Kyphosis

Kyphosis is an anteroposterior spinal curve that causes the back to bow, commonly at the thoracic level but sometimes at the thoracolumbar or sacral level. It was once known as "roundback." The normal spine ,has a slightly convex shape, but excessive thoracic kyphosis is abnormal.

Kyphosis occurs in children and adults. Symptomatic adolescent kyphosis affects more girls than boys and is most common between ages 12 and 16.

Disk lesions (Schmorl's nodes) may develop in this disorder. These small fingers of nuclear material (from the nucleus pulposus) protrupe through the cartilage plates and into the spongy bone of the vertebral bodies. If the protrusion destroys the anterior portions of cartilage, bridges of new bone may form at the intervertebral space and cause ankylosis.

Causes

Kyphosis is either caused by bad posture (the shape of your body), or because of a structural problem in the spine.

The most common causes of kyphosis are:

• Bad posture over a long period of time, such as slouching when you stand up, which stretches your spinal ligaments and can increase the natural curvature of your spine.
• Scheuermann's disease, when the back of the vertebrae (back bones) in the upper part of your spine grows more quickly than the front. This makes each vertebrae grow into a wedge shape, causing a curve in your spine. Scheuermann's disease usually develops in young people while the bones are still growing.
• Fractures of the bones in your back, which can be caused by conditions that weaken the bones, such as osteoporosis. If the fracture is uneven, it can cause the spine to curve.

Signs and Symptoms

Signs and symptoms may include:

• Slouching posture or hunchback
• Mild back pain
• Spinal stiffness or tenderness
• Fatigue

Diagnostic tests

Adolescent kyphosis must be distinguished from tuberculosis and other inflammatory or neoplastic diseases that cause vertebral collapse. The severe pain, bone destruction, and systemic symptoms common with these diseases help to rule out a diagnosis of kyphosis.

X-ray studies may show vertebral wedging, Schmorl's nodes, irregular end plates and, possibly, a 10- to 20-degree scoliotic curve.

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 correct the spinal curve until the patient stops growing.

Corrective exercises include pelvic tilt to decrease lumbar lordosis, hamstring stretch to overcome muscle contractures, and thoracic hyperextension to flatten the kyphotic curve. Exercises may be performed with or without the brace. Lateral X-rays (every 4 months) can be used to evaluate the success of correction. Gradual weaning from the brace can begin after the spine reaches full skeletal maturity and X-rays demonstrate maximum curve correction and decreased vertebral wedging.

Other treatment for adolescent and adult kyphosis includes management of the underlying disease
and spinal arthrodesis to relieve symptoms. Surgery is rarely necessary unless kyphosis causes neurologic damage, a spinal curve over 60 degrees, or intractable and disabling back pain in a skeletally mature patient.

Preoperative measures may include traction. Corective surgery may involve a posterior spinal fusion (with spinal instrumentation, iliac bone grafting, and plaster casting for immobilization) or an anterior spinal fusion (followed by casting) if kyphosis produces a spinal curve greater than 70 degrees.

Prevention

Having good posture when you stand up as well as when you are sitting down can prevent postural kyphosis. Keep you back and neck straight and don't slouch.

Osteoporosis is a major cause of kyphosis. You can cut your chances of getting osteoporosis by getting regular exercise to strengthen your bones and muscles, and by eating a diet rich in calcium. For women that have gone through the menopause, hormone replacement therapy can reduce the chances of getting osteoporosis.