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Kyphosis
Classification and external resources

X-ray of a kyphosis of 70°
ICD-10 M40.0-M40.2, M42.0, Q76.4
ICD-9 732.0, 737.0, 737.1
DiseasesDB 21885
MeSH D007738

Kyphosis (Greek - kyphos, a hump), also called hunchback, is a common condition of a curvature of the upper spine. It can be either the result of degenerative diseases (such as arthritis), developmental problems, osteoporosis with compression fractures 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 back and breathing difficulties. Severe cases can cause great discomfort and even lead to death.

Contents

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 the most severe hyperkyphosis 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) 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) 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.
  • Nutritional kyphosis can result from nutritional deficiencies, especially during childhood, such as vitamin D deficiency (producing rickets) which softens bones and results in curving of the spine and limbs under the child's body weight
  • Gibbus deformity is a form of structural kyphosis, often a sequela to [[tuberculosis.

Treatments

Orthosis (brace)

Modern brace for the treatment of a thoracic kyphosis. The brace is constructed using a CAD / CAM device. At this stage this is the only CAD / CAM brace designed to treat a thoracic kyphosis. It is called kyphologic™. [7]

Body braces showed benefit in a randomized controlled trial.[8]

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. As 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.[9]

Modern brace for the treatment of a lumbar / thoracolumbar kyphosis. The brace is constructed using a CAD / CAM device. At this stage this brace is the only CAD / CAM brace designed to treat a lumbar kyphosis and is called physio-logic™ brace. Restoration of the lumbar lordosis is the major aim.[10]

Specialized 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.[11]

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. The procedure is serious and consists of fusion of the abnormal vertebrae.[12]

Complications

The risk of undergoing spinal fusion surgery for kyphosis, like in scoliosis is estimated to be 5 % . Possible complications may be inflammation of the soft tissue or deep inflammatory processes, breathing impairments, bleeding and nerve injuries. However, according to the latest evidence the rate of complications is far beyond that rate. As early as five years after surgery another 5% require reoperation and today it is not yet clear what to expect from spine surgery in the long-term.[13][14] Taking into account that signs and symptoms of spinal deformity cannot be changed by surgical intervention, surgery remains to be a cosmetic indication.[13][15] Unfortunately the cosmetic effects of surgery are not necessarily stable.[13] In case one decides to undergo surgery a specialized centre should be preferred.

References

  1. ^ Annals of Human Biology, Volume 1, Number 3 / July 1974.
  2. ^ a b Kado DM, Prenovost K, Crandall C (2007). "Narrative review: hyperkyphosis in older persons". Ann. Intern. Med. 147 (5): 330–8. PMID 17785488. http://www.annals.org/cgi/content/full/147/5/330. 
  3. ^ Keller TS, Harrison DE, Colloca CJ, Harrison DD, Janik TJ (2003). "Prediction of osteoporotic spinal deformity". Spine 28 (5): 455–62. doi:10.1097/00007632-200303010-00009. PMID 12616157. 
  4. ^ Osteopathy: A Complete Health Care System, by Leon Chaitow N.D., D.O., M.R.O.
  5. ^ Back.com and [1] Emedicine.com
  6. ^ Natural History of Congenital Kyphosis and Kyphoscoliosis. A Study of One Hundred and Twelve Patients - MCMASTER and SINGH 81 (10): 1367 - Journal of Bone and Joint Surgery
  7. ^ Weiss HR, Turnbull D. 2010. Kyphosis (Physical and technical rehabilitation of patients with Scheuermann's disease and kyphosis). In: JH Stone, M Blouin, editors. International Encyclopedia of Rehabilitation. Available online: http://cirrie.buffalo.edu/encyclopedia/article.php?id=125&language=en
  8. ^ 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. doi:10.1097/01.PHM.0000113403.16617.93. PMID 15043351. 
  9. ^ Weiss HR, Turnbull D. 2010. Kyphosis (Physical and technical rehabilitation of patients with Scheuermann's disease and kyphosis). In: JH Stone, M Blouin, editors. International Encyclopedia of Rehabilitation. Available online: http://cirrie.buffalo.edu/encyclopedia/article.php?id=125&language=en
  10. ^ Weiss HR, Turnbull D. 2010. Kyphosis (Physical and technical rehabilitation of patients with Scheuermann's disease and kyphosis). In: JH Stone, M Blouin, editors. International Encyclopedia of Rehabilitation. Available online: http://cirrie.buffalo.edu/encyclopedia/article.php?id=125&language=en
  11. ^ Lehnert-Schroth, Christa (2007). Three-Dimensional Treatment for Scoliosis: A Physiotherapeutic Method for Deformities of the Spine. (Palo Alto, CA: The Martindale Press): 185-187 and passim.
  12. ^ SpineUniversity.com
  13. ^ a b c Hawes M. 2006. Impact of spine surgery on signs and symptoms of spinal deformity. Pediatr Rehabil. Oct-Dec;9(4):318-39.
  14. ^ Weiss HR, Goodall D: Rate of complications in scoliosis surgery - a systematic review of the Pub Med literature. Scoliosis. 2008 Aug 5;3:9.
  15. ^ Hawes MC, O'Brien JP. 2008. A century of spine surgery: What can patients expect? Disabil Rehabil. 30(10):808-17.

See also

External links

  • AAOS.org, Kyphosis (Curvature of the spine)







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