Kyphosis

Kyphosis is a forward rounding of your upper back (thoracic spine). Some rounding is normal, but the term "kyphosis" usually refers to an exaggerated rounding, more than 40 to 45 degrees. This deformity is also called round back or hunchback. Kyphosis is an anteroposterior curving of the spine that causes a bowing of the back, commonly at the thoracic, but sometimes at the thoracolumbar or sacral, level.

Normally, the spine displays some convexity, but excessive thoracic kyphosis is pathologic. Kyphosis occurs in children and adults.

Causes

Congenital kyphosis is rare but usually severe, with resultant cosmetic deformity and reduced pulmonary function.

Adolescent kyphosis

Also called Scheuermann's disease,juvenile kyphosis, and vertebral epiphysitis, adolescent kyphosis is the most common form of this disorder. It may result from growth retardation or a vascular disturbance in the vertebral epiphysis (usually at the thoracic level) during periods of rapid growth, or from congenital deficiency in the thickness of the vertebral plates.

Other causes include infection, inflammation, aseptic necrosis, and disk degeneration. The subsequent stress of weight bearing on the compromised vertebrae may result in the thoracic hump often seen in adolescents with kyphosis. Symptomatic adolescent kyphosis is more prevalent in girls than in boys and occurs most often between ages 12 and 16.

Adult kyphosis

Also known as adult roundback, adult kyphosis may result from aging and associated degeneration of intervertebral disks, atrophy, and osteoporotic collapse of the vertebrae; from endocrine disorders such as hyperparathyroidism, and Cushing's disease; and from prolonged steroid therapy.

Adult kyphosis may also result from conditions such as arthritis, Paget's disease, polio, compression fracture of the thoracic vertebrae, metastatic tumor, plasma cell myeloma, or tuberculosis. In both children and adults, kyphosis may also result from poor posture.

Disk lesions called Schmorl's nodes may develop in anteroposterior curving of the spine and are localized protrusions of nuclear material through the cartilage plates and into the spongy bone of the vertebral bodies. If the anterior portions of the cartilage are destroyed, bridges of new bone may transverse the intervertebral space, causing ankylosis.

Signs and symptoms

The following are the most common symptoms of kyphosis. However, each individual may experience symptoms differently. Symptoms may include:

• difference in shoulder height
• the head bends forward compared to the rest of the body
• difference in shoulder blade height or position
• when bending forward, the height of the upper back appears higher than normal
• tight hamstrings (back thigh) muscles

The symptoms of kyphosis may resemble other spinal conditions or deformities, or may be a result of an injury or infection. Always consult your physician for a diagnosis.

Diagnosis

Physical examination reveals curvature of the thoracic spine in varying degrees of severity. X-rays may show vertebral wedging, Schmorl's nodes, irregular end plates and, possibly, mild scoliosis of 10 to 20 degrees.

Adolescent kyphosis must be distinguished from tuberculosis and other inflammatory or neoplastic diseases that cause vertebral collapse; the severe pain, bone destruction, or systemic symptoms associated with these diseases help to rule out a diagnosis of kyphosis. Other sites of bone disease, primary sites of cancer, and infection must also be evaluated, possibly by a vertebral biopsy.

Treatment

For kyphosis caused by poor posture alone, treatment may consist of therapeutic exercises, bed rest on a firm mattress (with or without traction), and a brace to straighten the kyphotic curve until spinal growth is complete.

Corrective exercises include pelvic tilts to decrease lumbar lordosis, hamstring stretches to overcome muscle contractures, and thoracic hyperextensions to flatten the kyphotic curve. These exercises may be performed in or out of the brace.

Lateral X-rays taken every 4 months evaluate correction. Gradual weaning from the brace can begin after maximum correction of the kyphotic curve, vertebral wedging has decreased, and the spine has reached full skeletal maturity. Loss of correction indicates that weaning from the brace has been too rapid, and time out of the brace is decreased accordingly.

Treatment for both adolescent and adult kyphosis also includes appropriate measures for the underlying cause and, possibly, spinal arthrodesis for relief of symptoms. Although rarely necessary, surgery may be recommended when kyphosis causes neurologic damage, a spinal curve greater than 60 degrees, or intractable and disabling back pain in a patient with full skeletal maturity. Preoperative measures may include halo-femoral traction.

Corrective surgery includes a posterior spinal fusion with spinal instrumentation, iliac bone grafting, and plaster immobilization. Anterior spinal fusion followed by immobilization in plaster may be necessary when kyphosis produces a spinal curve greater than
70 degrees.

Prevention

Preventing osteoporosis is within the grasp of modern medicine. Menopausal women must start early with estrogen replacement, calcium supplementation, and appropriate exercise . The treatment must continue through the remainder of life. Evidence suggests that a high calcium intake even during younger years delays the onset of symptomatic osteoporosis. Dairy products are the major dietary sources of calcium.