2 types : round or angular kyphosis: Round: gentle backward curvature of spinal column; caused by diseases affecting number of vertebrae (e.g. senile kyphosis)
Angular: sharp backward prominence of the spinal column; may be prominence of one spinous process because of collapse of only one vertebral body occurs in compression fracture of vertebrae. Called as a knuckle Causes Postural: most common seen in tall females due to their tendency to stand with a forward stoop occurs in upper dorsal spine can be corrected by postural training and physiotherapy
Compensatory: Exaggerated lumbar lordosis due to some disease, the thoracic spine develops compensatory kyphosis Scheuermanns disease: Common type, is a developmental disorder of the growing spine where there is irregular ossifications due to osteochondritis affecting ring-epiphyses of the vertebral bodies gentle round kyphosis in the lower thoracic spine; may occur in the thoracolumbar region
Clinical features: Appears in mid-thoracic vertebrae Starts at/ shortly after puberty Common in boys Rounded shoulders Complain of backache and fatigue Examnation reveals smooth but well-marked thoracic kyphosis which does not improve with posture
X-rays: vertebral bodies appear wedge-shaped, narrower in front
Congenital kyphosis In some infants, the spinal column does not develop properly while the fetus is still in the womb. The bones may not form as they should. Several vertebrae may be fused together. Either of these abnormal situations may cause progressive kyphosis as the child grows. Surgical treatment may be needed at a very young age. Surgery can help maintain a more normal spinal curve. Consistent follow-up is required to monitor any changes. The MRI scan shows a posteriorly located Hemivertebra causing impingement on the spinal cord. Ankylosing spondylitis This disease produces a stiff and kyphotic spine It begins in young men, as low backache which gradually spreads to affect the whole spine Chest expansion is reduced because of the limitation of movements at the costo-vertebral joints In few cases, hips and shoulders are also affected Treatment Treatment will depend on the reason for the deformity. Most teens with postural kyphosis will do well throughout life. The posture of some patients with postural kyphosis may improve over time. An exercise program may help relieve any associated back pain Non-surgical treatment An initial program of conservative treatment that includes exercises and anti- inflammatory medications (for discomfort) is recommended for patients with Scheuermann's kyphosis. If the patient is still growing,a brace is prescribed . The patient typically wears the brace until skeletal maturity is reached. Surgical treatment 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