KYPHOSIS TREATMENT

Kyphosis, a spinal disorder, causes a forward curve of the spine that results in a rounding of the upper back. While this spinal defect can occur at any age, it occurs more often in young adults and older women.

SWSI Scoliosis Quiz

Kyphosis Treatment

The Southwest Scoliosis Institute with offices in Dallas and Plano, Texas has often been referred to as North Texas’s premier practice for treating Kyphosis, Scoliosis, and other complex spinal issues.

Dr. Hostin explains that his practice treats both children and adults. “We provide a continuum of care, and a commitment to take care of our patients throughout their life.”

In most cases, kyphosis causes few problems and does not require surgery. Some patients may need to use a back brace or do specific exercises to improve their posture and strengthen their spine. However, severe cases can be painful, cause spinal defect, and even lead to breathing problems. Patients with this severe problem may require surgery to reduce their spinal curve and improve their symptoms.

Types of Kyphosis:

  • Developmental Kyphosis (postural or Scheuermann’s kyphosis) – This usually becomes classified as either postural or structural in origin. Both occur in children and young adults, but they may occur at any age.
  • Congenital Kyphosis – This occurs when the spinal column fails to develop normally while in utero.
  • Post-Traumatic Kyphosis – This occurs as the result of an accident, and occurs due to an injury to the spine. This condition commonly occurs in the mid-to-lower back area.
  • Postural Kyphosis – This, the most common type, usually becomes noticeable during childhood. This spinal defect happens more commonly in girls than in boys.  It rarely becomes painful and does not normally lead to problems as an adult.
Kyphosis art and X-ray

Testing for Postural Kyphosis

Mild postural kyphosis often goes unnoticed until a scoliosis screening at school, which then prompts a visit to the doctor.  In more severe cases, the rounding of the upper back may be clearly seen.

During an exam, Dr. Kishan, Dr. Wiesman, or Dr. Hostin will ask your child to bend forward with both feet together, knees straight, and arms hanging free. This test allows the doctor to observe the curve of the spine and spot any spinal problem.

The doctor may also ask your child to lay down to see if this straightens a spinal curve. Doctors may also order X-rays to see if changes in the vertebrae or any other bony problems exist.  In patients with postural kyphosis who do not have any defects, correction can occur with proper posture.

Structural Kyphosis

Structural kyphosis, also known as Scheuermann’s kyphosis, occurs when the spine develops abnormally, with the front sections of the vertebrae growing slower than the back sections. Instead of normal, rectangular vertebrae with ideal alignment, this spinal defect results in more triangular, wedge-shaped vertebrae that cause the spine to not align properly.

Scheuermann’s kyphosis usually develops during periods of rapid bone growth (typically between the ages of 12 and 15 in males or a few years earlier in females). The doctor will notice a sharp and angular curve that appears stiff and rigid. Unlike postural kyphosis, Scheuermann’s kyphosis does not respond to good posture and standing up straight.

Developmental Kyphosis Treatment

Nonoperative Management

Observation is typically recommended for:

  • Postural kyphosis (rounded back straightens with proper posture)
  • Curves less than 60° in patients who are growing
  • Curves 60° – 80° in patients who finish growing

X-Rays and Exercise

Full-spine X-rays are taken every six months as the child grows using our advanced in-house imaging system that scans the entire spine in just seconds with a low dose of radiation.

Bracing

With a midley severe curve (60° – 80°) and a patient who continues to grow, we recommend brace treatment with a tailored exercise program. Full-time use of a brace (20 hours/day) is usually required in the beginning until a maximum correction has been achieved.

During the last year of treatment prior to skeletal maturity, part-time brace wear (12-14 hours/day) may be proposed. Brace wear must be continued for a minimum of 18 months in order to maintain a permanent correction of the defect.

Operative Treatment

At Southwest Scoliosis Institute, we consider surgery only when absolutely necessary. Our surgeons use the most advanced treatment options to ensure that patients can return to normal daily routine as soon as possible.

Spinal Fusion

If kyphosis has become severe (greater than 80°) and causes frequent back pain, surgical treatment may be considered. Surgery can correct the defect without the need for bracing after surgery. Pedicle screws, hooks, or cables are placed, two per level, and connected with two rods. Thanks to our enhanced recovery times after spine, pelvic and hip procedures, hospital stays for spine fusions performed here are shorter than most.

While most surgeries occur from the back, your doctor may suggest surgery on the front as well. Patients usually return to a normal daily routine within four to six months following surgery.

Spine Osteotomy

Spine osteotomy, a surgical procedure, cuts and removes a section of the spinal bone to allow for correction of spinal alignment. The Smith-Peterson Osteotomy, one of the most common procedures, involves removing sections of bone from the back of the spine, as well as the posterior ligament and facet joints. This causes the spine to lean more toward the back, correcting the kyphotic curve.

Long-Term Prognosis

Upon diagnosing kyphosis early, the majority of patients can be treated without surgery and go on to lead active healthy lives. If the condition does not get early treated, the growth of the curve could lead to problems in adulthood.

For patients with kyphosis, regular checkups are needed to monitor the condition and check for any growth of the curve.

Age-Related Kyphosis

Age-related kyphosis usually occurs as a result of a weakened vertebra that became compressed or cracked over time, leading to an increased curve.

This spinal problem affects between 20 – 40% of older adults (mostly women) and usually results from several factors, including:

  • Poor posture
  • Increased stress on the spine
  • Poor gait (which can lead to falls)

Age-Related Kyphosis Treatment

Exercise programs, spinal orthotics, and other treatments may help delay the growth of age-related kyphosis. However, research needs to distinguish which treatments provide the best choices for widespread clinical use.

Medicines provide bone-building medication for patients with age-related kyphosis and low bone density or spine fractures often due to conditions such as osteoporosis.

There are two surgical options, which involve reinforcing the damaged vertebrae with a specially designed bone cement. These surgeries mainly help to relieve pain and increase range of motion and mobility, and in some cases, surgery can reduce the spine angle as well.

Congenital Kyphosis

While congenital kyphosis occurs in lots of patients, its growth will cause debilitating effects. For instance, the bones may develop in an unusual shape, or several vertebrae may be fused together.

Unfortunately, casting and/or bracing does not appear effective for every patient with congenital kyphosis. Patients with this spinal problem often need surgical treatment at a young age to stop the progression of the curve.

Congenital Kyphosis Treatment

Non-operative Treatment

Our doctors strongly believe in watching our young patients and periodic x-rays to monitor a curvature. Unfortunately, casting/bracing does not work for congenital kyphosis. While braces may delay growth, research does not provide evidence that this method of treatment will be successful.

Operative Treatment

Over years of study and after hundreds of surgeries with very positive results on Congenital Kyphosis, our surgeons believe that the treatment of the spine should begin by fusing the deformed vertebrae.  In addition, the surgeon may recommend separate approaches from the front and the back of the spine.

Prognosis

Should your child require surgery to correct kyphosis, the expert surgeons and caregivers at our practice can provide the care and attention they deserve. In addition, Drs. Richard Hostin, Kathryn Wiesman, and Shyam Kishan have been treating children and young adults for more than 10 years.

Because the skeleton grows quite quickly in the first year of life, the chance of finding spinal cord compression is quite small.  However, when it does appear and continues to grow, surgery may not be needed until adolescence.

Post-Traumatic Kyphosis

Post-traumatic kyphosis occurs after an injury such as a fall from a height, a motor vehicle accident, or a horseback riding fall. The impact of these kinds of injuries can lead to fractures and/or dislocation of the vertebrae, which can lead to a curve of the spine, especially if treatment is not promptly obtained.

Post-Traumatic Kyphosis Treatment

Traumatic kyphosis can get even worse if the injury heals without treatment. Treatment options depend on many factors, including the type and size of the fracture, the degree of spine curvature, and the size of the patient.

For patients who do not need an operation, treatment includes bracing to support the spine to keep it in a more ideal position as it heals, as well as physical therapy, which can help lessen pain, strengthen muscles, and improve posture.

For patients that need an operation for traumatic kyphosis, spinal fusion and bone removal is conducted to restore proper alignment.

“Two of the most common conditions that we see associated with increased kyphosis are idiopathic – Scheuermann’s Kyphosis – in our adolescent patients.  Adult patients can also develop increased kyphosis with age-related and degenerative changes.” – Richard Hostin, MD

If you or a loved one suffers from spinal pain, you owe it to yourself to call Southwest Scoliosis Institute at 214-556-0555 to make an appointment.