KYPHOSIS

Excessive backward convexity of the spine

2 types : round or angular kyphosis:
Round: gentle backward curvature of
spinal column; caused by diseases
affecting number of vertebrae (e.g. senile
kyphosis)

Angular: sharp backward prominence of
the spinal column; may be prominence of
one spinous process because of collapse
of only one vertebral body occurs in
compression fracture of vertebrae. Called
as a knuckle
Causes
Postural:
most common
seen in tall females due to their tendency to stand
with a forward stoop
occurs in upper dorsal spine
can be corrected by postural training and
physiotherapy

Compensatory:
Exaggerated lumbar lordosis due to some disease,
the thoracic spine develops compensatory kyphosis
Scheuermanns disease:
Common type, is a developmental disorder of the growing spine
where there is irregular ossifications
due to osteochondritis affecting ring-epiphyses of the vertebral
bodies
gentle round kyphosis in the lower thoracic spine; may occur in
the thoracolumbar region

Clinical features:
Appears in mid-thoracic vertebrae
Starts at/ shortly after puberty
Common in boys
Rounded shoulders
Complain of backache and fatigue
Examnation reveals smooth but well-marked thoracic kyphosis
which does not improve with posture

X-rays: vertebral bodies appear wedge-shaped, narrower in front


Congenital kyphosis
In some infants, the spinal column does not
develop properly while the fetus is still in the
womb. The bones may not form as they should.
Several vertebrae may be fused together. Either
of these abnormal situations may cause
progressive kyphosis as the child grows.
Surgical treatment may be needed at a very
young age. Surgery can help maintain a more
normal spinal curve. Consistent follow-up is
required to monitor any changes.
The MRI scan shows a posteriorly located
Hemivertebra causing impingement on the spinal cord.
Ankylosing spondylitis
This disease produces a stiff and kyphotic
spine
It begins in young men, as low backache
which gradually spreads to affect the whole
spine
Chest expansion is reduced because of the
limitation of movements at the costo-vertebral
joints
In few cases, hips and shoulders are also
affected
Treatment
Treatment will depend on the reason for
the deformity. Most teens with postural
kyphosis will do well throughout life. The
posture of some patients with postural
kyphosis may improve over time. An
exercise program may help relieve any
associated back pain
Non-surgical treatment
An initial program of conservative
treatment that includes exercises and anti-
inflammatory medications (for discomfort)
is recommended for patients with
Scheuermann's kyphosis. If the patient is
still growing,a brace is prescribed . The
patient typically wears the brace until
skeletal maturity is reached.
Surgical treatment
Surgery may be recommended if the
kyphotic curve exceeds 75. The goals of
surgery are:
To reduce the degree of curvature by
straightening and fusing the abnormal
spinal segments together
To maintain the improvement over time
To alleviate significant back discomfort, if
present preoperatively


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