Case Studies

Symptoms
Symptoms of kyphosis can range from unattractive posture, to pain, to severe problems of pressure on the lungs and abdomen. The pain occurs primarily in the area of the kyphosis. A severe curve can also begin to put pressure on the spinal cord and spinal nerve roots, which may cause weakness in the lower extremities. Eventually there can be pressure on the lungs and abdomen, affecting breathing and appetite.


General Overview
The mid (thoracic) spine naturally has some kyphosis or “C”-shaped curve. A kyphotic spinal deformity means there is too much forward curve in the spine resulting in a rounded or hunch/hump back appearance.

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Postural Kyphosis
Postural kyphosis-sometimes called “round back”-is the result of poor posture. This condition is most common in adolescents and young adults. Slouching when standing or sitting causes the spine to curve forward. Postural kyphosis is often accompanied by hyperlordosis of the lumbar (lower) spine. The lumbar spine naturally has a lordosis or inward curve. Hyperlordosis means the lumbar spine compensates for too much thoracic kyphosis by curving too far in the inward direction.

A postural kyphosis corrects itself when lying down on a flat surface, or when the spine is hyper-extended. There are no noticeable vertebral abnormalities on X-rays because structural damage or deformity does not cause this kyphosis. Postural kyphosis is easily corrected with education about proper posture, including some retraining on how to sit and stand correctly. Special bracing or casting is usually not necessary. Strengthening exercises for the back muscles can be helpful in correcting posture.

Scheuermann’s Kyphosis
Scheuermann’s kyphosis affects the shape of the vertebral bodies in the mid back. The front of several vertebral bodies becomes narrow. The affected bones appear wedge-shaped, producing forward rounding (kyphosis) in the thoracic spine.Researchers are unsure what causes Scheuermann’s kyphosis. Genetics appear to have a role, meaning it runs in families. Spine specialists suspect the problem may have to do with damage in the area where growth occurs in the vertebral body. Others suggest mild osteoporosis or muscle abnormalities could contribute to the deformity.

Congenital Kyphosis
Congenital kyphosis means a person is born with some sort of defect, such as incomplete formation of the spine. This can lead to a severe abnormal kyphosis. Extreme kyphosis is the most common cause of paralysis in the lower part of the body, other than trauma or infection. With congenital kyphosis, there is a strong (20-30 percent) association of congenital abnormalities with the body’s urinary collecting system. If this type of kyphosis is suspected, your doctor may suggest that you have a special X-ray that looks at the kidneys (called an IVP), an ultrasound of the kidneys, a myelogram, or an MRI. The myelogram and the MRI can show whether or not the parts of the spine have developed normally. A 3-D CT scan gives a three dimensional view of the misshapen vertebrae.

Severe congenital kyphosis deformities are usually treated surgically. Conservative treatment plans are less successful at correcting this type of kyphosis. Early surgical intervention generally produces the best results and can prevent progression of the curve. The type of surgical procedure will depend on the nature of the abnormality. If nonsurgical treatment is chosen, there is a critical need for observation and close medical follow-up to prevent possible problems later.

Paralytic Disorders
Conditions that cause paralysis can lead to kyphosis. Paralysis can be caused by disorders such as Polio, muscular dystrophy, and Cerebral Palsy (paralysis caused by trauma at birth or developmental defects in the brain). The development of kyphosis in these cases is gradual rather than sudden.

Post-Traumatic Kyphosis
Injury to the spine can lead to progressive kyphosis and nerve problems in the spine. A vertebral fracture in the thoracic or lumbar spine will almost always cause some degree of kyphosis. Post-traumatic kyphosis is sometimes treated with either bracing or surgery. The choice will depend on the severity of the condition.

Post-Surgical Kyphosis
Kyphosis can develop after spine surgery has been done to correct other problems. This usually occurs when the procedure does not heal as intended. For example, a spine fusion may not heal, and the unstable fusion may cause the spine to collapse into kyphosis. The ligaments of the spine may not heal strongly enough to support the vertebrae, and a kyphosis develops. A second operation might be needed.

Degenerative Kyphosis
There are cases of kyphosis that are caused by degeneration (wear and tear of the spine). Over time, the degenerative process can result in collapse of the intervertebral disc, changes in the shape of the vertebrae, and weakening of the ligaments that support the spine. This can result in the gradual development of a kyphosis over many years. Once the kyphosis begins to form, it gets worse because the imbalance of the forces continually increases the wear and tear.

Other Causes
Different types of systemic (whole body) diseases can cause a kyphosis to develop over time. These conditions include infection in the spine, cancer or tumors that involve the spine, and different types of systemic arthritis. These conditions affect the bones and soft tissues of the mid back and may produce kyphosis. Children with cancer sometimes need radiation treatment. Radiation of the spine in childhood can alter the strength of the spinal vertebrae, leading to kyphosis later in life.

Kyphosis Treatment

Non-surgical Treatment
Non-surgical treatments are chosen first whenever possible and commonly include medications, exercise, and certain types of braces to support the spine.

If osteoporosis is present, treatment of the condition may also slow the progression of the degenerative kyphosis. This can be accomplished in several ways. The current recommendations include increasing calcium and vitamin D intake, hormone replacement therapy, and weight-bearing exercises.

 

  • Physical Therapy
  • Adolescents and adults with kyphosis may work with a physical therapist. A well-rounded rehabilitation program assists in calming pain and inflammation, improving mobility and strength, and helping you do your daily activities with greater ease and ability.

    Exercise has not proven helpful for changing the kyphotic curve in the back. However, it can be helpful in providing pain relief. Therapy sessions may be scheduled two to three times each week for up to six weeks.

    The goals of physical therapy are to help you learn correct posture and body movements to counteract the effects of kyphosis, maintain appropriate activity levels, maximize your range of motion and strength and learn ways to manage your condition.

  • Bracing
  • Bracing is the standard treatment to control curve progression in adolescents if the patient is still growing and the curve is likely to get bigger. It is important that the patient wear the brace daily for the number of hours prescribed by the doctor.

    Sometimes an adolescent might feel self-conscious about wearing a brace. Though the brace can help the curve from getting worse, it may take some time for the patient (and caregiver) to get used to it. Adults tend to be less concerned about what their peers think, but adolescence is a time when appearance is often of great importance. Listen to the child’s concerns and look for ways to help overcome feelings about appearance.

    A spinal brace may provide some pain relief. In adults, it will not cause the spine to straighten. Once you have reached skeletal maturity, bracing is used for pain relief rather than prevention.

    Surgical Treatment
    The most common reason for kyphosis surgery is pain relief for chronic discomfort that keeps getting worse. Most cases of adult kyphosis surgeries are done to relieve severe pain. However, if the pain is manageable through conservative treatments, surgery will probably not be recommended.

    Progression of the kyphosis deformity is another reason for considering surgery. If the curvature continues to worsen, surgery may be suggested. Surgery is recommended in this situation to prevent the problems that come from severe kyphosis.

    When adult kyphosis requires surgery, doctors may choose many different procedures. Each case of kyphosis is somewhat different and may require a very specialized approach for optimal results. Surgery is suggested to solve the problems brought on by the kyphosis, not just to straighten the spine. The goals of most surgical procedures for adult kyphosis are to:

    • reduce the deformity (straighten the spine as much as possible)
    • stop the progression of the deformity
    • remove any pressure from the nerves and spinal cord
    • protect the nerves and spinal cord from further damage

    To achieve these goals, your surgeon may suggest an operation on the back of the spine, the front of the spine-or both. The goal is to first straighten the spine and then to fuse the vertebrae together into one solid bone (fusion).

    Nearly all surgeons will use some type of instrumentation metal screws, plates, or rods, in order to help straighten the spine and hold the vertebrae in place while the fusion heals and becomes solid. The screws are placed into the vertebrae. The rods or plates then attach to the screws to connect everything together. Tightened together, they form an internal brace to hold the vertebrae in alignment while the fusion heals.