Kyphosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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 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.

Kyphosis is classified into postural, Scheuermann’s, congenital, nutritional and gibbus variety.

Osteoporosis, disk degeneration like arthritis, ankylosing spondylitis are some of the risk factors which predispose to developing kyphosis.

Complications such as inflammation of the soft tissue or deep inflammatory processes, breathing impairments, bleeding, and nerve injuries may develop with longstanding kyphosis. The prognosis depends upon the underlying cause (worst, if caused by tumors) and whether the patient has developed any complications.

The common symptoms in a patient with kyphosis include appearance of hunchback, fatigue, back pain and shortness of breath.

The kyphotic deformity may be visible on gross inspection or may require Adam’s forward bending test for the rounded curve of kyphosis to appear.

MRI is used to show the abnormality of the spine and also to identify the cause of the kyphosis.

NSAIDs are used to relieve pain in kyphosis. Ca-D is recommended in old patients with osteoporosis. Antibiotics are used in case of infectious etiology and chemotherapy is used for tumors. Correct posture is recommended and braces like the Milwaukee brace is often used to treat kyphosis. In patients with progressive kyphotic deformity due to vertebral collapse, a procedure called a kyphoplasty may arrest the deformity and relieve the pain. Appropriate posture can help prevent postural variety of kyphosis.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Kyphosis, an abnormal curvature of the spine, is classified into postural, Scheuermann’s, congenital, nutritional and gibbus types.

There are several kinds of kyphosis (ICD-10 codes are provided):

The most common type, normally attributed to slouching, can occur in both the old 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.^[1] Otherwise, the aging body tends towards a loss of musculoskeletal integrity^[2], and kyphosis can develop due to aging alone.^[3][1]

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^[4]. 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 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. ^[5]. 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.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Various diseases of the spine, the spinal cord, and the connective tissue are risk factors for developing kyphosis of the spine. Infections such as polio and tuberculosis, as well as mechanical issues such as trauma and poor posture, are also risk factors for the development of kyphosis.

The following are the risk factors which predispose to development of kyphosis-

• Osteoporosis
• Disk degeneration such as arthritis
• Ankylosing spondylitis
• Connective tissue disorders such as Marfan syndrome
• Muscular dystrophy
• Neurofibromatosis
• Paget’s disease
• Polio
• Spina tuberculosis
• Spina tumors
• Spina bifida
• Scoliosis
• Trauma
• Poor posture of teenagers

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Complications of kyphosis include; inflammation of the soft tissue or deep inflammatory processes, breathing impairments, bleeding, and nerve injuries. These complications usually occur after longstanding kyphosis. The prognosis depends upon the underlying cause, which is poor if caused by a tumor, and whether the patient has developed any complications.

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.

Prognosis of kyphosis depends on:

• Underlying causes: Prognosis of patients with kyphosis caused by tumors is poor than other causes.
• Whether the patient is accompanied with complications such as decreased lung function, disabling back pain, neurological symptoms iand round back deformity.

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