Kyphosis

Alternative Names: Scheuermann’s disease; Roundback; Hunchback; Postural kyphosis

Definition:
Kyphosis is a curving of the spine that causes a bowing or rounding of the back, which leads to a hunchback or slouching posture.

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Some rounding is normal, but the term “kyphosis” usually refers to an exaggerated rounding, more than 50 degrees. This deformity is also called round back or hunchback.

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With kyphosis, your spine may look normal, or you may develop a hump. Kyphosis can occur as a result of developmental problems; degenerative diseases, such as arthritis of the spine; osteoporosis with compression fractures of the vertebrae; or trauma to the spine. It can affect all ages.

In the sense of a deformity, it is the pathological curving of the spine, where parts of the spinal column lose some or all of their lordotic profile. This causes a bowing of the back, seen as a slouching back and breathing difficulties. Severe cases can cause great discomfort and even lead to death.

Causes:

Our spine (vertebral column) is composed of bones (vertebrae), which are held together by tough, fibrous bands (ligaments). The vertebral column consists of seven neck (cervical) vertebrae, 12 middle back (thoracic) vertebrae and five lower back (lumbar) vertebrae. Lumbar vertebrae are the largest, and they carry most of your body’s weight. The sacrum, containing five fused vertebrae, is below the lumbar vertebrae. The last three tiny vertebrae, also fused together, are called the tailbone (coccyx).

Kyphosis is a forward rounding of the vertebrae in your thoracic spine. The vertebrae in your thoracic spine connect to your ribs.

Causes of kyphosis depend on the different types of kyphosis.
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Types of kyphosis in children and adolescents
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For children or adolescents, the most common types include:

*Postural kyphosis. This type mainly becomes apparent in adolescence. The onset of postural kyphosis generally is slow. It’s more common in girls. Poor posture or slouching may cause stretching of the spinal ligaments and abnormal formation of the bones of the spine (vertebrae). Postural kyphosis often is accompanied by an exaggerated inward curve (hyperlordosis) in the lower (lumbar) spine. Hyperlordosis is the body’s way of compensating for the exaggerated outward curve in the upper spine.

*Scheuermann’s kyphosis.
Like postural kyphosis, Scheuermann’s kyphosis typically appears in adolescence, often between ages 10 and 15, while the bones are still growing. Also called Scheuermann disease, it’s slightly more common in boys. Scheuermann’s kyphosis may deform the vertebrae so that they appear wedge shaped, rather than rectangular, on X-rays. There may be another finding, known as Schmorl’s nodes, on the affected vertebrae. These nodes are the result of the cushion (disk) between the vertebrae pushing through bone at the bottom and top of a vertebra (end plates).

The cause of Scheuermann’s kyphosis is unknown, but it tends to run in families. Some people with this type of kyphosis also have scoliosis, a spinal deformity that causes a side-to-side curve. Adults who developed Scheuermann’s during childhood may experience increased pain as they get older.

*Congenital kyphosis
. A malformation of the spinal column during fetal development causes kyphosis in some infants. Several vertebrae may be fused together or the bones may not form properly. This type of kyphosis may worsen as the child grows. In some cases, congenital kyphosis eventually leads to paralysis of the lower body (paraplegia).

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Causes in adults
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Disorders that may cause a curvature of the spine in adults, resulting in kyphosis, include:

*Osteoporosis,
a bone-thinning disease that’s associated with fractures of the vertebrae, which cause compression of the spine and contribute to kyphosis
*Degenerative arthritis of the spine, which can cause deterioration of the bones and disks of the spine
*Ankylosing spondylitis, an inflammatory arthritis that affects the spine and nearby joints
*Connective tissue disorders, such as Marfan syndrome, that may affect the connective tissue’s ability to hold joints in their proper position
*Tuberculosis and other infections of the spine, which can result in destruction of joints
*Cancer or benign tumors that impinge on bones of the spine and force them out of position
*Spina bifida, a birth defect in which part of the spine doesn’t form completely, and which causes defects of the spinal cord and vertebrae
*Conditions that cause paralysis, such as cerebral palsy and polio, and that stiffen the bones of the spine

Symptoms:
•Difficulty breathing (in severe cases)
•Fatigue
•Mild back pain
•Round back appearance
•Tenderness and stiffness in the spine


Diagnosis:

TestsPhysical examination by Your doctor confirms the abnormal curve of the spine. Your doctor will record a history of your condition and conduct a physical exam. The  physical  exam  may include the following:

*Forward bend tes
t. Your doctor asks you to bend forward from the waist while he or she views the spine from the side. With kyphosis, the rounding of the upper back may become more obvious in this position. In postural kyphosis, the deformity corrects itself when you lie on your back.
*Neurological functions test. Although neurological changes accompanying kyphosis are rare, your doctor may check for them by looking for weakness, changes in sensation or paralysis below the site of the kyphosis.
*Spinal imaging tests. Your doctor may take an X-ray to confirm the kyphosis, determine the degree of curvature and detect any deformity of the vertebrae, which helps identify the type of kyphosis. For example, the appearance of wedge-shaped vertebrae or other features on X-ray differentiates between postural kyphosis and Scheuermann’s kyphosis. In older adults, X-rays may show arthritic changes in the spine, which can contribute to an increase in pain. If your doctor suspects a tumor or infection, he or she may request an MRI of your spine.
*Pulmonary function tests. Your doctor may also use breathing tests to assess any breathing difficulty caused by the kyphosis.

The doctor will also look for any nervous system (neurological) changes (weakness, paralysis, or changes in sensation) below the curve.


Other tests may include:

•Spine x-ray
•Pulmonary function tests (if kyphosis affects breathing)
•MRI (if there may be a tumor, infection, or neurological symptoms)

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Treatment:

Kyphosis treatment depends on the cause of the condition and the signs and symptoms that are present.

Less serious cases

In some cases, less aggressive types of treatment are appropriate:

*Postural kyphosis. This type of kyphosis doesn’t progress and may improve on its own. Exercises to strengthen back muscles, training in using correct posture and sleeping on a firm bed may help. Pain relievers may help ease discomfort if exercise and physical therapies aren’t fully effective.
*Structural kyphosis. For kyphosis caused by spinal abnormalities, treatment typically depends on your age and sex, the severity of your symptoms and how rigid the curve in your spine is. With Scheuermann’s kyphosis, monitoring for progression of the curvature may be all that’s recommended if you have no symptoms. Anti-inflammatory medications may help relieve pain. General conditioning exercises and physical therapy may help alleviate symptoms.
*Osteoporosis-related kyphosis. Multiple compression fractures in people who have low bone density can lead to abnormal curvature of the spine. If no pain or other complications are present, treatment for the kyphosis may not be necessary. But your doctor may recommend treatment of the osteoporosis to prevent further fractures and worsening of the kyphosis.
More serious cases
More severe cases of kyphosis require more aggressive treatment. The primary approaches are bracing and, as a last resort, surgery. With children and adolescents, the sooner treatment begins, the more effective it may be in halting the deformity.

When bracing is necessary

If your teenager is still growing and has moderate to severe kyphosis, your doctor may recommend bracing. Wearing a brace may slow or prevent further progression of the curvature and may even provide some correction.

There are several types of braces for children who have kyphosis. Your doctor can help you decide which brace would be most effective for your child.

Children who wear braces usually have few restrictions and can participate in most activities. Although a brace may feel uncomfortable and awkward at first, it must be worn as prescribed to be effective. Once the bones are fully grown, your child can be weaned off the brace according to your doctor’s instructions.

There are different types of braces for treating kyphosis in adults, varying from postural training devices to rigid body jackets. The goal of bracing in adults is typically to control pain.

When surgery is necessary

Spinal surgery carries many risks, so your doctor may recommend surgery only if you or your child has any of the following:

*Severe curvature of the spine that doesn’t respond to other treatment measures
*Kyphosis that continues to worsen
*Debilitating pain that doesn’t respond to medication
*Resulting neurological problems, such as paralysis
*Kyphosis related to a tumor or infection
Surgery also may be recommended for an infant with congenital kyphosis, in order to straighten the spine.

The goal of surgery is to reduce the degree of curvature. This is commonly done by fusing or joining the affected vertebrae. Doctors typically perform the surgery through incisions in the back, during general anesthetic.

Fusing the vertebrae involves connecting two or more of them with pieces of bone taken from the pelvis. Eventually, the vertebrae fuse with the bone pieces to prevent further progression of the curvature. Doctors attach metal rods, hooks, screws or wires to the spine to hold the vertebrae together while the bones fuse, which may take several months. Doctors leave the metal in the body to help support the fused area even after the bones have fused.

A drawback of spinal fusion is that it stops growth in that area of the spine. A child’s ultimate height isn’t affected greatly because the leg bones and the unaffected portion of the spine continue to grow normally.

The complication rate for spinal surgery is relatively high. Complications include bleeding, infection, pain, nerve damage, arthritis and disk degeneration. If the surgery fails to correct the problem, a second surgery may be needed.

Other procedures
Procedures called vertebroplasty and kyphoplasty have been developed recently to treat vertebral fractures. These procedures involve injecting a type of inert cement into the affected vertebrae. They can be effective in controlling pain associated with compression .

Coping & Support:
Adolescence is a time when young people are struggling with physical and emotional changes. Having a noticeable spinal deformity or wearing a brace can make this challenging time even more difficult.

Make sure your child has caring people to turn to, including supportive family and friends, or even a professional counselor, if necessary. Consider joining a support group for parents and kids with kyphosis or other spinal deformities to help you and your child connect with others facing similar challenges.

Prognosis:
Adolescents with Scheuermann’s disease tend to do well even if they need surgery, and the disease stops once they stop growing. If the kyphosis is due to degenerative joint disease or multiple compression fractures, surgery is needed to correct the defect and improve pain.


Possible Complications

•Decreased lung capacity
•Disabling back pain
•Neurological symptoms including leg weakness or paralysis
•Round back deformity

Prevention:

Treating and preventing osteoporosis can prevent many cases of kyphosis in the elderly. Early diagnosis and bracing of Scheuermann’s disease can reduce the need for surgery, but there is no way to prevent the disease.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://en.wikipedia.org/wiki/Kyphosis
http://www.mayoclinic.com/health/kyphosis/DS00681
http://www.nlm.nih.gov/medlineplus/ency/imagepages/9561.htm
http://www.spineuniverse.com/conditions/kyphosis/kyphosis-scheuermanns-disease
http://www.nlm.nih.gov/medlineplus/ency/article/001240.htm
http://www.bbc.co.uk/health/physical_health/conditions/backcurves1.shtml

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