through bone at the bottom and top of a vertebra (end plates), these nodes result.
This type tends to run in families, however, its cause is still not known. In some cases, people that have this type of kyphosis also have a spinal deformity that causes a side-to-side curve, called scoliosis. As adults who developed Scheuermann during childhood grow old, they may experience increased pain.

Postural kyphosis:

This type of kyphosis, which becomes apparent in adolescence, is more common in girls than in boys. Usually, the onset of this type is slow. The abnormal formation of the vertebrae (the bones of the spine) and the stretching of the spinal ligaments could be caused by poor posture or slouching. Hyperlordosis, which is an exaggerated inward curve, in the lower (lumbar) spine usually accompanies postural kyphosis. Hyperlordosis is the body's way of compensating for the exaggerated outward curve in the upper spine.

Congenital kyphosis:

In some infants, kyphosis could be caused by a malformation of the spinal column during fetal development. The bones may not form properly, or several vertebrae may be fused together. As the child grows, this type of kyphosis may worsen. The most common cause of paraplegia, which is paralysis of the lower body, is congenital kyphosis, right after trauma and infection.

 

ADULTS:

These are some of the disorders that could cause a curvature of the spine in adults, and end up causing kyphosis:

Degenerative arthritis of the spine:

This condition could cause deterioration of the bones, as well as disks of the spine.

Osteoporosis:

Osteoporosis, which is a bone-thinning disease, is associated with fractures of the vertebrae. This contributes to kyphosis and causes compression of the spine.

Connective tissue disorders:

These disorders could affect the ability of the connective tissue to hold joints in their proper position, just like in Marfan syndrome.

Ankylosing spondylitis:

The spine and nearby joints are affected by this inflammatory arthritis.

Tuberculosis and other infections of the spine:

These conditions could cause destruction of joints.

Conditions that cause paralysis:

These include conditions that stiffen the bones of the spine, in addition to cerebral palsy and polio.

Spina bifida:

Defects of the spinal cord and vertebrae are caused by this birth defect, in which case part of the spine doesn't form completely.

Cancer or benign tumors:

These could impinge on the bones of the spine and force them out of position.

 

Complications

Complications:

These are some of the complications that could be caused by kyphosis:

Neurological signs and symptoms:

As a result of pressure on the spinal nerves, leg weakness or paralysis could be caused in some rare cases.

Body image problems:

Having a rounded back or wearing a brace to correct the condition could cause the development of a poor body image, particularly in adolescents.

Deformity:

Over time, the hump on the back may become prominent.

Breathing difficulties:

In some severe cases, the person’s ability to breathe may be inhibited when the curve causes the rib cage to press against his/her lungs.

Back pain:

In some cases, severe and disabling pain could be caused because of the misalignment of the spine.
 

Treatments:

Based on the cause of kyphosis and its signs and symptoms, treatment will be determined.

 

In less serious cases, less aggressive types of treatment are appropriate, such as:

Postural kyphosis:

This particular type of kyphosis could improve on its own, and it doesn't progress. Sleeping on a firm bed, training in using correct posture and exercises to strengthen back muscles could be beneficial. In case exercises and physical therapies are not fully effective in easing the discomfort, a person could try taking pain relievers.

Osteoporosis-related kyphosis: 

Abnormal curvature of the spine could be caused by multiple compression fractures in people who have low bone density. This type of kyphosis may not need treatment if there's no pain or other complications. However, to prevent further fractures and worsening of the kyphosis, the patient will be recommended treating the osteoporosis.

Structural kyphosis:

The treatment of kyphosis that is caused by spinal abnormalities will depend on age and sex, in addition to the severity of the symptoms and how rigid the curve in the spine is. In the case of Scheuermann kyphosis, if the person has no signs and symptoms, he/she may be recommended monitoring for progression of the curvature. To relieve the pain, anti-inflammatory medications could be taken. Symptoms could be relieved with general conditioning exercises and physical therapy.

 

MORE SERIOUS CASES:

More aggressive treatment is required for the more severe cases of kyphosis. The primary approaches include bracing, and surgery, as a last resort. The chances of halting the deformity in children and adolescents is better the sooner treatment begins.

 

BRACING:

Bracing may be recommended in case the teenager is still growing and has moderate to severe kyphosis. When a child wears a brace, further progression of the curvature will be prevented; it may even provide some correction.

 

For children with kyphosis, there are several types of braces. Parents could decide which brace will be most effective for their child with the help of a doctor.
Usually, children who wear braces can participate in most activities and have only a few restrictions. In order to be effective, a brace must be worn exactly as prescribed, despite the fact that it may feel uncomfortable and awkward at first. After the bones are fully grown, based on the doctor's instructions, the child can be weaned off the brace.

 

Controlling pain is the goal of bracing in adults. Several types of braces are available for treating kyphosis in adults, ranging from postural training devices to rigid body jackets.

 

SURGERY:

Because spinal surgery has numerous risks, the child may be recommended surgery only if he/she has any of these:

 

  • Kyphosis that continues to worsen
  • Tumor- or infection-related kyphosis
  • Severe curvature of the spine that doesn't respond to other treatment measures.
  • Paralysis, or other resulting neurological problems
  • Debilitating pain that doesn’t respond to medication

 

In order to straighten the spine in an infant with congenital kyphosis, he/she may also be recommended surgery.
Reducing the degree of the curvature is the aim of surgery, which is usually done by fusing or joining the affected vertebrae. Using general anesthetic, the surgery is generally performed through incisions in the back.

 

In order to fuse the vertebrae, two or more of them will be connected with pieces of bone taken from the pelvis. The vertebrae fuse with the bone pieces, so that further progression of the curvature is prevented. To hold the vertebrae together while the bones fuse, which could take a few months, metal rods, screws, wires or hooks may be attached to the spine. To help support the fused area even after the bones have fused, the metal is usually kept in the body.

 

One of the bad points about a spinal fusion is that it stops growth in that area of the spine. Because the leg bones and the unaffected portion of the spine continue to grow normally, a child's ultimate height isn't affected greatly.

 

There are a lot of possible complications in a spinal surgery. Arthritis, bleeding, nerve damage, disk degeneration, pain and infection are some of these possible complications. In some cases, a second surgery may be needed in case the first surgery fails to correct the problem.

 

OTHER PROCEDURES:

There are some procedures to treat vertebral fractures that have recently developed. Some of them include kyphoplasty and vertebroplasty, in which a type of inert cement is injected into the affected vertebrae. These procedures are quite effective in controlling the pain that is associated with compression fractures.
 

Prognosis:

Not available

Expert's opinion

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