Adult Kyphosis describes a type of abnormal curve in the spine. The thoracic spine naturally possesses some kyphosis or “C” shaped curve. A kyphotic spinal deformity means an unusually large forward curve in the spine. This “C” shape occurs because of a wedge-shaped vertebrae that get rigid and get worse as the person grows. Normal vertebrae appear shaped like rectangles and stack on top of each other like a tower of blocks stacked on each other. Adult kyphosis displays varying symptoms and degrees of severity, from minor changes in the shape of your back to severe deformity, nerve problems, and chronic pain. Kyphosis usually occurs in the thoracic spine, though it can also affect the cervical and lumbar spine.
Methods of treating kyphosis have greatly improved over the past decade, and today numerous effective treatment options correct severe kyphotic deformities. Your Spine Specialist will help you determine which one is the best treatment for you and your condition.
In order to understand symptoms and treatment choices, patients should learn about mid-back anatomy. This includes becoming familiar with the various parts that make up the thoracic spine and how they work together.
A kyphotic curve normally exists in the thoracic spine. A kyphotic curve looks like the letter “C” with the opening of the C pointing towards the front. The normal curve maintains 20 to 40 degrees within the entire thoracic spine. When the curve reaches more than 40 to 45 degrees, doctors consider the spine as deformed.
Adult Kyphosis Causes
The following lists some of the causes for this condition:
- An abnormal curve can be congenital, which means the condition began at birth. Also called congenital kyphosis, this condition affects the development of the spine as a person grows.
- The deformity can also stem from a traumatic event, called Post Traumatic Kyphosis, which means trauma or injury to the spine caused the problem.
- Iatrogenic factors derive from the effects of medical treatment or surgery.
- Postural Kyphosis is one of the most common conditions, usually caused by “slouching.” Exercising with posture improvement can improve and reverse this condition.
Osteoporosis causes a good number of kyphosis cases in adults. Osteoporosis leads to major losses of bone mass, leaving the bones brittle and prone to fractures.
Symptoms of Kyphosis
A patient’s symptoms can range from cosmetic, unattractive posture to pain, to severe pain and problems of pressure on the lungs and abdomen, based on the type of kyphosis and other underlying medical conditions of the patient. The pain occurs primarily in the area of the spine where the condition occurs. 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, pressure on the lungs and abdomen can affect breathing and appetite.
In order to make a proper diagnosis and rule out other possible conditions, the patient will provide his or her health history. To do this, your doctor will want to investigate the following specific items:
- Family History – Some types of kyphosis tend to run in families, so genetics could link to the deformity cause. Your doctor will want to know about other family members with kyphosis.
- Date of Onset – When did you first notice the appearance of the spinal condition?
- Measured Curve Progression – If previous X-rays exist, the doctor will want to compare old ones with new ones — measuring the size of the curve, or measuring changes in your height.
- The Presence or Absence of Pain – Not all cases of kyphosis produce pain. If their pain exists, your doctor needs to know where, what brings it on or intensifies it, and if any radicular pain radiates away from the spine. This usually comes from irritation of the nerves as they leave the spine.
- Bowel or Bladder Dysfunction – Knowing when to urinate or make a bowel movement? This could signal the presence of pressure on the spinal cord or the nerves that go to the pelvis.
- Motor Function – Changes in how your muscles work? The case of this may be linked to pressure on the nerves or spinal cord.
- Previous Surgery – If you previously experienced any surgery on your spine, kyphosis could occur due to weakened muscles or other problems. In order to properly evaluate your condition, your physician needs to know of any previous spinal surgery.
You will then undertake a physical exam. Your doctor will want to get an understanding of the curve in your back and how it affects you. This means first trying to get a “mental picture” of the spine’s curvature from examining your back and watching you move. The doctor will look at the flexibility you have by asking you to bend in certain directions.
Your doctor will generally look for abnormalities in the following areas:
- Spine Movement – Pain when you twist, bend, or move? If so, where? Have you lost flexibility?
- Strength – The strength of your muscles will get tested. You might be asked to try to push or lift your arm, hand, or leg against resistance.
- Pain – The doctor may try to determine tenderness in certain areas.
- Sensation – Can you feel certain sensations in specific areas of your feet or hands?
- Reflexes – Your tendon reflexes might get tested, such as below the kneecap and in the Achilles tendon behind your ankle.
- Motor Skills – You might be asked to walk on your heels or toes.
- Special Signs – Your doctor will also check for any indicators of something other than spinal/vertebrae problems. Some signs of other problems include tenderness in certain areas, a fever, an abnormal pulse, chronic steroid use (leads to loss of bone mass), or rapid weight loss.
Usually, after the physical exam, X-rays will taken so your doctor can see the structure of the spine and measure the curve. You will be asked to hold very still in certain positions while standing or lying on a table. If thoracic kyphosis potentially exists, the following images may be taken:
- Front view of the entire spine taken from the front
- Lateral view of the entire spine taken from the side
- Extension view of the spine while you bending backward
Depending on the outcome of your history, physical exam, and initial X-rays, other tests may be ordered to look at specific aspects of the spine. The most common tests: an MRI scan to look at the nerves and spinal cord, a CT scan to get a better picture of the vertebral bones, and special nerve tests to determine irritated or pinched nerves.
Originally, body casts were used to treat adult kyphosis and later turned to surgery. Today, we prioritize conservative treatments whenever possible and they commonly include medications, exercise, physical therapy, and certain types of braces to support the spine. Furthermore, spinal surgery will generally occur as the last treatment choice due to the risks involved.
If osteoporosis exists, treatment of the condition may also slow the progression of the degenerative kyphosis. This can get accomplished in several ways. The current recommendations include increasing calcium and vitamin D intake, and weight-bearing exercises. Medications exist specifically for osteoporosis that your Specialist may prescribe.
The use of a spinal brace may provide some pain relief. However, in adults, it will not cause the spine to straighten. Once you have reached skeletal maturity, bracing becomes a pain relief tool rather than a preventive tool.
Your doctor may have you work with a physical therapist. A well-rounded rehabilitation program assists in calming pain and inflammation, improving your 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:
- learn correct posture and body movements to counteract the effects of kyphosis
- maintain appropriate activity levels
- maximize your range of motion and strength
- learn ways to manage your condition
All Surgeries involve some significant risks. For this reason, surgery recommendations only occur when the expected benefits far outweigh the risks. Surgery will not be recommended for most cases of kyphosis but may be recommended in the following situations:
Pain provides the most common reason for kyphosis surgery — especially when chronic discomfort that keeps getting worse. Most cases of adult kyphosis surgeries occur to relieve severe pain. However, if the pain becomes manageable through conservative treatments, surgery will probably not be recommended.
Progression of Curve
Progression of the spine deformity provides another reason for considering surgery. If the curvature continues to worsen, surgery should occur to prevent the problems that come from severe spine deformity.
In most cases, we will not recommend surgery for the sake of appearance. However, in some cases, the kyphosis causes physical deformity becomes unbearable to the patient. In these cases, surgery becomes the only option for correcting the condition. Most cases of cosmetic surgery happen in young adults that have very noticeable curves.
When Adult Kyphosis requires surgery, doctors possess many different procedures from which to choose. Each case of kyphosis requires a very specialized, well-planned approach for optimal results. Surgery solves the problems of pain and discomfort that occur by the spine condition, not just to straighten the spine. The goals of most surgical procedures for adult kyphosis:
- reduce the deformity (straighten the spine as much as possible)
- stop the progression of the deformity and the symptoms
- remove any pressure from the nerves and spinal cord
- protect the nerves and spinal cord from further damage
Finally, to achieve these goals, your surgeon may suggest an operation on the back of the spine, the front of the spine, or both. The operation will straighten the spine and then fuse the vertebrae together into one solid bone.
Nearly all surgeons will use some type of 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 go 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.
If you or a loved one suffers from spinal pain, you owe it to yourself to call Southwest Scoliosis and Spine Institute at 214-556-0555 to make an appointment.