Kyphosis is the condition of the upper back or the thoracic vertebrae characterized by rounding or bowing of the back. The condition is also termed as round back or commonly called as a hunchback.
The human spine generally has a normal curve, particularly in the neck, upper back and the lower back. This curve however is naturally curved at an angle to help in absorbing shock during movements while also supporting the head. The curve in Kyphosis is defined at an arch which is rather excessive resulting to an over-curvature of the spine or the round back appearance of the spine.
Kyphosis can affect anyone at any age level except that it seldom occurs in newborns as Kyphosis is mostly caused by a poor posture. The normal curvature of the upper back is measured at 20 degree to 40 degree angle as measured by the Cobb angle. The abnormal Kyphosis on the other hand assumes an arch that is beyond the average degree of the arch which leads to an obvious slouching of the upper back. Most cases of Kyphosis are rather mild and lead to fewer problems. The severe case of Kyphosis can significantly affect the lungs, other organs and tissues of the body which can cause several medical problems.
Kyphosis is a condition involving the thoracic characterized by an exaggerated curvature of the upper back. This exaggerated curvature is the prominent manifestation of Kyphosis among patients and which may appear as hunchback or round back or a slouching posture. In mild cases of Kyphosis, signs and symptoms may not be noticed and may not cause discomfort to the patient although this case still requires regular monitoring for progression of thoracic curvature.
The common signs and symptoms of Kyphosis include the following:
- Presentation of slouching posture or the hunchback or round back.
- Back pain is also a common experience.
- Stiffness of the back
- Difficulty in assuming an upright position.
- Weakness of the legs and the back.
- Muscle fatigue
Severe cases of Kyphosis on the other hand have signs and symptoms associated with the affected organ and body tissues and such signs and symptoms include the following:
- A more defined over the curvature of the back.
- Possible onset of spinal cord compression due to the more exaggerated curvature of the back.
- General weakness
- Bowel and bladder incontinence.
- Numbness or loss of sensation.
- Chest pain
- Shortness of breath
- Difficulty in the digestion.
- Severe back pain
- Irregular heart beats
Kyphosis occurs when the normal and healthy structure of the spine deforms and develops a wedge like structure of the vertebrae instead of square stack columns. Kyphosis is more common in adults and rarely affects newborns while it may occur due to several reasons.
The potential causes of Kyphosis may include the following:
- Disk degeneration that usually occurs with the normal aging process or the normal wear and tear process where the disk dry out and get smaller over time or as an individual advances in age.
- Degenerative disease of the bone such as osteoporosis which can cause compression fractures.
- Age advancement especially if associated with poor posture.
- Neoplasm in the spine which can make the vertebrae more weak and potential for compression fractures.
- Birth defects or a congenital deformity such as spina bifida where an error occurred during the development of the fetus in the womb.
- Diseases and disorders of the endocrine system and of the connective tissues.
- Other diseases and disorders that can affect the spine such as infection and muscular dystrophy.
Kyphosis can be identified either as postural or structural.
Postural kyphosis is characterized by a smooth and very round hump. This type of kyphosis is caused by poor postures.
Structural kyphosis is a type of kyphosis that occurred as a result of deformity in the spine. It is further classified as primary structural kyphosis or secondary structural kyphosis. Primary structural kyphosis is a kyphosis that directly resulted and not from other diseases and disorders while secondary structural kyphosis resulted as secondary to another existing condition.
The different types of Kyphosis under the structural kyphosis include the following:
Congenital kyphosis is among the main types of Kyphosis although the rare type of Kyphosis. It is characterized by a rapid progression that can result to severe deformity. This type of Kyphosis is further classified according to the degree of anomalies and the clinical feature is usually a peak in between T10 and L1. Congenital kyphosis develops during the fetal development where a malformation or fusion of the vertebrae occurred before the child is born.
Postural kyphosis is the most common type and prevalent in girls and is usually first noticed during the age of adolescence and can occur in both the young and elderly individuals. This type of kyphosis is caused by a poor posture and a weakening ligament and muscles at the back. Postural kyphosis however develops slowly and does not worsen over time.
Scheuermann’s kyphosis is among the main types of kyphosis and is caused by a structural deformity of the vertebrae. This kyphosis is characterized by a severe curvature resulting in a cosmetic deformity and pain of varying degrees. It is regarded as a type of juvenile osteochondrosis of the spine and the apex of kyphosis is rather quite rigid. The pain is also felt at the apex of kyphosis and is aggravated by movements and long periods of inactivity. Scheuermann’s kyphosis is more prevalent among teenagers and is exhibited with an extreme deformity and affects the quality of life of the patient often causing an embarrassment. It is also potential for kyphoscoliosis which is a combination of kyphosis and scoliosis.
Gibbus deformity is a structural kyphosis secondary to tuberculosis of the thoracic vertebral body. It is characterized by sharp angulations of the vertebral columns while the hump is easily observed when the patient is bending forward. Gibbus deformity is the result of hypoplasia of one or more neighboring vertebrae and is high potential for spinal cord compression.
The initial step in diagnosing Kyphosis is through medical history taking where the physician will basically ask for any family member with similar medical problems, the time of the onset or when the signs and symptoms of the condition was first noticed.
The physical exam is the next step in assessing kyphosis in patients. Several physical tests may be done by the doctor to evaluate the deformity and such physical tests include the following:
Adam’s forward bending test
This is a test done to evaluate for any angulations and rounded curve of the thoracic which is indicative of kyphosis. In this test, the patient will be asked to bend forward up to the waist for easy examination and identification of abnormal kyphosis.
Range of motion
Range of motion is also part of the diagnostic test where a patient is asked to do a series of bend movements such as forward, sideways and backward including twisting. People with kyphosis usually have difficulties in achieving these specific movements.
Nervous system test
Nervous system test is also part of the diagnostic procedure where a patient is asked by the physician of significant pain, numbness, tingling and weakness especially in severe cases of kyphosis where other organs and body tissues are affected.
Lung function test
It is also a necessary test in determining the severity of kyphosis which may have affected the lungs and interfere with the ability of the patient to breathe.
Imaging tests are also necessary depending on the presentation of signs and symptoms and such tests include the following:
X-ray is an imaging test useful in determining the degree of angulations or curvatures. Plain x-ray can also identify unusual shapes of the vertebrae which is wedge-like in kyphosis.
CT scans or computerized tomography scan may be required if cross sectional images of the structure are necessary.
MRI or magnetic resonance imaging is usually required if there is a suspicion of nerve problem, infection and tumor growth in the spine that is contributing to the incidence of kyphosis.
Photos, Images and Pictures collection of Kyphosis…
The treatment for Kyphosis depends on the cause and the severity of the condition including the signs and symptoms presented.
Pharmacological therapy is best given to the patient suffering from pain and is also given to address the other signs and symptoms associated Kyphosis. Over-the-counter pain relievers such as acetaminophen, ibuprofen and naproxen are usually given. Prescribed pain medications are given if the pain is not responding well to over-the-counter medications and as such may be given with stronger dose.
Drugs to help strengthen the bone especially in the cases of kyphosis that resulted from osteoporosis can be given. Osteoporosis drugs are indicated to inhibit spinal fractures which can contribute or worsen Kyphosis. No medication can directly cure or treat Kyphosis but it can definitely help in relieving the symptoms to give patient comfort.
Physical therapy is useful in correcting posture and strengthening the muscles of the spine. It is also helpful in achieving flexibility and improve range of motions which have become difficulties for most patients of Kyphosis especially those with structural type of Kyphosis.
Orthosis or body brace is a treatment option for structural kyphosis such as Scheuermann’s disease while it is not necessary for postural kyphosis. The type of brace to be used depends on the pattern of the curves as there are different curves and angulations in Kyphosis.
Surgery is usually recommended for severe case of Kyphosis although this form of treatment is usually the last option and if despite conservative treatments the patient is not responding well or no improvement has been achieved. The goal of doing surgical procedure is to reduce the deformity, reduce the pain and other signs and symptoms and to prevent progression of kyphosis and to prevent further damage and deformity. Several criteria are also being considered prior to opting for surgical procedures. The severity and degree of the curve, the progression, balance and neurological symptoms are all the criteria a patient has to meet prior to the procedure.
Surgical procedures for Kyphosis are the following:
Kyphoplasty is a minimal invasive procedure that requires only a small incision in the skin to allow a passage for the bone cement injection. The goal is to relieve back pain and restore the damaged vertebrae.
Osteotomy is a procedure of reshaping the bone by cutting bone wedges to correct the curvature and angular deformity and realigning bone ends. This procedure is usually combined with spinal instrumentation and fusion to stabilize the spine while in the process of healing.
Spinal instrumentation and fusion is a procedure where two or more affected bones are permanently connected by creating an environment where the connected vertebrae will fuse together over time. This is achieved with the use of metal wires, plates and screws to hold together or connect bits of bones placed between the affected vertebrae.
Surgery is generally followed by physical therapy to carefully and steadily regain the strength, flexibility and range of motion. A physical therapist is the usual person to create a program apt for the patient who has just undergone a surgery to correct Kyphosis.