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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.
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