Edit concept Question Editor Create issue ticket

Kyphosis

Kyphoses

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.


Presentation

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 [4]. 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 [5]. The involvement of the thoracic nerve roots that supply the diaphragm muscles would present clinically as difficulty in breathing.

Acute Abdomen
  • Spinal deformity surgeons and intensivists should be aware of this entity, and should have a high index of suspicion for it if sepsis of unknown origin, an acute abdomen, or elevated liver enzymes are encountered after surgery after correction of a kyphotic[ncbi.nlm.nih.gov]
Delayed Wound Healing
  • Abstract It is unclear whether osteoporosis itself is a main risk factor for delayed wound healing after tooth extraction in humans.[ncbi.nlm.nih.gov]
Hyperkeratosis
  • Skin histology showed hyperkeratosis, edema and increased subcutaneous fat suggestive of ichthyosis. On the basis of gross and microscopic features seen, a diagnosis of Neu-Laxova syndrome was made.[ncbi.nlm.nih.gov]
Spine Pain
  • 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]
Broad Nasal Bridge
  • The clinical problems comprised severe MR, cataracts with onset in late adolescence, kyphosis, contractures of large joints, bulbous nose with broad nasal bridge, and thick lips. Two patients also had uni- or bilateral iris coloboma.[ncbi.nlm.nih.gov]
Thick Lips
  • The clinical problems comprised severe MR, cataracts with onset in late adolescence, kyphosis, contractures of large joints, bulbous nose with broad nasal bridge, and thick lips. Two patients also had uni- or bilateral iris coloboma.[ncbi.nlm.nih.gov]
Dystonia
  • BACKGROUND CONTEXT: Acute fixed cervical kyphosis may be a rare presentation of conversion disorder, psychogenic dystonia, and potentially as a side effect from typical antipsychotic drugs. Haldol has been associated with acute dystonic reactions.[ncbi.nlm.nih.gov]
Spastic Paraplegia
  • DISCUSSION: Neurological impairment such as spastic paraplegia in children can lead to an erroneous diagnosis of cerebral palsy, resulting in unnecessary surgeries with their attendant potential complications.[ncbi.nlm.nih.gov]

Workup

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 [6].
  • 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.

Treatment

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 [7].

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 [8]. 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 [9]. Kyphosis caused by the destruction of the vertebral bodies from tuberculosis will benefit from the surgical fusion procedure of the spine to regain functionality [10].

Prognosis

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.

Etiology

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 [2]. 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.

Epidemiology

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.

Sex distribution
Age distribution

Pathophysiology

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 [3].

Prevention

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.

Summary

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 [1]. 

Patient Information

Definition

Kyphosis is the medical condition of the spine characterized by the abnormal or exaggerated rounding of the back. Severe cases will result to hunchback among elderly patients.

Cause

Kyphosis has been seen to have a genetic origin but it can also be caused by other clinical conditions like osteoporosis, trauma, spinal tumor, and other spinal deformities.

Symptoms

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.

Diagnosis

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.

References

Article

  1. Katzman WB, Huang MH, Lane NE, Ensrud KE, Kado DM. Kyphosis and decline in physical function over 15 years in older community-dwelling women: the Study of Osteoporotic Fractures. J Gerontol A Biol Sci Med Sci. 2013; 68(8):976-83 
  2. Damborg F, Engell V, Nielsen J, Kyvik KO, Andersen MØ, Thomsen K. Genetic epidemiology of Scheuermann's disease. Acta Orthop. Oct 2011; 82(5):602-5.
  3. McKenzie L, Sillence D. Familial Scheuermann disease: a genetic and linkage study. J Med Genet. Jan 1992; 29(1):41-5.
  4. Li WS, Chen ZQ, Guo ZQ, Qi Q, Zeng Y. The impact of thoracic and thoracolumbar angular kyphosis on pelvic shape and sagittal alignment. Zhonghua Wai Ke Za Zhi. 2011; 49(2):135-9 
  5. Haveman LM, van Es HW, ten Berge-Kuipers M. Complaints of back pain in childhood: find curable causes. Ned Tijdschr Geneeskd. Feb 16 2008; 152(7):353-8.
  6. Summers BN, Singh JP, Manns RA. The radiological reporting of lumbar Scheuermann's disease: an unnecessary source of confusion amongst clinicians and patients. Br J Radiol. May 2008; 81(965):383-5.
  7. de Mauroy J, Weiss H, Aulisa A, Aulisa L, Brox J, Durmala J, et al. 7th SOSORT consensus paper: conservative treatment of idiopathic & Scheuermann's kyphosis. Scoliosis. May 30 2010; 5:9.
  8. Riddle EC, Bowen JR, Shah SA, et al. The duPont kyphosis brace for the treatment of adolescent Scheuermann kyphosis. J South Orthop Assoc. 2003; 12(3):135-40.
  9. Vetrile ST, Kuleshov AA, Shvets VV, et al. Operative treatment of severe spine deformities. Vestn Ross Akad Med Nauk. 2008; 34-40.
  10. Zeng Y, Chen ZQ, Guo ZQ, Qi Q, Li WS. The posterior surgical treatment of old tuberculous kyphosis. Zhonghua Wai Ke Za Zhi. 2012; 50(1):23-7 

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!
Last updated: 2019-07-11 22:43