Kyphosis

Source: Wikipedia, the free encyclopedia.
For other uses, see Kyphosis (disambiguation).
"Hunchback" redirects here. For other uses, see Hunchback (disambiguation).

Hyperkyphosis
Other namesRoundback, hunchback
Orthopedics

Kyphosis is an abnormally excessive convex curvature of the spine as it occurs in the

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

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,

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 term is from Greek κυφός kyphos, a hump.

Signs and symptoms

Kyphosis (at far right) in comparison with other vertebral column disorders, including scoliosis and lordosis

Complications

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]

Diagnosis

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[7] and the young. In the young, it can be called "slouching" and is reversible by correcting muscular imbalances. In the old, it may be a case of hyperkyphosis and called "dowager's hump". About one third of the most severe hyperkyphosis cases in older people have vertebral fractures.[8] Otherwise, the aging body does tend towards a loss of musculoskeletal integrity,[9] and hyperkyphosis can develop due to aging alone.[8][10]
  • Fatigue is a very common symptom, most likely because of the intense muscle work that has to be put into standing or sitting properly. The condition appears to run in families. Most patients who undergo surgery to correct their kyphosis have Scheuermann's disease.[citation needed
    ]
  • 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.[13] 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 the teenage years, more commonly in children with cerebral palsy and other neurological disorders.[citation needed]
  • Nutritional kyphosis can result from nutritional deficiencies, especially during childhood, such as vitamin D deficiency (producing rickets), which softens bones and results in the 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.
  • Post-traumatic kyphosis (M84.0) can arise from untreated or ineffectively treated vertebral fractures.[14]

Grading

Sagittal balance measurement[15]

Kyphosis can be graded in severity by the

C7 and the superior-posterior border of the endplate of S1 on a lateral radiograph.[15]

Treatments

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]

Brace

randomised controlled trial.[16]

The

thoracolumbar, and lumbar), different types of brace are in use, with different advantages and disadvantages.[17]

  • Modern brace for the treatment of a thoracic kyphosis. The brace is constructed using a CAD/CAM device.[17]
    Modern brace for the treatment of a thoracic kyphosis. The brace is constructed using a CAD/CAM device.[17]
  • Modern brace for the treatment of lumbar or thoracolumbar kyphosis. The brace is constructed using a CAD/CAM device. Restoration of the lumbar lordosis is the main aim.[17]
    Modern brace for the treatment of lumbar or thoracolumbar kyphosis. The brace is constructed using a CAD/CAM device. Restoration of the lumbar lordosis is the main aim.[17]

Physical therapy

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]

Surgery

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]

Society and culture

People affected by condition

Main article: List of people known as the Hunchback

Popular culture

Illustration of The Little Hunchback, a story from One Thousand and One Nights

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.

See also

References

  1. PMID 6768276
    .
  2. PMID 3757369
    .
  3. ^ "What is Kyphosis?". Your Body Posture. 14 February 2018. Retrieved 14 February 2018.
  4. ^
    S2CID 20680230
    .
  5. PMID 18681956
    .
  6. S2CID 19443315
    .
  7. PMID 4419577
    .
  8. ^
    S2CID 24505639
    .
  9. PMID 12616157
    .
  10. ^ Chaitow L. "Posture And Correct Body Use". Archived from the original on 8 February 2005.
  11. ^ "Scoliosis and Spinal Curvatures". Medtronic.
  12. ^ Nowak JE (5 December 2019). Kishner S (ed.). "Scheuermann Disease". Medscape.
  13. PMID 10535587
    .
  14. ^ "Kyphosis and Upper Crossed Syndrome". ProHealthcareProducts.
  15. ^
    PMID 26229765
    .
  16. S2CID 44930140
    .
  17. ^ a b c Weiss, Hans-Rudolf; Turnbull, Deborah (2010). "Kyphosis - Physical and technical rehabilitation of patients with Scheuermann's disease and kyphosis". International Encyclopedia of Rehabilitation. Archived from the original on 20 January 2015. Retrieved 20 February 2010.
  18. ^ Lehnert-Schroth, Christa (2007). Three-Dimensional Treatment for Scoliosis: A Physiotherapeutic Method for Deformities of the Spine. Palo Alto, CA: The Martindale Press. pp. 185–187 and passim.
  19. ^ "Kyphoplasty: Minimally invasive procedure diagrams". Brain And Spine Institute of California. Archived from the original on 30 May 2012.
  20. ^ "Kyphoplasty". Spine University. Archived from the original on 4 July 2011.
  21. ^ Paijmans, Theo. “The Monster Makers.” Fortean Times, no. 334, Dec. 2015, pp. 30–31. EBSCOhost via Wikipedia Library.
  22. JSTOR 1133105
    .

External links

Wikimedia Commons has media related to Kyphosis.
  • Kypho, definition and other related medical terms
Retrieved from "https://en.wikipedia.org/w/index.php?title=Kyphosis&oldid=1220257868"