Kyphosis of the Spine
Kyphosis is a spinal disorder in which an excessive outward bend of the spine creates an irregular rounding of the upper back. The condition is typically called "roundback" or, in the case of a serious curve, as "hunchback." Kyphosis may occur at all age groups, but is common during adolescence. That is the reason why Kathleen Weaver of Audrain Orthopaedics is enthusiastic about ensuring that parents of Central Missouri teenagers with orthopaedic problems find out about this important information.
In most cases, kyphosis causes few issues and doesn't necessitate treatment. Occasionally, a patient might need to wear a back brace or do exercises to develop their posture and strengthen the spine. In severe circumstances, however, kyphosis may be painful, cause significant vertebral deformity, and lead to respiration problems. Patients with severe kyphosis may need surgery to help to lower the extreme spinal curve and improve their symptoms.
Your spine is comprised of three segments. When viewed from the side, these segments form three natural curves.
The "c-shaped" curves of the neck (cervical spine) and lower back (lumbar spine) are known as lordosis. The "reverse c-shaped" curve of the chest (thoracic spine) is known as kyphosis.
This natural curvature of the spine is really important for stability and helps us to stand upright. If any one of the curves becomes too large or too small, it becomes hard to stand up straight and the posture will look unnatural.
Other parts of your spine include:
- Vertebrae. The spine consists of 24 small rectangular-shaped bones, called vertebrae, which are built on top of each other. These bones create the natural curves of your back and connect to create a canal that protects the spinal cord.
- Intervertebral disks. In between the vertebrae are flexible intervertebral disks. These disks are flat and round and approximately a half-inch thick. Intervertebral disks cushion the vertebrae and act as shock absorbers when you walk or run.
Even though thoracic spine really should have a natural kyphosis between 20 to 45 degrees, postural or structural abnormalities may result in a curve that's outside this normal range. Although the medical term for a curve that's greater than normal (more than 50 degrees) is really "hyperkyphosis," the term "kyphosis" is commonly used by physicians to refer to the clinical condition of excessive curvature in the thoracic spine which leads to a rounded upper back.
Kyphosis can affect patients of all ages. The condition, nevertheless, is common during adolescence, a time period of quick bone growth.
Kyphosis can differ in seriousness. As a whole, the greater the curve, the more serious the condition. Milder curves may cause mild back pain or no symptoms whatsoever. More severe curves can cause significant spinal deformity and result in a visible hump on the patient's back.
Kinds of Kyphosis
There are lots of types of kyphosis. The three that most commonly affect children and teens are:
- Postural kyphosis
- Scheuermann's kyphosis
- Congenital kyphosis
Postural kyphosis, the most typical kind of kyphosis, normally becomes noticeable during adolescence. It is observed clinically as poor posture or slouching, but isn't related to severe structural abnormalities of the spine.
The curve caused by postural kyphosis is normally round and smooth and can often be corrected by the patient when she or he is asked to "stand up straight."
Postural kyphosis is a bit more common in girls than boys. It is seldom painful and, since the curve doesn't progress, it doesn't normally cause problems in adult life.
Scheuermann's kyphosis is named after the Danish radiologist who first described the condition.
Just like postural kyphosis, Scheuermann's kyphosis often becomes apparent in the teen years. However, Scheuermann's kyphosis may result in a significantly more severe deformity than postural kyphosis, particularly in skinny patients.
Scheuermann's kyphosis is caused by a structural irregularity within the spine. In someone with Scheuermann's kyphosis, an x-ray from the side will show that, as opposed to the normal rectangular shape, a few successive vertebrae have a more triangular shape. This irregular shape causes the vertebrae to wedge together toward the front of the spine, lowering the normal disk space and creating an exaggerated forward curvature in the upper back.
The curve caused by Scheuermann's kyphosis is typically sharp and angular. It is also stiff and rigid; unlike a patient with postural kyphosis, the patient with Scheuermann's kyphosis isn't able to correct the curve by standing up straight.
Scheuermann's kyphosis normally affects the thoracic spine, but sometimes develops in the lumbar (lower) spine. The condition is much more prevalent in boys than girls and stops progressing whenever growing is finished.
Scheuermann's kyphosis can be painful. If pain is present, it is generally felt at the highest part or "apex" of the curve. Pain might also be felt in the lower part of the back. This results when the spine attempts to make up for the rounded upper back by increasing the natural inbound curve of the lower back. Activity could make the pain worse, as can extended periods of standing or sitting.
Congenital kyphosis is found at birth. It takes place when the spinal column failed to develop normally when the little one was in utero. The bones might not form as they ought to or several vertebrae may be fused together. Congenital kyphosis ordinarily gets worse as a child ages.
People with congenital kyphosis often require surgical treatment at a really early age to stop advancement of the curve. Frequently, these patients will have additional birth defects that impact other parts of the body such as the heart and kidneys.
The symptoms of kyphosis vary, based upon the cause and severity of the curve. These could include:
- Rounded shoulders
- A visible hump on the spine
- Moderate back pain
- Spine stiffness
- Tight hamstrings (the muscles at the back of the thigh
Rarely, over time, progressive curves may lead to:
- Weakness, numbness, or tingling in the legs
- Loss of sensation
- Shortness of breath or other respiration difficulties
Mild kyphosis in Mexico, Missouri commonly goes unseen until a scoliosis screening at school and this prompts a trip to the doctor. If changes to the patient's back are evident, however, it is usually rather unpleasant for both the parents and the child. Concern about the cosmetic appearance of the youngster's back is generally what leads the family to seek medical help.
Your physician will start by taking a medical history and asking about your little one's general health and symptoms. He or she will then examine your child's back, pushing on the spine to ascertain if there are any regions of tenderness.
In more severe instances of kyphosis, the rounding of the upper back or a hump could be plainly visible. In milder cases, however, the condition may be more difficult to diagnose.
During the exam, the doctor will ask your son or daughter to bend forward with both feet together, knees straight, and arms hanging free. This test, which is called the "Adam's forward bend test," enables your doctor to better see the slope of the spine and observe any spinal deformity.
Your doctor may also ask your son or daughter to lay down to determine if this straightens the curve, a sign that the curve is flexible and might be representative of postural kyphosis.
X-rays. These studies provide pictures of dense structures, like bone. Your physician may order x-rays from different angles to figure out if there are changes in the vertebrae or any other bony irregularities.
X-rays will also help appraise the degree of the kyphotic curve. A curve that's in excess of fifty degrees is regarded as abnormal.
Pulmonary function tests. If the curve is serious, your doctor might order pulmonary function tests. These tests will help determine if your child's breathing is restricted because of reduced chest space.
Other tests. In patients with congenital kyphosis, progressive curves can result in symptoms of spinal cord compression, such as pain, tingling, numbness, or weakness in the lower body. If your little one is experiencing any of these symptoms, your doctor might order neurologic tests or a magnetic resonance imaging (MRI) scan.
The aim of treatment is to stop progression of the curve and avoid deformity. Your physician will consider numerous things when determining treatment for kyphosis, including:
- Your child's age and overall health
- The total number of remaining growing years
- The type of kyphosis
- The severity of the curve
Nonsurgical treatment is advised for people with postural kyphosis. It is also appropriate for people with Scheuermann's kyphosis who have curves of less than seventy-five degrees.
Nonsurgical treatment may include:
Observation. Your physician can recommend simply monitoring the curve to make sure it doesn't get worse. Your son or daughter may be expected to go back for periodical visits and x-rays until he or she is fully grown.
Unless the curve becomes worse or ends up being painful, no other treatment may be needed.
Physical therapy. Certain exercises can help alleviate back pain and improve posture by strengthening muscles in the abdomen and back. Certain exercises will also help stretch tight hamstrings and strengthen areas of the body which can be impacted by misalignment of the spine.
Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs, such as aspirin, ibuprofen, and naproxen, can help alleviate back pain.
Bracing. Bracing may be suited to patients with Scheuermann's kyphosis who are still growing. The particular type of brace and the number of hours a day it ought to be worn will depend upon the seriousness of the curve. Your doctor will adjust the brace regularly as the curve improves. Usually, the brace is worn until the child reaches skeletal maturity and growing is complete.
Surgery is often suggested for those with congenital kyphosis.
Surgery may also be recommended for:
- Patients with Scheuermann's kyphosis who have curves above 75 degrees
- Patients with severe back pain that doesn't improve with nonsurgical treatment
Spinal fusion is the surgery most often utilized to treat kyphosis.
The goals of spinal fusion are to:
- Reduce the degree of the curve
- Lessen any further progression
- Maintain the improvement over time
- Relieve significant back pain, if it's present
Spinal fusion is essentially a "welding" process. The basic idea is to fuse together the affected vertebrae so they heal into one single, solid bone. Fusing the vertebrae will reduce the degree of the curve and, because it eliminates motion between the affected spinal vertebrae, can also help lessen back pain.
During the procedure, the vertebrae that make up the curve are first realigned to reduce the rounding of the spine. Small pieces of bone, called bone graft, are then placed into the spaces between the vertebrae to be fused. With time, the bones grow together, similar to the way a broken bone heals.
Before the bone graft is placed, your physician will typically use metal screws, plates, and rods to increase the rate of fusion and further stabilize the spine.
Precisely how much of the spine is fused depends on the size of your child's curve. Only the curved vertebrae are fused together. The other bones in the spine can still move and assist with bending, straightening, and rotation.
If kyphosis is recognized early, nearly all patients can be treated effectively without surgery and carry on to lead active, healthy lives. If not dealt with, however, curve progression could potentially lead to trouble during adulthood. For people with kyphosis, regular check-ups are required to track the condition and check progression of the curve. If you’d like to learn more, get a hold of Audrain Orthopaedics, serving the people of Mexico, Moberly, Fulton, and Centralia, MO with kyphosis and other orthopedic problems.