KYPHOSIS - Curving of the spine that causes a bowing of the back, such that the apex of the angle

points backwards leading to a hunchback or slouching posture. - a curvature of the spine measuring 45 degrees or greater on x-ray . - Also called Kelsos hunchback or roundback. TYPES OF KYPHOSIS: Postural Kyphosis - Attributed to poor posture, usually presenting a smooth curve, which can be corrected by the patient. Structural Kyphosis - Caused by an abnormality affecting the bones, intervertebral discs, nerves, ligaments, or muscles. Gibbus deformity - A form of structural kyphosis. The posterior curve presents sharply angled; the curvature is not smooth. - This deformity may result in a humpback found more prominent when bending forward. Hyperkyphosis - Used to describe excessive curvature exceeding the normal range. - Occurs in thoracic spine - Osteoporosis is a common cause in adults Scheuermanns disease - A juvenile thoracic kyphosis. - The cause is unknown. - can caused decrease intervertebral disc space and vertebral wedging resulting in an excessive curve described as stiff or rigid. ETIOLOGY Kyphosis can be caused by trauma, developmental problems, or degenerative disease. Some specific causes of kyphosis are: Infection (such as tuberculosis) Scoliosis Neurofibromatosis Connective tissue disorders Muscular dystrophy Spina bifida

Disk degeneration Certain endocrine diseases Paget's disease Polio Tumors

PATHOPHYSIOLOGY Low Calcium Smoking Menopause Sedentary Life

Metabolic bone disease

Poor absorption of nutrients Decrease in density

Bone more porus

Thinning of

Prone to Fracture

ANATOMY AND PHYSIOLOGY ` The Spinal Cord is connected to the brain and is about the diameter of a human finger. From the brain the spinal cord descends down the middle of the back and is surrounded and protected by the bony vertebral column. The spinal cord is surrounded by a clear fluid called Cerebral Spinal Fluid (CSF), that acts as a cushion to protect the delicate nerve tissues against damage from banging against the inside of the vertebrae.

Anatomy of Spine 4 curves Cervical Thoracic (20-50 degrees kyphosis) Lumbar (31-79 degrees Lordosis) Sacral LABORATORY TEST: Blood tests PHARMACOLOGICAL MANAGEMENTS: Acetaminophen detects bone fractures and different abnormalities. NSAIDS help to reduce swelling and inflammation DIAGNOSTIC PROCEDURES : Bone Scan a nuclear imaging method to evaluate any degenerative and/or arthritic changes in the joints. X-ray - X-rays of the spine will show if there are any bony abnormalities. X-rays will also help measure the degree of the kyphotic curve. A kyphotic curve that is more than 50 is considered abnormal. Magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.

Computed tomography scan (Also called a CT or CAT scan.) - a diagnostic imaging procedure that uses a combination of x-rays and that uses a combination of x-rays and computer technology to produce crosshorizontally and vertically of the body.

TREATMENT:
Orthosis (brace) The Milwaukee brace is one particular body brace that is often used to treat kyphosis in the US. Modern CAD / CAM braces are used in Europe to treat different types of kyphosis. These are much easier to wear and have better in-brace corrections than reported for the Milwaukee brace. Since there are different curve patterns (thoracic, thoracolumbar and lumbar) different types of braces are in use. The advantages / disadvantages of different braces are discussed in a recent review article.[7] Physical therapy In Germany, a standard treatment for both Scheuermann's disease and lumbar kyphosis is the Schroth method, a system of physical therapy for scoliosis and related spinal deformities CONSERVATIVE MANAGEMENT: Surgery may be recommended if the kyphotic curve exceeds 75. The goals of surgery are: To reduce the degree of curvature by straightening and fusing the abnormal spinal segments together To maintain the improvement over time To alleviate significant back discomfort, if present preoperatively Vertebroplasty and Kyphoplasty Vertebroplasty Percutaneous injection of polymethylmethacrylate (PMMA) into a fractured vertical body.

Kyphoplasty Insertion of balloon that is inflatede in vertebral body before injection of PMMA NURSING RESPONSIBILITIES: 1. 2. 3. 4. 5. 6. Teach or encourage exercise as ordered. Provide care for patients with brace Provide cast/traction care Provide care for patients with Harrington insertion Promote comfort with proper fit of brace/cast Advise the patient to rest in bed on firm mattress or with bedboards beneath mattress for support 7. Keep pillow between flexed knees while in side-lying position-minimizes strain on back muscles. 8. Avoid prolonged periods of sitting 9. Asses skin integrity and fit of brace or cast. 10. Provide positive body image with brace.

Normal Vertebrae and 2 Kyphosis