The spine has a series of normal curves when viewed from the side. These curves help to better absorb the loads applied to the spine from the weight of the body. The normal curves of the spine allow the head to be balanced directly over the pelvis. Kyphosis is a forward rounding of upper back. Some rounding is normal, but the term "kyphosis" usually refers to an exaggerated rounding, more than 50 degrees. When discussing about spinal deformity scoliosis refers to bending in the frontal view whereas kyphosis refers to bending of the back in the side view. This deformity is also called round back or hunchback. Kyphosis can be in the form of hyper kyphosis or sharp angular gibbus deformity. Some of the kyphotic defomities may look benign but some of the kyphotic deformities are quite dangerous and it is important that patients and attendants are aware about this.
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.
Postural round-back; the most common type, normally attributed to slouching can occur in both the old and the young. In the young, it can be called 'slouching' and is reversible by correcting muscular imbalances. The vertebrae are typically shaped normally in postural kyphosis. This type of kyphosis does not lead to a severe curve with a risk of neurologic, cardiac, or pulmonary problems.
Most frequently seen in our country. It occurs due to the damage caused by a tuberculous bacillus which infects the spinal column. They cause necrosis of the vertebral bodies and loss of structural support to the spine .This in turn leads to collapse of the spinal column and kyphotic deformity. It can be in the form of angular kyphosis. These patients need medical attention. In the acute stage it gives the patients lot of pain and spasm of the back. The formation of abscess and the dead bone can cause compression of the spinal cord leading to paralysis of the limbs. This some times needs surgical intervention along with chemotherapy with anti tuberculosis drugs. Especially in children even if tuberculosis spine heals well it can lead to gradual progression of the deformity even after the control and healing of the primary disease. This is because of the growth disturbance between the anterior and posterior aspects of the spinal column leading to progression of the deformity It may lead to late onset paraplegia, even though the tuberculous disease is cured.
Scheuermann's Disease Scheuermann's Disease is juvenile (adolescent) thoracic kyphosis. Although the cause is unknown, it may be familial. 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.
Congenital means the disorder is found at birth. Can results in infants whose spinal column has not developed correctly in the womb. Vertebrae may be malformed or joined together and can cause further progressive deformity as the child develops. Some times these can occur due to complex neuromuscular problems like, fractures of spine, Osteoporosis and Other miscellaneous conditions leading to kyphosis Kyphosis secondary to trauma, tumors, infection, and arthritis : Senile kyphosis occurs in elderly people due to multiple osteoporotic wedge compression fractures.
Kyphosis occurring in Ankylosing spondylitis needs special mention. These patients develop a stiff back along with kyphosis, making their lives miserable. Because of the forward bending patients will not be able to look forwards while walking. Surgical correction of the deformity in these patients will give dramatic results.
If somebody has kyphosis, the easiest-to-recognize symptom is a rounded back or abnormal prominence of the back. The extreme curve in upper spine will cause hunch back deformity. The severe deformity may lead to the rib cage pressing over the lung causing respiratory problems. Reduced lung function may lead to difficulty in breathing
In severe cases as a result of pressure over spinal cord develop tightness in lower limbs, weakness in lower limbs, and difficulty in walking, parasthesia or urinary problems. Rarely they may develop complete paraplegia.
Most cases of kyphosis are caused by postural changes and rarely progress to cause serious complications. However any patient that develops signs or symptoms of kyphosis should be evaluated by a doctor to rule out a more serious cause. Additionally, any patient with worsening of symptoms or who develops any weakness, numbness, or tingling in the legs or chest pain and shortness of breath should be seen by a doctor. Sometimes delay may lead to unfortunate neurological deficits in the patients which could be avoided.
Clinical evaluation to see the amount of deformity, any neurological involvement and any associated disorders. Postural kyphosis can usually be treated with physical therapy to help strengthen the muscles of your back and correct your posture. Mild pain relievers and anti inflammatory medications can also help with symptoms. These curves do not continue to worsen with time or lead to more serious complications. Surgery is not needed for postural kyphosis
brace can help control pain, and it c an slow or stop the curve's progression. A brace may help a patient avoid surgery later on. It's designed to hold the spine straight chin up, shoulders back and to take pressure off the vertebrae. There are different types of braces, and the doctor will carefully select the appropriate option for the patient. The brace will then be custom-fitted, to ensure that it fits comfortably. Wearing a brace can be hard because it may feel uncomfortable at first. It may take some time to adjust to how the brace looks and feels. 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
Surgery for abnormal kyphosis is usually the last treatment option tried. Indications for surgery in these conditions is based on:
Kyphosis can affect the spinal nerves because changes in the spine such as vertebral fractures can cause pinched nerves. You may have weakness, numbness, or tingling, and in severe cases, when surgery is recommended, you may have bowel or bladder dysfunction. Kyphosis is one condition in which neglected deformities would lead to increased morbidity in terms of progressive paralysis of the legs. By using spinal implants and instrumentation the deformity correction is achieved .Sometimes decompression is done in the presence of any deficits so as to ensure neurological recovery.. Along with spinal instrumentation and spinal fusion is done to prevent the further progression of the deformity. With latest techniques like Spinal Osteotomy and vertebral column resection technique good correction of even rigid and ugly deformities are obtained. These corrections will lead to improvement of the appearance and overall well being of the patient.
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