kyphosis

see also:

• orthopaedics in the ED
• scoliosis

• kyphosis is the excessive convex bowing of the thoracic spine causing a hunchback appearance
• it can be graded in severity by the Cobb angle taken in sagittal view ( the greatest angle at a particular region of the vertebral column, when measured from the superior endplate of a superior vertebra to the inferior endplate of an inferior vertebra)
• the normal thoracic spine has a convex bowing ranging from 20° to 45° and degrees more than this is called kyphosis or hyperkyphosis

• this can be voluntarily corrected by the person
• larger breast size is associated with a more habitually flexed posture, and greater cervical lordosis and thoracic kyphosis, upper back pain and increases compressive forces on the thoracic spine but does not seem to increase risk of vertebral fractures ¹⁾
  • mean kyphotic angle (mean value ± SD) of 47.9° ± 10.3°, with cup size B of 49.3° ± 10.5°, with cup size C of 53.9° ± 13.5° and with cup size D of 56.7° ± 10.2°. ²⁾
  • this is further exacerbated by obesity
    • obesity and breast weight increases thoracic flexion torque by 4-5x ³⁾
• can often be treated with:
  • posture re-education
  • focused strengthening exercises
  • weight reduction if over-weight
  • breast reduction is large breast size

• congenital kyphosis
  • vertebrae may be malformed or fused together and can cause further progressive kyphosis as the child develops
• childhood rickets
  • vitamin D deficiency causes softening of bones which curve under the weight of the body
• Gibbus deformity
  • a form of structural kyphosis typically found in the upper lumbar and lower thoracic vertebrae, where one or more adjacent vertebrae become wedged resulting in an especially sharp angle
  • most often develops in young children as a result of spinal tuberculosis causing collapse of vertebral bodies
  • may result in paraplegia
  • aetiology:
    • tuberculosis (TB)
    • cretinism (the childhood form of hypothyroidism)
    • mucopolysaccharidosis (MPS)
    • achondroplasia
    • Scheuermann's kyphosis may be severe enough to cause a gibbus deformity
  • a kyphosis of >70° can be an indication of the need for surgery and these surgeries can be necessary for children as young as two years old
• Scheuermann's kyphosis
  • due to adolescent Scheuermann's disease of the spine
  • the thoracic vertebrae and discs appear irregular, often herniated, and wedge-shaped over at least three adjacent levels
• post-traumatic kyphosis
  • due to untreated or ineffectively treated thoracic vertebral fractures
• pathologic fractures of vertebral spine
  • osteoporotic fractures
  • multiple myeloma
• degenerative disc disease
• Copenhagen disease
  • very rare - only 100 reports
  • progressive non-infectious anterior vertebral fusion (PAVF), is a unique spinal disorder with distinctive radiological features

• cosmetic issues and potential social isolation, depression, etc
• high degrees may cause:
  • severe pain and discomfort
  • breathing and digestion difficulties
  • cardiovascular irregularities
  • neurological compromise
• in the more severe cases, it can be debilitating and may significantly shortened life spans

• braces
• pillow under scapula region when sleeping supine
• kyphoplasty
• spinal fusion for severe cases
  • 5% severe complication rate
  • mainly for cosmetic improvement
  • 5% need repeat surgery within 5yrs