What
Is Kyphosis?
Kyphosis is a progressive spinal disorder that can
affect children or adults. This disorder may cause a deformity described
as humpback or hunchback. Kyphosis can be in the form of hyperkyphosis or
sharp angular gibbus deformity (see 'Gibbus Deformity' below). Abnormal
kyphotic curves are more commonly found in the thoracic or thoracolumbar
spine, although they can be cervical.
Frequent
causes of kyphosis are:
>Postural
round-back
>Scheuermann's Disease
>Congenital
Kyphosis
>Kyphosis
associated with neuromuscular disorders
>Kyphosis
secondary to trauma, tumors, infection, and arthritis
Kyphosis in
the thoracic spine means exaggerated kyphotic angle from the spine's
normal kyphotic curve. Normal lordotic curves in the cervical and lumbar
regions may also be diminished to contribute to the overall
pitched-forward posture. The spine's natural curves position the head over
the pelvis and work as shock absorbers to distribute mechanical stress
during movement.
Postural
and Structural Kyphosis
Kyphosis
is classified as either postural or structural. Postural means the
kyphosis is attributed to poor posture, usually presenting a smooth curve,
which can be corrected by the patient. Structural kyphosis is caused by an
abnormality affecting the bones, intervertebral discs, nerves, ligaments,
or muscles. Kyphosis with a structural pathology may require medical
intervention because the patient alone cannot control curve progression.
Gibbus
Deformity
A Gibbus
Deformity is a form of structural kyphosis. The posterior (from behind)
curve presents sharply angled; the curvature is not smooth. This deformity
may result in a humpback found to be more prominent when bending forward.
Hyperkyphosis
This
term is used to describe 'excessive' (hyper) curvature exceeding the
normal range. Hyperkyphosis occurs in the thoracic spine. In adults,
osteoporosis is a common cause often involving several vertebrae.
Congenital
Congenital means the disorder is found at birth. Congenital
kyphosis is a structural abnormality.
Scheuermann's Disease
Scheuermann's Disease is juvenile (adolescent) thoracic
kyphosis. Although the cause is unknown, it may be familial. This disease
can cause decreased intervertebral disc space and vertebral wedging
resulting in an excessive curve described as stiff or rigid. The classic
definition of Scheuermann's is anterior (front) vertebral wedging of at
least 5 degrees involving three consecutive vertebrae. The neck and head
may present in an abnormal forward position. The onset usually begins (or
is noticed) between the ages of 12 and 15 years affecting females more
often than males. For many patients (up to 50%), pain is a common
complaint.
Diagnosis
Deformity and pain often motivates the patient
to visit their physician. Early treatment is important to control curve
progression especially in adolescents.
Physical
Examination
A
thorough physical examination reveals a lot about the health and general
fitness of the patient. The exam provides a baseline from which the
physician can measure the patient's progress during treatment. The
physical exam will include:
>Observation of the posture may reveal round-back or
gibbus deformity. The sagittal balance or balance of the head and trunk
over the pelvis viewing from the side can be assessed. Any associated
scoliosis will be observed.
>Adam's
Forward Bending Test requires the patient to bend forward at the waist.
This may reveal a thoracolumbar kyphosis.
>Palpation
determines spinal abnormalities by feel. Often the paraspinal musculature
is tender. When Scheuermann's Disease is present, the hamstring muscles
may be tight.
>Range of
Motion measures the degree to which a patient can perform movements of
flexion, extension, lateral bending, and spinal rotation. Asymmetry is
also noted. The deformity is palpated during range of motion to assess
flexibility or rigidity of the curve.
Neurologic Evaluation
A
neurological evaluation includes an assessment of the following symptoms:
pain, numbness, paresthesias (e.g. tingling), extremity sensation and
motor function, muscle spasm, weakness, and bowel/bladder changes.
Radiographs
Full-length AP (anterior/posterior, front/back) x-rays are
taken of the spinal column. The patient stands with arms extended forward
while keeping the head erect. To determine curve flexibility, x-rays may
be taken with the patient supine. These x-rays are used to evaluate
vertebral wedging and end plate irregularities, characteristic of
Scheuermann's Disease.
An MRI may be
ordered if the spinal cord has been compromised (or suspected). The Cobb
Angle Method measures the kyphotic curve in degrees using a standard
full-length AP x-ray.
