Kyphosis refers to the physiological sagittal contour of the thoracic and sacral spine. As a pathologic entity, it is an abnormally increased convexity in the curvature of the thoracic spine.
Mild forms of kyphosis will remain asymptomatic with abnormal curvature, poor posturing, and rounding of the back. The abnormal curvature of the spine may adversely affect the morphology of the pelvic canal that may intervene during normal vaginal childbirth . Nerve compression signs will usually present with chronic low back pains, fatigue, and back stiffness among affected individuals. The pain of nerve compression are more pronounced during heavy activity and is usually relieved by rest . The involvement of the thoracic nerve roots that supply the diaphragm muscles would present clinically as difficulty in breathing.
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An 89-year-old man with vision loss in the left eye from a macula-involving retinal detachment of 4 weeks was scheduled for pars plana vitrectomy and retinal detachment repair. [ncbi.nlm.nih.gov]
Delayed Wound Healing
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Cobb angle measures degree of scoliosis Respiratory problems secondary to changes in rib-cage space Women affected more frequently than men due to postmenopausal alteration Pain and stiffness at rest/sleep Inability to sleep supine Stiffness in the spine [accessphysiotherapy.mhmedical.com]
Some people have no problems (mild threatening) but others will experience problems such as increasing curved spine, pain, neurological, heart or lung problems. [physio-pedia.com]
Face, Head & Neck
A thorough clinical history and a meticulous physical examination are needed to identify kyphosis among patients. Primary physicians may ask patients to stand upright while measuring their heights. Patients are viewed laterally while they are asked to slowly bend forward until the rounding at the upper back portion becomes eminent with kyphosis. The following tests and diagnostic methods are used to evaluate patients suffering from kyphosis:
- X-ray or chest radiograph: Plain chest X-ray at posteroanterior with lateral views are used to determine the degree of curvature and detect vertebral malformations of the spine in kyphosis .
- Computerized tomography (CT): This imaging technique will also utilize X-ray beams taken at different angles of the spine, elucidating the different soft tissue structures of the spine for a more detailed view of the vertebral structures.
- Magnetic resonance imaging (MRI): This imaging modality makes use of magnetic resonance to demonstrate a detailed view of the spinal structures. This the imaging technique of choice to elucidate spinal tumors and cancers in the spine.
- Nerve conduction studies: This neurologic conduction test determines the integrity of the spinal nerves in conducting impulses from the spine to the extremities. It is only utilized among kyphotic patients presenting with nerve compression signs.
The treatment of kyphosis is largely dependent on the extent of the curvature and the associated signs and symptoms of the disease. Over the counter pain relievers like acetaminophen, ibuprofen, and naproxen reduce the symptoms of back pain. Bone strengthening drugs like calcium carbonate and androgen may afford some relief in the impending primary osteoporotic conditions that causes the kyphosis among postmenopausal women. Patients with mild Scheuermann’s disease does not require any treatment and any interventions .
Physical therapy may control the progressive exaggeration of the back curvature and modulate pain symptoms while restoring normal mobility to carry out everyday tasks. Back bracing or orthosis is sometimes implored to support the back and prevent nerve root compression of the spine . Surgery of the spine may be indicated in severe cases of kyphosis where a spinal fusion procedure is done to bind the vertebral bodies together with the use of screws and bolts in the spine . Kyphosis caused by the destruction of the vertebral bodies from tuberculosis will benefit from the surgical fusion procedure of the spine to regain functionality .
The general outlook of patients with kyphosis due to degenerative diseases depends on the extent of the kyphosis. Spine curvature beyond 60 degrees kyphosis with nerve compression signs is associated with poorer prognosis. Corrective surgery is indicated to correct the deformity and control the pain of nerve compression. Patients with juvenile kyphosis have a better prognosis even without corrective surgery because symptoms may regress beyond the growth spurt years of adolescence.
Kyphosis occurs when there is a wedging of the upper spinal column and vertebrae. The genetic basis of inheritance for kyphosis among the juvenile cases has been extensively studied but its definitive mode of genetic transmission is still not well understood . The eminent wedging causing the exaggerated curvature can be caused by the following medical conditions:
- Degenerative bone disease: The disk in between the vertebrae can shrink and dry up with age causing an excessive curvature of the spine.
- Osteoporosis: This clinical condition is very common among postmenopausal women or in patients undergoing chronic corticosteroid therapy. The consequent thinning of the bones may result in compression fractures and the abnormal wedging of the vertebrae.
- Juvenile kyphosis: This spinal disease condition is also referred to as Scheuermann’s disease characterized by spinal kyphosis during the pubertal growth spurt period among adolescent males. Kyphosis will progressively worsen even beyond the growing years among these patients.
- Congenital spinal defects: Infants may be born with congenital spinal defects which may present as kyphosis during childhood. Congenital syndromes like Marfan syndrome and Prader-Willi syndrome can manifest as kyphosis among the afflicted children.
- Cancer and cancer treatments: Cancerous neoplasm within the spine can cause the weakening of the spinal column and cause exaggerated curvature. Chemotherapy and radiotherapy in the same way can also lead to bone softening and compression fractures in the future.
The international incidence of kyphosis may reach to as high as 8 cases per 100 people population. The relative angulation of the spine and the presence of concurrent nerve compression signs varies directly with the morbidity of the disease. In the elderly population, kyphosis is more commonly seen among osteoporotic female patients than their male counterparts. Juvenile kyphosis however, is more commonly seen among male adolescents beyond the age of 10 years old.
Kyphosis among the adult population typically presents after a direct injury to the spinal vertebrae. Degenerative diseases of the bone and arthritis may soften the intervertebral disk causing a wedging of the vertebral column at the upper spine. Traumatic injury and tumorous growths in the spine directly disrupts the integrity of the vertebral bodies causing the exaggerated curvature of the spinal column. The slippage of one or more vertebral bodies due to trauma and weight may cause the spinal condition spondylolisthesis and lead to kyphosis. In Scheuermann’s disease, an autosomal-dominant disease that causes an osteochondrosis of the secondary ossification centers during adolescence can adversely affect the lower thoracic and the upper lumbar spine .
The early active control of osteoporosis by taking daily doses of calcium and Vitamin D3 supplementations may prevent the onset of kyphosis due to degenerative bone diseases. Juvenile kyphosis must immediately be brought to medical attention to prevent the need for surgical interventions in the future. Weight management and regular exercises may strengthen the back muscles and prevent the early degeneration of the vertebras.
Kyphosis is a clinical condition characterized by the abnormal curvature of the spine commonly referred to as humpback. The abnormal curving of the spinal column can give rise to the bowing and rounding of the back which may result to a slouching posture.
Although kyphosis can occur in all age groups, it is most commonly seen among the elderly female population. The age related deformity with kyphosis is due to the cracking and compression of the spinal bones following a progressive osteoporosis. Children may present with kyphosis secondary to the wedging of the spinal bones or the congenital malformation of the spine. Severe cases of kyphosis can cause chronic pain, permanent disfigurement, and disrupt daily normal physical activities .
Patient will present with an abnormal posturing with the rounding of the spine at the upper back. Patients may complain of low back pains and difficulty of breathing when nerve compression is concurrently seen.
A detailed clinical history, physical examination, and neurological examination are needed to evaluate patients with kyphosis. Imaging studies like chest X-ray, CT-scan, and MRI may be needed to elucidate the lesion and its extent. Nerve conduction studies are implored for those with nerve compression involvements.
Treatment and follow-up
Mild symptoms of back pain are treated with common oral pain killers. Physical therapy and the use of back braces may allay the symptoms and prevent the progressive rounding of the back. Surgical spinal fusion is indicated for severe cases of kyphosis.
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