Kyphosis – This is a curvature of the spine in the anteroposterior (sagittal) plane. It can be both physiological (normal) and pathological. Pathological kyphosis often develops in the thoracic region, often accompanied by back pain. With a significant curvature, compression of the nerve roots and the spinal cord with appropriate symptoms (weakness in the legs, sensitivity disorders, pelvic disorders) is possible. In especially severe cases, there may be a violation of the heart and lungs. Diagnosed on the basis of external examination and radiography. Treatment of kyphosis is generally conservative. In certain situations, an operation is shown.
Kyphosis refers to both pathological and physiological curvature of the spine in the anterior-posterior direction. Physiological kyphosis is determined in all people in the thoracic spine. About pathology speak in cases where the angle of bending is 45 degrees or more. Kyphosis can be observed both separately and in combination with scoliosis (curvature of the spine in the lateral plane). Vertebral fractures are the most common cause of the development of pathological kyphosis.
Depending on the nature of the curvature, kyphosis can be angular or arc-shaped. Angular kyphosis usually occurs with spinal tuberculosis, accompanied by the formation of a hump, shortening of the body and protrusion of the chest forward. In arcuate kyphosis, a smooth C-shaped deformation of the entire thoracic spine is observed.
Causes of Kyphosis
Pathology can occur due to intrauterine development disorders, unfavorable heredity, injuries and spinal surgery, weak back muscles with insufficient physical exertion, etc. In elderly people (especially women), kyphosis often develops as a result of abnormal compression fractures of the thoracic vertebrae. The cause of such fractures is osteoporosis – a decrease in bone density.
In addition, kyphosis can form in some infectious and non-infectious diseases: spondylitis, ankylosing spondylitis (ankylosing spondylitis) and spinal tumors. Very rarely, radiation therapy for the treatment of malignant neoplasms in childhood becomes the cause of pathological kyphosis.
Excessive curvature of the thoracic region has an adverse effect on both the anatomical structures of the spine itself and the adjacent organs. The volume of the chest and the capacity of the lungs at the maximum inhalation decrease. Insufficient oxygen supply to the blood causes disturbances on the part of the circulatory system and other systems.
The diaphragm puts more pressure on the abdominal cavity, which is why the normal functioning of the organs located there is disrupted, in particular, constipation develops. Due to the redistribution of the load intervertebral discs are affected, osteochondrosis occurs. In severe kyphosis, compression of the spinal cord and nerve roots is possible, accompanied by loss or weakening of sensitivity, muscle weakness, and disorders of the pelvic organs.
Taking into account the cause of occurrence in orthopedics and traumatology, the following types of pathological kyphosis are distinguished:
- functional kyphosis (stoop);
- dorsal juvenile kyphosis (develops in Scheuermann-Mau disease);
- congenital kyphosis;
- paralytic kyphosis;
- posttraumatic kyphosis;
- degenerative kyphosis.
Taking into account the angle of curvature, normal, strengthened (with an increased angle) and straightened (with a reduced angle) kyphosis are isolated.
Enhanced kyphosis, in turn, is divided into three degrees:
- 1 degree, at which the bend angle is 35 degrees or less.
- 2 degree, at which the angle of curvature varies from 31 to 60 degrees.
- 3 degree, at which the bend angle makes 60 and more degrees.
Types of kyphosis
Functional kyphosis is a manifestation of incorrect posture. Arises due to weak development of the back muscles or a non-physiological position during study or work. In some cases, such kyphosis is due to psychological factors (usually among adolescents who are shy of their height). The body tends to compensate for an excessive bend of the thoracic spine, and therefore, with such a kyphosis, concomitant lumbar hyperlordosis often develops (an excessive bend of the lumbar region anteriorly).
Unlike other types of kyphosis, with this pathology, excessive curvature disappears when you try to straighten your back or lay on a hard flat surface. On radiographs of any anomalies are not detected. Treatment of functional kyphosis is conservative. The patient is trained to maintain the correct position while sitting, standing and walking. To strengthen the muscles of the back are assigned specially designed exercises (exercise therapy). Wearing corsets is not shown.
Dorsal youthful kyphosis
The reasons for the development of this form of kyphosis (Scheuermann-Mau disease) are not fully understood, but it is well established that a hereditary predisposition plays a certain role in its development. It is assumed that kyphosis in this case occurs either as a result of avascular necrosis (necrosis) of the switching plates (layers of hyaline cartilage between the vertebra and the intervertebral disk), or due to excessive growth of bone tissue in the vertebral bodies. There is also an assumption that kyphosis develops due to multiple vertebral microfractures due to osteoporosis.
The bodies of three or more thoracic vertebrae in Scheuermann-Mau disease are deformed, become wedge-shaped (on the lateral radiographs, they look almost triangular). Due to the change in the shape of the vertebrae kyphosis increases. Bending in the thoracic spine reaches 45-75 degrees.
In the early stages, patients usually do not make any complaints. As the kyphosis progresses and spinal curvature increases, pain in the affected part appears. Due to the concomitant deformity of the chest, the act of breathing becomes difficult with time. Cardiac abnormalities may occur. Neurological symptoms are usually absent.
The diagnosis of dorsal juvenile kyphosis is made on the basis of anamnesis, clinical and radiographic examination. In some cases, electruromyography and MRI of the spine are performed additionally. Treatment is usually conservative. Assigned to massage, physiotherapy, exercise therapy and manual therapy, sometimes – wearing a corset. The indication for surgery is a large angle of curvature (more than 75 degrees), persistent pain syndrome, as well as impaired breathing and circulation.
Congenital kyphosis is a consequence of a violation of embryonic development. Occurs when anomalies appear at the stage of vertebral formation, resulting in the formation of butterfly-like or wedge-shaped vertebrae, posterior semi-vertebrae, micro-vertebrae and
Possible as a “clean” kyphosis, in which the spine is curved only in the anterior-posterior direction, and kyphoscoliosis, accompanied by a curvature in the anterior-posterior and lateral directions. The top of the kyphotic curvature can be located at any level – from the cervicothoracic to the lumbar spine. Kyphosis in this disease is often progressive.
Often (about 13% of cases), a combination of kyphosis is observed as with other anomalies of the spinal canal (dermoid cysts, fibrous constriction, dermal sinuses, abnormal spinal roots, etc.), and with impaired development of various organs and systems (urinary, cardiac – pulmonary and limbs, abdominal and chest wall). Usually, the curvature of the spine is accompanied by neurological disorders.
Radiography (survey and target images in various projections), CT and MRI are used as additional research methods. A radiopaque examination of the spinal canal may be prescribed. Neurological examination is required. Conservative treatment of congenital kyphosis is ineffective. We recommend surgery in childhood to correct the pathological kyphosis, stabilize the spine and prevent its further deformation.
Paralytic kyphosis is caused by diseases accompanied by paresis and paralysis of the back muscles (cerebral palsy, polio, etc.). With cerebral palsy, there is an increase in thoracic kyphosis and an increase in its length (the bend extends to the upper part of the lumbar spine). Kyphosis can be combined with scoliosis. A gradual progression of deformity is characteristic. Treatment is usually conservative, complex, long-term.
The diagnosis is made on the basis of anamnesis, clinical and radiological examination. According to the testimony of patients sent to CT and MRI. Patients are prescribed massage, exercise therapy, physiotherapy, manual therapy. The operation is indicated for severe pain syndrome and dysfunction of organs located in the chest.
Fractures of the thoracic and lumbar vertebrae are the most common cause of the development of kyphotic deformity (about 40% of all kyphosis). The risk of kyphosis depends on the severity of the injury, disorders of the musculoskeletal system (osteoporosis, weakness of the back muscles) and adherence to medical recommendations during the treatment period. The basis for the diagnosis is the appropriate history, clinical and radiological signs of post-traumatic kyphosis.
In some cases, kyphosis is combined with neurological disorders. The treatment is mainly surgical. If there are contraindications to surgery (advanced age, severe comorbidities, etc.), conservative therapy is carried out, and a corset is prescribed.
Degenerative kyphosis occurs as a result of degenerative disorders (osteoporosis, osteochondrosis). It is more often observed at women of advanced and senile age. Often combined with previous injuries (pathological compression fractures of the vertebral bodies). Kyphosis contributes to the aggravation of degenerative changes in the spine and is progressive. The treatment is mostly conservative.
The diagnosis begins with a detailed survey and examination of the patient. A doctor (orthopedic traumatologists are engaged in the treatment of kyphosis) studies the history of the development of the disease, specifies the features of the pain syndrome, draws attention to the absence or presence of neurological disorders. Examination includes palpation of the back and neck, determination of muscle strength and skin sensitivity. The specialist examines the tendon reflexes and conducts special tests to assess the neurological status, performs auscultation of the heart and lungs.
An indispensable stage of the examination is spinal radiography, which may include both viewing direct and side images, as well as targeted radiographs in non-standard projections and with a specially selected patient position (for example, in conditions of stretching the spine).
An MRI scan may be used to detect pathology on the part of soft tissue. To assess the pathological changes on the part of the bone structures of the patient can refer to computed tomography.
Treatment is often conservative, includes exercise therapy to strengthen the muscular system of the back, massage and physiotherapy. Manual therapy is indicated for some patients. Wearing corsets is assigned primarily to reduce pain. However, the constant use of corsets in most cases is not recommended, since they themselves do not correct the posture and, moreover, can cause weakening of the back muscles with subsequent aggravation of the kyphosis.
The indication for surgery is:
- Persistent pain, which can not be eliminated by conservative methods.
- The rapid progression of kyphosis, especially – accompanied by neurological disorders, as well as impaired lung and heart function.
- Cosmetic defect that significantly reduces the patient’s quality of life and interferes with the performance of professional duties.
The purpose of the operation is to correct the angle of bending of the spine as far as possible and stop the progression of the deformity, as well as to eliminate the compression of the nerve trunks and protect them from damage in the future. Spinal surgeries are categorized as complex, large-scale interventions and are performed under general anesthesia only after a full examination of the patient. Sometimes it takes several operations to achieve the desired result.
For the fixation of the spine, various designs are used, made of inert metals (titanium, titanium nickelide). They do not cause rejection reactions and can be in the body without consequences for many years.