Kyphosis

What is Kyphosis?

Kyphosis is characterised by abnormal or excessive curvature of the spine – a healthy adult spine has natural ‘S’ shaped curvature, this includes a slight curve at the neck and lower back with a gentle convex curve in the thoracic and sacral regions. The curvature is necessary, allowing space for internal organs such as the lungs and heart. However, when the curvature is excessive it causes deformity of the spine – curvature more than 45°c is usually considered excessive.

Although there are several different types of Kyphosis, the disorder is usually categorised as either postural Kyphosis (a secondary disorder) or Scheurmann’s disease (a primary disorder). Another rarer form of the disease is congenital Kyphosis. This occurs when the spine doesn’t develop properly while the infant is growing in its mother’s womb, such as in the case of Spina Bifada – the vertebrae may be malformed or even fused together, developing into Kyphosis as the child ages.

Postural Kyphosis

Poor posture during childhood such as continual slouching or carrying heavy backpacks can cause a flexible curve in the spine – this type of Kyphosis can in most cases, be corrected.

Degenerative Conditions

When Kyphosis occurs in the elderly it is often a result of degenerative diseases such as Osteoporosis or Spondylolysis, it may also be due to severely worn discs or even a fracture of one of the vertebral bodies, as result of a general loss of musculoskeletal integrity.

Vitamin Deficiencies

Nutritional deficiencies can also be a possible cause of postural kyphosis – vitamin D deficiency (rickets) can lead to softer bones which subsequently bend under the body’s weight.

Scheurmann’s Disease

A form of developmental Kyphosis which typically occurs during childhood and causes a much more severe deformity.  The healthy spine consists of rectangular vertebrae stacked upon one another, these are bound together by ligaments and muscles, and are separated by cervical discs which also act as shock absorbers.

Scheurmann’s kyphosis is characterised by wedge shaped spinal vertebrae, this occurs when the front of the spine doesn’t grow as fast as the back, causing the vertebrae to become triangular shaped and wedged together, as a result the thoracic spine curves more than usual and patients become stooped forward, exhibiting bent over posture. In some cases, the ligaments surrounding the vertebrae may be thicker than usual in individuals with Scheurmann’s, further contributing to symptoms.

Causes of Scheurmann’s Disease

The exact cause of Scheurmann’s disease is unknown, there are various possible contributory factors, as well as evidence to suggest it appears to run in families.

Symptoms

The condition typically appears during childhood or adolescence from around 10 to 16 years of age and is often mistakenly attributed to poor posture and excessive slouching.

Scheurmann’s disease is characterised by back pain, anything from mild to severe, as well as a rigid curve in the thoracic spine which gets noticeably worse when bending forward, and only partially corrects itself when in an upright standing position. In some cases a compensatory curve in the lumbar spine may develop in addition to the convex curve in the thoracic spine.

There may also be a co-existence of mild to moderate scoliosis, and in some extreme cases patients may experience a difficulty breathing due to decreased lung capacity.

Adult patients often experience tightness in the hamstrings, hip flexors and pectoral muscles as well as localised back pain.

Diagnosis of Postural Kyphosis and Scheurmann’s Disease

A physical examination and a detailed medical history will help to rule out other similar conditions. A definitive diagnosis will be confirmed with the use of X-Ray and other imaging techniques.  Excessive spinal curvature and the wedge-shaped vertebrae typical of Scheurmann’s will be visible on X-Ray – which is also useful for diagnosing other bone related conditions such as fractures and osteoporosis.  An MRI may be required to provide further detailed imaging of the spine. Blood tests may be used to eliminate the possibility of infection such as tuberculosis.

Treatment

Treatment for Kyphosis depends very much on the severity of the condition as well as the age and physical condition of the patient.

Physiotherapy

In the case of postural Kyphosis, self-corrective measures can be very effective, this may include physiotherapy methods such as hands on manipulation, exercises and stretches for strengthening and postural correction.

Bracing

In the case of a confirmed diagnosis Scheurmann’s, in which the patient hasn’t finished growing but exhibits excessive curvature, a back brace may be necessary to straighten the spine. The brace relives the pressure on the vertebrae, allowing the spinal vertebrae to grow.

The use of bracing can in some cases reverse or prevent the progression of Scheurmann’s disease and is usually used in conjunction with a specifically designed physiotherapy and exercise program.

Pain Relief Medication

Over the counter medication such as paracetamol and ibuprofen can help to relieve back pain, in more severe cases, stronger medication may be required. Pain relief medication is usually prescribed in conjunction with other treatment methods such as physiotherapy.

Surgery

Surgery is only recommended in severe cases of Scheurmann’s disease, where other treatment methods have failed to alleviate the extremely painful symptoms. Typical surgery for the correction of Scheurmann’s disease consists of fusion of the abnormal vertebrae. The surgery is usually performed in two parts – posterior and anterior; the spinal vertebrae are fused posteriorly and anteriorly with surgical implants.

Spinal surgery carries with it associated risks and possible complications, such as infection at the site of the operation, internal bleeding and accidental damage to the spinal cord potentially causing paralysis –  these risks should be weighed up against perceived benefits.

The Pain Management Clinic

Chronic pain conditions can be extremely complex, requiring a combination of different treatments in order to attain a successful outcome. The Pain Management clinic consists of a multi-disciplinary team which includes Pain Management consultants, surgeons, psychologists, physiotherapists and other health professionals. The Pain Management team provides a highly individualised treatment plan, taking into consideration the intricate interactions between the individual’s physiological, psychological and sociocultural state.

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