Kyphosis

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 (pictured to the right) is taken from the side, where the X-ray machine is programmed to show the spine with high definition.^{[citation needed]}

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.

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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 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. This can be due to dietary deficiency of vitamin D or lack of exposure to sunlight. Also any infectious illness in childhood which involves prolonged periods of nausea, vomiting, or poor apetite, can result in nutritional deficiency and weight loss, and loss of muscle bulk and tone, which leads to curvature of the spine. re: The posture theory

Treatments

Physiotherapy

• Physical therapy
• Chiropractic

"While physical therapy (PT) doesn't help in severe cases of scoliosis and kyphosis, it is still the mainstay of treatment for minor scoliosis and kyphosis, The sooner physical therapy is started, the more likely the child will not end up with a humpback. We recommend that PT be started as early as age 10. At age 15 PT is considered too late to start, at this point bracing or surgery are the two most viable treatments especially if the curve is progressive and/or is accompanied by C-spine deformity."^[7]

Orthosis (brace)

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

Surgery

Surgical treatment can be used in severe cases. Surgical treatment also has greater risk involved than a brace, for example as in any surgery there is a risk of infection, which could be potentially serious in the current situation of multiple drug resistant bacteria such as MRSA. 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^[9].

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.
3. ^ Keller TS, Harrison DE, Colloca CJ, Harrison DD, Janik TJ (2003). "Prediction of osteoporotic spinal deformity". Spine 28 (5): 455–62. doi:10.1097/01.BRS.0000048651.92777.30. PMID 12616157.
4. ^ Osteopathy: A Complete Health Care System, by Leon Chaitow N.D., D.O., M.R.O.
5. ^ http://www.back.com/causes-developmental-scheuermann.html and http://www.emedicine.com/pmr/topic129.htm
6. ^ http://www.ejbjs.org/cgi/content/abstract/81/10/1367
7. ^ Spinal Deformities: Benefits of Early Screening and Treatment, by John Albert Odom, Jr., M.D.
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. PMID 15043351.
9. ^ http://www.spineuniversity.com/public/spinesub.asp?id=48

See also

• Lordosis
• Kyphoscoliosis
• Scoliosis
• Pott's disease

acquired deformities of fingers and toes (Boutonniere deformity, Bunion, Hallux rigidus, Hallux varus, Hammer toe) - other acquired deformities of limbs (Valgus deformity, Varus deformity, Wrist drop, Foot drop, Flat feet, Club foot, Unequal leg length, Winged scapula)

patella (Luxating patella, Chondromalacia patellae)

synovium and tendon: Synovitis - Tenosynovitis (Stenosing tenosynovitis, Trigger finger, DeQuervain's syndrome)

bursitis (Olecranon, Prepatellar, Trochanteric)

fibroblastic (Dupuytren's contracture, Plantar fasciitis, Nodular fasciitis, Necrotizing fasciitis, Fasciitis, Fibromatosis)

enthesopathies (Iliotibial band syndrome, Achilles tendinitis, Patellar tendinitis, Golfer's elbow, Tennis elbow, Metatarsalgia, Bone spur, Tendinitis)