Kyphosis
Excessive convex curvature of the lower and middle spine From Wikipedia, the free encyclopedia
Excessive convex curvature of the lower and middle spine From Wikipedia, the free encyclopedia
Kyphosis (from Greek κυφός (kyphos) 'hump') is an abnormally excessive convex curvature of the spine as it occurs in the thoracic and sacral regions.[1][2] Abnormal inward concave lordotic curving of the cervical and lumbar regions of the spine is called lordosis.
| Hyperkyphosis | |
|---|---|
| Other names | Roundback, hunchback |
| |
| A preoperative image of a 22-year-old man with Scheuermann's disease, a type of structural kyphosis | |
| Specialty | Orthopedics |
It can result from degenerative disc disease; developmental abnormalities, most commonly Scheuermann's disease; Copenhagen disease, osteoporosis with compression fractures of the vertebra; multiple myeloma; or trauma.
A normal thoracic spine extends from the 1st thoracic to the 12th thoracic vertebra and should have a slight kyphotic angle, ranging from 20° to 45°. When the "roundness" of the upper spine increases past 45° it is called kyphosis or "hyperkyphosis". Scheuermann's kyphosis is the most classic form of hyperkyphosis and is the result of wedged vertebrae that develop during adolescence. The cause is not currently known and the condition appears to be multifactorial and is seen more frequently in males than females.[3]
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. Kyphosis is distinguished from scoliosis, a condition in which the spine has a sideways curve.
While most cases of kyphosis are mild and only require routine monitoring, serious cases can be debilitating. High degrees of kyphosis can cause severe pain and discomfort, breathing and digestion difficulties, cardiovascular irregularities, neurological compromise and, in the more severe cases, significantly shortened life spans. These types of high-end curves typically do not respond well to conservative treatment and almost always warrant spinal fusion surgery, which can restore the body's natural degree of curvature.
The risk of serious complications from spinal fusion surgery for kyphosis is estimated to be 5%, similar to the risks of surgery for scoliosis. Possible complications include inflammation of the soft tissue or deep inflammatory processes, breathing impairments, bleeding, and nerve injuries. According to the latest evidence, the actual rate of complications may be substantially higher. Even among those who do not develop serious complications, 5% of patients require reoperation within five years of the procedure, and in general it is not yet clear what one would expect from spine surgery during the long-term.[4][5] Given that the signs and symptoms of spinal deformity cannot be changed by surgical intervention, surgery remains essentially a cosmetic choice.[4][6] However, the cosmetic effects of surgery are not necessarily stable.[4]
There are several kinds of kyphosis (ICD-10 codes are provided):
Kyphosis can be graded in severity by the Cobb angle. Also, sagittal balance can be measured. The sagittal balance is the horizontal distance between the center of C7 and the superior-posterior border of the endplate of S1 on a lateral radiograph.[15]
A diagnosis of kyphosis is generally made through observation and measurement. Idiopathic causes, such as vertebral wedging or other abnormalities, can be confirmed through X-ray. Osteoporosis, a potential cause of kyphosis, can be confirmed with a bone density scan. Postural thoracic kyphosis can often be treated with posture reeducation and focused strengthening exercises. Idiopathic thoracic kyphosis due to vertebral wedging, fractures, or vertebral abnormalities is more difficult to manage, since assuming a correct posture may not be possible with structural changes in the vertebrae. Children who have not completed their growth may show long-lasting improvements with bracing. Exercises may be prescribed to alleviate discomfort associated with overstretched back muscles. A variety of gravity-assisted positions or gentle traction can minimize pain associated with nerve root impingement. Surgery may be recommended for severe idiopathic kyphosis.[citation needed]
Body braces showed benefit in a randomised controlled trial.[16]
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. Since there are different curve patterns (thoracic, thoracolumbar, and lumbar), different types of brace are in use, with different advantages and disadvantages.[17]
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.[18] It involves lying supine, placing a pillow under the scapular region and posteriorly stretching the cervical spine. In China, many people use spinal care mattresses to correct kyphosis while sleeping.[citation needed]
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. Kyphoplasty is a minimally invasive procedure,[19] requiring only a small opening in the skin. The main goal is to return the damaged vertebra as close as possible to its original height.[20]
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One of the most well-known and enduring depictions of kyphosis is Quasimodo, the eponymous hero of Victor Hugo's 1831 novel The Hunchback of Notre-Dame, which solidified the popular conception of the hunchback as a destitute and pitiable outcast from European society. The legendary Comprachicos of the sort popularized in Hugo's similar work The Man Who Laughs are instead described as being able to turn able-bodied young children into hunchbacks, alongside a variety of other deformities, using poisons and mutilation, before selling their results into bondage as court dwarfs or freak show performers.[21][22]
Early horror films developed the hunchbacked Igor as a stock character assistant to a mad scientist.
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