Kyphosis and Posture
Kyphosis is characterized by an abnormal spinal curvature which causes a physical deformity of the thoracic spine, commonly known as hunchback. Normally the thoracic spine has a mild convexity, but an exaggeration of this convexity results in kyphosis.
Kyphosis may arise as a consequence of degenerative diseases which include traumatic injuries, osteoporotic fractures, arthritis, disc degeneration, and slipped-disc. Kyphosis mainly involves the thoracic spine, but sometimes the cervical and lumbar spine may also be affected. Kyphosis can also be caused by systemic diseases such as malignancies or infections of the spine, and specific types of systemic arthritis. Patients who underwent radiation therapy for management of malignancies in their childhood are predisposed to develop kyphosis.
Types of kyphosis
Kyphosis is categorized into the following major types:
- Postural Kyphosis
- Scheuermann’s Kyphosis
- Congenital Kyphosis
- Paralytic Disorders
- Post-Traumatic Kyphosis
- Post-Surgical Kyphosis
- Degenerative Kyphosis
The symptoms of kyphosis depend on the extent of the disorder, ranging from a slight alteration in the structure or appearance of the back to additional neurological dysfunction and long-term back pain. It may also be associated with decreased strength in the legs. Breathing may be affected due to a pressure on the lungs.
For the accurate diagnosis of the condition, a complete medical and family history is essential. This is followed by a physical examination to evaluate the movements of the spine, muscle strength and neurological function to arrive at an accurate diagnosis. Various diagnostic techniques such as X-rays, MRI and CT scans may also be performed to view the structures of the spine and evaluate the curve. The CT and MRI scans assist in detecting abnormalities of the spinal cord and nerves.
The treatment options for adult kyphosis range from conservative treatments to surgical rectification of the spine. Initially a conservative approach is preferred, which comprises of medications, exercises, supportive braces and casts to support the spine. Physical therapy and a rehabilitation program facilitate pain management and improve strength and mobility to enable the performance of daily routine activities. Physical therapy plans may be arranged 2-3 times a week and must be performed for at least six weeks.
If osteoporosis is the primary cause of kyphosis, slowing the progression of osteoporosis is recommended through the intake of vitamin D and calcium supplements, hormone replacement therapy, and regular exercises.
Spinal surgery is regarded as the final resort because of the associated risks and complications and is considered only if the advantages of the surgery prevail over the risks. The conditions in which surgery for kyphosis may be recommended include:
- Chronic pain of a high intensity
- Increase in the curvature to a more critical state
- Cosmetic purpose
The objective of surgery is to re-align the spine and fuse the vertebrae into a single bone which reduces the deformity. Specially designed plates, metallic screws and rods are employed to retain the vertebrae in position, during the fusion process.