KYPHOSIS TREATMENT

 

 

Questions and Answers

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 not to 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.
In contrast to patients with postural kyphosis, those with Scheuermann’s disease have specific abnormalities in the thoracic vertebrae and the discs. Some of their thoracic vertebrae are trapezoidal in shape, a defining feature of the disease. This structural anomaly leads to a kyphosis that is rigid and severe. If it is severe, your doctor may suggest surgical treatment to correct the curvature.

Untreated Kyphosis

If kyphosis is left untreated, individuals may experience pain or stiffness in the back and shoulder blades, numb and tingling extremities, and painful and difficult breathing due to the excessively curved spine that presses and obstructs the airways. Patients with this severe problem may require surgery to reduce their neck spine curve and improve their well-being. They may also experience tenderness of the spine and extreme fatigue alongside persistent pain that sometimes defies medication. Balance problems and bladder incontinence are also a source of concern with kyphosis.

The progression of kyphosis largely depends on its underlying cause. For instance, if a patient has kyphosis resulting from vertebral compression fractures due to osteoporosis and fails to treat the osteoporosis, the kyphosis will likely worsen. Conversely, taking medications to increase bone density can significantly slow or even halt the progression.

In the case of Scheuermann’s kyphosis, a condition with an unknown cause, progression is typically linked to the growth history. A healthy 35-year-old with Scheurmann’s disease and a 70-degree curvature is unlikely to see much progression into adulthood. However, a 12-year-old with the same degree of curvature is at a higher risk for significant progression due to ongoing growth.

Ultimately, the rate of kyphosis progression is individually determined and varies from patient to patient. Regular follow-ups with surgeons or spine specialists are crucial. Periodic X-rays help both the patient and the healthcare provider anticipate the need for treatment or continued observation, ensuring proactive management of the condition.

Diagnosing Kyphosis

The diagnostic process for kyphosis begins with a thorough patient history. This involves gathering detailed information about the patient’s symptoms, medical background, family history, lifestyle factors, and any potential causes of the spinal curvature.

Symptom Evaluation

The patient’s symptoms are a critical component of the diagnostic process. Kyphosis can present with a range of symptoms, depending on the severity and underlying cause of the condition.

Pain

Pain is a common symptom associated with kyphosis, particularly in adults. The patient may report localized pain in the mid-back, which can get worse by prolonged sitting, standing, or physical activity. In some cases, the pain may radiate to the shoulders, neck, or lower back.

Postural Changes

Patients often notice changes in their posture, such as a visible hump or rounding of the back. This may occur when accompanied by a forward head posture or rounded shoulders.

Fatigue and Weakness

Patients with kyphosis may experience fatigue or muscle weakness, particularly in the back muscles, which are strained by the abnormal curvature.

Respiratory and Digestive Issues

In severe cases, kyphosis can lead to respiratory difficulties due to the compression of the lungs, as well as digestive issues caused by the compression of abdominal organs.

Onset and Progression

Understanding the onset and progression of the kyphosis is crucial for identifying the underlying cause and guiding treatment. The patient should advise the doctor of his or her age when the curve first appeared, whether it has worsened over time, and any factors that may have influenced its progression.

Congenital vs. Acquired

Determining whether the kyphosis is congenital (present at birth) or acquired (developed later in life) is essential for diagnosis. Congenital kyphosis often presents in infancy or early childhood, while acquired forms may develop due to degenerative diseases, trauma, or poor posture.

Rapid vs. Gradual Onset

A rapid onset of kyphosis may suggest a more serious underlying condition, such as a vertebral fracture or tumor, while a gradual onset is more typical of postural kyphosis or degenerative conditions.

Medical History

The patient’s medical history provides valuable context for the diagnosis of kyphosis. Relevant aspects of the medical history include:

Previous Spinal Conditions or Surgeries

A history of spinal conditions, such as scoliosis, or previous spinal surgeries, may contribute to the development of kyphosis or complicate its management.

Chronic Diseases

Chronic diseases, such as osteoporosis or arthritis, can weaken the vertebrae and lead to kyphosis. Patients should advise the doctor about any diagnosed conditions that may affect bone health.

Trauma or Injury

A history of spinal trauma, such as a fall or car accident, can lead to vertebral fractures and the subsequent development of kyphosis.

Family History

A family history of kyphosis or other spinal conditions may indicate a genetic predisposition to the condition. This is particularly relevant in cases of congenital kyphosis or Scheuermann’s disease, a form of kyphosis that typically presents in adolescence.

Lifestyle Factors

Lifestyle factors, such as occupation, physical activity level, and posture habits, can contribute to the development or exacerbation of kyphosis. Patients should advise the doctor about their daily activities, including any repetitive motions or postures that may strain the spine.

Physical Examination

The physical examination is a critical step in diagnosing kyphosis. It involves a detailed assessment of the patient’s posture, spine, and musculoskeletal system.

Postural Assessment

The postural assessment involves evaluating the patient’s standing and sitting posture to identify any abnormalities in spinal alignment.

Sagittal Plane Analysis

The sagittal plane analysis focuses on the side view of the patient’s spine, where the kyphotic curve is most apparent. The examiner will observe the degree of forward curvature, the position of the head and shoulders, and the alignment of the pelvis.

Coronal Plane Analysis

The coronal plane analysis evaluates the patient’s spine from the front or back. While kyphosis primarily affects the sagittal plane, the examiner should also check for any lateral curvature (scoliosis) or asymmetry in the shoulders or hips.

Spine Palpation

Palpation of the spine is performed to assess the vertebrae, identify areas of tenderness, and detect any structural abnormalities.

Vertebral Tenderness

The examiner will palpate each vertebra to identify areas of tenderness, which may indicate underlying conditions such as fractures, infections, or tumors.

Step-Off Deformities

Step-off deformities, where one vertebra is displaced relative to another, may be palpable in cases of spondylolisthesis or fractures. These deformities can contribute to the kyphotic curvature.

Range of Motion (ROM) Testing

ROM testing evaluates the flexibility and mobility of the spine. The patient is asked to perform various movements, such as bending forward, backward, and to the sides, to assess the degree of spinal flexibility.

Thoracic Flexibility

Thoracic flexibility is particularly important in kyphosis. Reduced flexibility in the thoracic spine may indicate structural abnormalities or muscle tightness contributing to the curvature.

Lumbar and Cervical Mobility

The examiner will also assess the mobility of the lumbar and cervical spine, as these regions can compensate for the thoracic curvature, leading to additional strain and discomfort.

Neurological Examination

A neurological examination is conducted to assess for any nerve involvement, which may occur in more severe cases of kyphosis, particularly those involving spinal cord compression.

Sensory Testing

Sensory testing involves checking for any changes in sensation, such as numbness or tingling, in the extremities. This can help identify potential nerve compression or damage.

Motor Strength Testing

Motor strength testing assesses the strength of the muscles innervated by the spinal nerves. Weakness in specific muscle groups may indicate nerve root compression or spinal cord involvement.

Reflex Testing

Reflex testing helps assess the integrity of the spinal cord and peripheral nerves. Abnormal reflexes, such as hyperreflexia or hyporeflexia, may indicate neurological involvement in kyphosis.

Functional Assessment

The functional assessment evaluates the impact of kyphosis on the patient’s daily activities and overall quality of life.

Gait Analysis

Gait analysis involves observing the patient’s walking pattern to identify any abnormalities related to kyphosis, such as altered balance, shortened stride length, or compensatory movements.

Activity Limitations

The patient is asked about any difficulties performing daily activities, such as bending, lifting, or reaching.

Imaging Studies

Imaging studies are essential for confirming the diagnosis of kyphosis, assessing the severity of the curvature, and identifying any underlying causes. Your doctor has several imaging modalities to use, depending on the clinical presentation and the information needed.

X-Rays

X-rays are the primary imaging modality used in the diagnosis of kyphosis. They provide a detailed view of the bones and alignment of the spine.

Lateral X-Rays

Lateral X-rays are taken from the side of the patient and are the most informative view for assessing the degree of kyphosis. The Cobb angle, a measure of the curvature, is calculated from these images to determine the severity of the kyphosis.

• Mild Kyphosis: Cobb angle of 20-40 degrees.
• Moderate Kyphosis: Cobb angle of 40-60 degrees.
• Severe Kyphosis: Cobb angle greater than 60 degrees.

Anteroposterior (AP) X-Rays

AP X-rays provide a frontal view of the spine, allowing for the assessment of any lateral curvatures (scoliosis) or vertebral anomalies that may contribute to the kyphosis.

Flexion-Extension X-Rays

Flexion-extension X-rays are dynamic images taken while the patient bends forward and backward. These images help assess spinal stability and flexibility, particularly in cases where instability is suspected.

Magnetic Resonance Imaging (MRI)

MRI provides detailed images of the soft tissues, including the spinal cord, intervertebral discs, and nerves. It is particularly useful in assessing complications associated with kyphosis.

Spinal Cord Compression

MRI can identify any compression of the spinal cord or nerve roots, which may occur in severe kyphosis. This is critical for planning treatment, particularly if surgical intervention is being considered.

Disc Degeneration and Herniation

MRI can also detect degenerative changes in the intervertebral discs, such as disc herniation or degeneration, which may contribute to the kyphotic curvature.

Infections and Tumors

In cases where infection or tumors are suspected as the underlying cause of kyphosis, MRI is the imaging modality of choice, as it provides superior soft tissue contrast compared to X-rays.

Computed Tomography (CT) Scan

CT scans provide highly detailed images of the bony structures of the spine and are useful for assessing complex fractures, congenital anomalies, and spinal instability.

Congenital Anomalies

CT scans can identify congenital anomalies, such as vertebral malformations or fusion, that may contribute to kyphosis.

Fractures

In cases where vertebral fractures are suspected, particularly in the setting of trauma or osteoporosis, CT scans provide precise imaging of the fracture patterns and any associated spinal instability.

Bone Density Testing

Bone density testing, often performed using dual-energy X-ray absorptiometry (DEXA), is important in assessing the bone health of patients with kyphosis, particularly in older adults who may have osteoporosis.

Osteoporosis Assessment

Osteoporosis is a common underlying cause of kyphosis in older adults, leading to vertebral compression fractures and subsequent spinal curvature. DEXA scans measure bone mineral density and help identify patients at risk for fractures.

Nuclear Medicine Imaging

In certain cases, your doctor may use nuclear medicine imaging, such as bone scans, to assess bone activity and identify conditions such as infections, tumors, or fractures that may contribute to kyphosis.

Differential Diagnosis

The differential diagnosis process involves distinguishing kyphosis from other conditions that may present with similar symptoms or spinal deformities.

Scoliosis

Scoliosis, a lateral curvature of the spine, can sometimes mimic kyphosis, particularly when it is accompanied by a rotational component. However, scoliosis primarily affects the coronal plane, while kyphosis affects the sagittal plane.

Lordosis

Lordosis is an exaggerated inward curvature of the lumbar spine, often leading to a swayback posture. While lordosis primarily affects the lower back, it can sometimes coexist with kyphosis, complicating the diagnosis.

Ankylosing Spondylitis

Ankylosing spondylitis is a form of inflammatory arthritis that primarily affects the spine, leading to stiffness, pain, and eventual fusion of the vertebrae. It can result in a stooped posture similar to kyphosis, but the underlying pathology is distinct.

Spinal Tumors

Spinal tumors can cause localized pain, neurological symptoms, and spinal deformities, including kyphosis. Imaging studies, particularly MRI, are crucial in differentiating tumors from other causes of kyphosis.

Spinal Infections

Spinal infections, such as osteomyelitis or discitis, can lead to vertebral destruction and subsequent kyphotic deformity. These conditions often present with systemic symptoms, such as fever and elevated inflammatory markers, and require prompt diagnosis and treatment.

Conclusion

The diagnosis of kyphosis is a multifaceted process that involves a thorough patient history, comprehensive physical examination, and the use of advanced imaging techniques. Accurate diagnosis is essential for determining the underlying cause of the kyphosis and guiding appropriate treatment. Early recognition and intervention can significantly improve outcomes for patients with kyphosis, preventing further progression of the curvature and associated complications. As diagnostic techniques continue to evolve, clinicians will have better technology to diagnose kyphosis and develop individualized treatment plans for their patients.

Testing for 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, especially with adults doctors can easily see the rounding of the upper back.

During an exam, one of our doctors, Richard Hostin, MD, Devesh Ramnath, MD, Ishaq Syed, MD, Shyam Kishan, MD, and Kathryn Wiesman, MD, will ask you or your child to bend forward with both feet together, knees straight, and arms hanging free. This test allows the doctor to see the abnormal forward curvature of the spine and see any spinal problems.

The doctor may also ask you or your child to lie 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 possess any defects, a correction can occur with proper posture.

The Scoliosis and Spine Institute has the latest EOS X-ray machine. An EOS X-ray provides medical imaging technology that uses low-dose X-rays to create highly detailed 3D images of bones, joints, and other structures in the human body. Unlike traditional X-ray machines, which produce 2D images, EOS X-ray uses a special digital scanner to take two simultaneous X-ray images of the patient from different angles. This allows for the creation of a 3D image that provides greater clarity and accuracy for diagnosing Kyphosis than traditional X-rays.

The EOS X-ray uses significantly less radiation than traditional X-ray machines, which is an important consideration for patient safety. If the doctor sees mild kyphosis in children or adults, he can schedule a full spine X-ray every six months with the low-dose in-house imaging system.

Kyphosis Symptoms

One of the most noticeable symptoms of kyphosis is the abnormal curvature of the upper spine, leading to a hunched or rounded back appearance. The extent of curvature can vary:

• Mild Kyphosis: Typically involves curvature of 20-40 degrees and doctors may not see it and believe it is poor posture.
• Moderate to Severe Kyphosis: Curvature exceeding 40 degrees, leading to a visible hump on the back, particularly when viewed from the side. This deformity can cause the head to protrude forward, and the shoulders may appear rounded.

Back Pain

Pain is a common symptom of kyphosis, especially as the curvature increases:

• Localized Pain: Pain is often localized to the area of the abnormal curvature, usually in the mid to upper back. Patients may described the pain as a dull ache or, in some cases, a sharp pain.
• Muscle Fatigue and Strain: The muscles surrounding the spine may become strained from attempting to support the abnormal curvature, leading to fatigue and discomfort.
• Radiating Pain: In severe cases, pain may radiate to other areas, such as the neck, shoulders, or lower back, due to the altered biomechanics of the spine.

Stiffness and Reduced Mobility

Patients with kyphosis often experience stiffness in the thoracic region, which can limit the range of motion:

• Reduced Flexibility: An excessive curvature can restrict spinal flexibility, making it difficult to perform certain movements, such as bending forward or twisting.
• Difficulty Standing Upright: Severe kyphosis can make it challenging to stand fully upright, as the spine’s curvature forces the body into a forward-leaning position.

Breathing Difficulties

In cases of severe kyphosis, particularly when the curvature exceeds 70-80 degrees, the deformity can impact respiratory function:

• Compression of the Lungs: The abnormal curvature can reduce the space within the thoracic cavity, compressing the lungs and leading to restricted breathing capacity.
• Shortness of Breath: Patients may experience dyspnea, or shortness of breath, especially during physical activity, due to compromised lung function.

Neurological Symptoms

Kyphosis can lead to nerve compression, particularly when the curvature is severe or associated with other spinal abnormalities:

• Radiculopathy: Compression of spinal nerve roots can cause radiculopathy, characterized by pain, numbness, tingling, or weakness in the arms or legs, depending on the level of the spine affected.
• Myelopathy: In extreme cases, kyphosis can compress the spinal cord itself, leading to myelopathy. Symptoms may include difficulty walking, loss of coordination, and, in severe cases, bladder or bowel dysfunction.

Neuromuscular Fatigue

The altered spinal curvature can place additional strain on the neuromuscular system:

• Chronic Muscle Fatigue: Patients may experience chronic fatigue in the muscles of the back, neck, and shoulders due to the continuous effort required to maintain posture.
• Coordination and Balance Issues: Severe kyphosis can affect the body’s center of gravity, leading to balance issues and an increased risk of falls.

Psychological Symptoms

The visible deformity associated with kyphosis can have significant psychological impacts:

• Self-esteem Issues: Individuals with kyphosis may struggle with body image, leading to low self-esteem, especially during adolescence when body image is particularly important.
• Social Withdrawal: The visible nature of the deformity may cause individuals to withdraw socially, avoiding situations where their appearance is more noticeable, such as swimming or sports.

Depression and Anxiety

Chronic pain, physical limitations, and body image issues can contribute to mental health challenges:

• Depression: The chronic nature of pain and the limitations imposed by kyphosis can lead to feelings of hopelessness and depression.
• Anxiety: Concerns about worsening curvature, potential disability, and social stigma can lead to anxiety.

Symptoms Based on the Underlying Cause of Kyphosis

Postural Kyphosis

Postural kyphosis is the most common form and is usually seen in adolescents. It is primarily caused by poor posture rather than structural abnormalities:

• Mild Back Pain: Typically not severe, and the curvature is flexible, meaning it can improve with correct posture.
• No Neurological Symptoms: Since it is not associated with structural changes in the spine, neurological symptoms are generally absent.

Scheuermann’s Kyphosis

Scheuermann’s kyphosis is a more severe form, often identified during adolescence, and involves structural changes in the vertebrae:

• Severe Back Pain: Often more intense than postural kyphosis, with pain that worsens with activity.
• Progressive Curvature: The curvature is more rigid and tends to worsen over time if untreated.
• Potential Neurological Symptoms: In severe cases, nerve compression may occur, leading to neurological symptoms.

Congenital Kyphosis

Congenital kyphosis is present at birth due to malformations in the spine:

• Rapidly Progressive Curvature: The curvature can progress rapidly as the child grows, leading to significant deformity.
• Early Onset Neurological Symptoms: Due to structural abnormalities, nerve compression and associated symptoms can occur early in life.
• Associated Anomalies: Often associated with other congenital anomalies, such as heart or kidney defects, which may present additional symptoms.

Degenerative Kyphosis

Degenerative kyphosis is most commonly seen in older adults and is associated with age-related changes in the spine, such as osteoporosis or disc degeneration:

• Chronic Back Pain: Persistent pain due to the degenerative changes in the spine.
• Height Loss: Individuals may notice a decrease in height over time due to the collapsing vertebrae.
• Neurological Symptoms: Nerve compression can lead to symptoms such as pain, numbness, or weakness in the legs.
• Increased Risk of Fractures: Osteoporosis-related kyphosis increases the risk of vertebral fractures, which can worsen the curvature and symptoms.

Nutritional and Metabolic Kyphosis

Certain nutritional deficiencies or metabolic disorders, such as rickets or osteomalacia, can lead to kyphosis:

• Bone Pain and Tenderness: Due to the underlying metabolic bone disease.
• Muscle Weakness: Often associated with these conditions, contributing to spinal deformity.
• General Fatigue: A common symptom due to the overall health impact of the underlying condition.

Kyphosis Non-Surgical Treatment

Physical Therapy

Physical therapy is a cornerstone of non-surgical treatment for kyphosis. It focuses on improving posture, strengthening the muscles supporting the spine, increasing flexibility, and reducing pain. Physical therapy programs are                  often tailored to the individual’s specific needs and the underlying cause of kyphosis.

Postural Training

Postural training is fundamental in managing kyphosis, particularly postural kyphosis, which is caused by poor posture habits rather than structural abnormalities in the spine. The goal is to retrain the muscles to support a                         more neutral spine alignment.

Postural Awareness

Patients are educated on maintaining proper posture during daily activities, such as sitting, standing, and lifting. Postural awareness exercises involve practicing correct alignment and using mirrors or visual cues to monitor                         posture.

Adjustments

Adjustments to the workplace, home environment, and daily routines can help maintain proper posture. This may include modifying desk height, chair support, and computer screen positioning to encourage spinal                                        alignment.

Strengthening Exercises

Strengthening exercises target the muscles of the back, shoulders, and core, which play a critical role in supporting the spine and maintaining posture.

Back Extensor Strengthening

Strengthening the back extensors (muscles that help straighten the spine) is essential in counteracting the forward curvature of kyphosis. Exercises such as prone back extensions, deadlifts, and resistance band rows are commonly used.

Core Stability

A strong core supports the spine and reduces the load on the back muscles. Core stability exercises include planks, bridges, and abdominal exercises that do not exacerbate the curvature.

Shoulder and Upper Back Strengthening

Strengthening the shoulder and upper back muscles helps improve posture and reduce kyphosis. Exercises such as scapular retractions, shoulder blade squeezes, and reverse flys are beneficial.

Stretching and Flexibility Exercises

Stretching exercises help improve flexibility in the muscles and joints around the spine, which can reduce the severity of kyphosis and relieve discomfort.

Chest Stretching

Stretching the chest muscles, particularly the pectoralis major and minor, can counteract the forward rounding of the shoulders often seen in kyphosis. Wall stretches, doorway stretches, and foam roller stretches are commonly used techniques.

Hamstring and Hip Flexor Stretching

Tight hamstrings and hip flexors can contribute to pelvic tilt and exacerbate kyphosis. Regular stretching of these muscles can improve pelvic alignment and reduce spinal curvature.

Thoracic Spine Mobility

Improving mobility in the thoracic spine is crucial for managing kyphosis. Thoracic extension exercises, such as using a foam roller or performing cat-cow stretches, can increase spinal flexibility.

Balance and Coordination Training

Balance and coordination exercises help improve overall stability and reduce the risk of falls, particularly in older adults with kyphosis.

Exercises for balance

Balance exercises, such as standing on one leg, using a balance board, or performing Tai Chi, can enhance proprioception and stability.

Functional Training

Functional training exercises mimic daily activities and help improve coordination and strength. Examples include sit-to-stand exercises, stair climbing, and reaching exercises.

Manual Therapy

Manual therapy, performed by a physical therapist, involves hands-on techniques to improve spinal alignment, reduce pain, and increase mobility.

Spinal Mobilization

Spinal mobilization techniques involve gentle movements of the spine to increase joint mobility and reduce stiffness. These techniques can help alleviate discomfort associated with kyphosis.

Soft Tissue Mobilization

Soft tissue mobilization focuses on the muscles, tendons, and fascia around the spine. Techniques such as massage, myofascial release, and trigger point therapy can reduce muscle tension and pain.

Bracing

Bracing is a non-surgical treatment option that can help in managing kyphosis during adolescence when the spine is still growing. Braces aim to prevent the progression of spinal curvature and improve posture.

Indications for Bracing

Bracing is most commonly used for individuals with Scheuermann’s kyphosis, a structural form of kyphosis that typically develops during adolescence. Doctors may also consider it for adults with progressive kyphosis or those who cannot undergo surgery.

Types of Braces

Several types of braces are available, each designed to address different aspects of kyphosis. The choice of brace depends on the severity of the curvature, the patient’s age, and the specific characteristics of the kyphosis.

Milwaukee Brace

The Milwaukee brace is one of the oldest and most traditional braces used for kyphosis. It is a full-torso brace that extends from the pelvis to the base of the skull, with metal uprights and chin support to correct spinal curvature.

• Advantages: The Milwaukee brace provides comprehensive support and is effective in halting the progression of severe kyphosis.
• Disadvantages: It can be uncomfortable, particularly for children and adolescents, and may affect daily activities and self-esteem.

Thoracolumbosacral Orthosis (TLSO)

The TLSO is a more modern and commonly used brace for kyphosis. It is a rigid brace that covers the thoracic and lumbar regions of the spine, extending from the armpits to the hips. The TLSO is designed to be worn under clothing, making it more discreet than the Milwaukee brace.

• Advantages: The TLSO is less intrusive than the Milwaukee brace and is generally better tolerated by patients. It can be customized to fit the individual’s body and curvature.
• Disadvantages: The effectiveness of the TLSO depends on patient compliance, as it must be worn for a significant portion of the day.

Kyphologic Brace

The Kyphologic brace is a dynamic brace designed specifically for Scheuermann’s kyphosis. It is made of lightweight materials and uses corrective forces to gradually reduce the kyphotic curve while allowing some movement.

• Advantages: The Kyphologic brace is more comfortable and less restrictive than traditional rigid braces, promoting better compliance.
• Disadvantages: It may not help for severe or rigid curves compared to more traditional bracing options.

Bracing Protocol

The success of bracing in managing kyphosis depends on adherence to the prescribed protocol, which typically involves wearing the brace for 16 to 23 hours a day.

Duration of Bracing

Bracing is generally recommended until skeletal maturity is reached, which for adolescents is typically around 18-24 months. In some cases, bracing may be discontinued earlier if significant improvement is achieved.

Weaning Off the Brace

As the patient nears the end of their growth period or if the curvature stabilizes, the bracing schedule may be gradually reduced. Weaning off the brace helps assess whether the spine can maintain alignment without external support.

Compliance and Monitoring

Regular follow-up visits with an orthopedic specialist are essential to monitor the progress of the curvature and adjust the brace as needed. Your doctor willl take X-rays periodically to evaluate the effectiveness of bracing.

Pain Management

Pain management is an important aspect of non-surgical treatment for kyphosis, particularly in adults who may experience chronic pain due to curvature.

Medications

Medications are often used to manage pain and inflammation associated with kyphosis. The choice of medication depends on the severity of the pain and the patient’s overall health.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

NSAIDs, such as ibuprofen and naproxen, are commonly used to reduce pain and inflammation in patients with kyphosis. They are particularly effective for mild to moderate pain.

• Advantages: NSAIDs are widely available, effective, and have relatively few side effects when used short term.
• Disadvantages: Long-term use of NSAIDs can lead to gastrointestinal issues, kidney problems, and increased cardiovascular risk.

Acetaminophen

Acetaminophen is another over-the-counter option for managing pain in kyphosis patients. It is particularly useful for those who cannot tolerate NSAIDs.

• Advantages: Acetaminophen is generally well-tolerated and does not have the gastrointestinal side effects associated with NSAIDs.
• Disadvantages: It is less effective in managing inflammation and may not be sufficient for more severe pain.

Muscle Relaxants

Muscle relaxants, such as cyclobenzaprine or methocarbamol, may be prescribed for patients experiencing muscle spasms or tension

Kyphosis Surgical Treatment

The degree of curvature is a primary indication for surgery. Kyphosis with a Cobb angle greater than 70-80 degrees is often considered severe and may require surgical correction. The curvature can cause significant cosmetic deformity, pain, and functional impairment, necessitating surgical intervention.

Intractable Pain

Patients with kyphosis who experience persistent and debilitating pain that does not respond to conservative treatments may require surgery. The pain may result from spinal instability, nerve compression, or severe muscle fatigue caused by the abnormal curvature.

Neurological Symptoms

Surgical intervention is often indicated when kyphosis leads to neurological symptoms such as radiculopathy, myelopathy, or cauda equina syndrome. These symptoms arise due to spinal cord or nerve root compression and can manifest as pain, numbness, weakness, or loss of bowel and bladder control.

Progressive Deformity

In cases where kyphosis is rapidly progressing despite conservative treatment, surgery may be necessary to halt further curvature progression. Progressive deformity can lead to worsening symptoms, increased disability, and higher surgical risks if not addressed promptly.

Respiratory Compromise

Severe kyphosis can restrict lung function by reducing the thoracic cavity’s volume, leading to respiratory difficulties. Surgery may be indicated in cases where the curvature compromises pulmonary function and conservative measures are ineffective.

Cosmetic Concerns

In some cases, significant cosmetic deformity associated with kyphosis may prompt patients to seek surgical correction. Although cosmetic concerns alone are not typically the sole indication for surgery, they can contribute to the overall decision-making process when combined with other clinical factors.

Surgical Techniques

The choice of surgical technique for kyphosis depends on the underlying cause, the severity of the curvature, the patient’s overall health, and the surgeon’s expertise. The primary surgical approaches include posterior spinal fusion, anterior spinal fusion, and combined anterior-posterior fusion. Minimally invasive techniques have also gained popularity in recent years.

Posterior Spinal Fusion

Posterior spinal fusion is the most commonly performed surgical procedure for kyphosis. It involves fusing the affected vertebrae together to stabilize the spine and correct the abnormal curvature.

Pedicle Screw Instrumentation

Pedicle screws are inserted into the vertebrae on either side of the spine, and rods are connected to these screws to provide structural support and realign the spine. The fusion process involves placing bone graft material between the vertebrae, promoting bone growth and permanent fusion over time.

Osteotomies

In cases of severe kyphosis, osteotomies (surgical cutting of bone) may be performed to correct the deformity. The Smith-Petersen osteotomy, pedicle subtraction osteotomy (PSO), and vertebral column resection (VCR) are common osteotomy techniques used to achieve greater curvature correction.

• Smith-Petersen Osteotomy: Involves removing a wedge of bone from the posterior elements of the spine to increase the lordosis (inward curve) and reduce the kyphotic curve.
• Pedicle Subtraction Osteotomy (PSO): A more extensive procedure where a wedge of bone is removed from the vertebral body, allowing for a greater degree of curvature correction.
• Vertebral Column Resection (VCR): Involves removing one or more entire vertebrae and reconstructing the spine to correct severe deformities.

Anterior Spinal Fusion

Anterior spinal fusion involves accessing the spine from the front of the body, typically through the chest or abdomen. This approach is often used in conjunction with posterior spinal fusion for severe or rigid kyphosis.

Disc Removal and Bone Grafting

The intervertebral discs between the affected vertebrae are removed, and bone graft material is placed in their place. This promotes fusion and stabilization of the spine.

Anterior Instrumentation

Anterior instrumentation, such as plates and screws, may be used to provide additional support and maintain the alignment of the spine during the fusion process.

Combined Anterior-Posterior Fusion

In cases of severe, rigid, or complex kyphosis, a combined anterior-posterior fusion may be necessary. This approach allows for maximum correction of the deformity and provides greater spinal stability.

Staged Procedures

The combined approach may be performed as a single surgery or as staged procedures, where the anterior and posterior components are completed on different days. Staged procedures may be preferred in patients with significant comorbidities or in cases where the surgical correction is particularly complex.

Minimally Invasive Techniques

Minimally invasive spinal surgery (MISS) techniques have been developed to reduce the morbidity associated with traditional open surgeries. These techniques involve smaller incisions, less muscle dissection, and reduced blood loss.

Percutaneous Pedicle Screw Placement

Pedicle screws can be placed percutaneously, using small incisions and fluoroscopic guidance. This technique minimizes tissue damage and may reduce postoperative pain and recovery time.

Approaches

For anterior spinal fusion, a thoracoscopic approach may be used. This involves making small incisions in the chest and using a camera and specialized instruments to perform the surgery with minimal disruption to the surrounding tissues.

Advantages and Limitations

Minimally invasive techniques offer several advantages, including reduced postoperative pain, shorter hospital stays, and faster recovery times. However, they may not be suitable for all patients, particularly those with severe or complex deformities that require extensive correction.

Spinal Fusion Using Intervertebral Cages to Treat Kyphosis

Surgical Procedure:

• Preparation: The patient is placed under general anesthesia. The surgeon makes an incision to access the spine.
• Removal of Damaged Disc: The damaged intervertebral disc is removed to prepare the space for the cage.
• Insertion of Cage: An intervertebral cage filled with bone graft material (either autograft, allograft, or synthetic) is inserted into the disc space. The cage helps to maintain disc height and alignment.
• Stabilization: Rods, screws, or other fixation devices are often used to stabilize the spine during the fusion process.
• Bone Fusion: Over time, the bone graft material promotes the growth of new bone, fusing the adjacent vertebrae.

Types of Cages:

• Metal Cages: Made from titanium or other alloys, offering strength and durability.
• PEEK Cages: Made from polyetheretherketone, a plastic-like material that is radiolucent, allowing for better post-operative imaging.
• Expandable Cages: These can be adjusted to fit the patient’s anatomy more precisely.

Recovery:

• Initial Hospital Stay: Typically lasts a few days, during which pain management and initial mobilization are prioritized.
• Physical Therapy: Essential for regaining strength and mobility.
• Follow-Up: Regular check-ups to monitor the fusion process and adjust any external support devices like braces.

If kyphosis becomes severe (greater than 80°) and causes frequent back pain, our doctors will recommend surgical treatment. Surgery can correct the defect without the need for bracing after surgery. Pedicle screws, hooks, or cables get placed, two per level, and connected with two rods. Thanks to our enhanced recovery times, hospital stays for spine fusions are shorter than most. While most surgeries occur from the back, your doctor may also suggest surgery from the front.

Patients usually return to a normal daily routine within four to six months following surgery. With increasingly sophisticated surgical techniques and instrumentation, surgical treatment for kyphosis has become easier to recover from than ever before.

Preoperative Considerations

A thorough preoperative evaluation is essential to assess the patient’s overall health, the severity of the kyphosis, and any associated conditions.

Imaging Studies

Imaging studies, including X-rays, MRI, and CT scans, are crucial for evaluating the extent of the spinal deformity, assessing spinal cord or nerve root compression, and planning the surgical approach.

Pulmonary Function Tests

In patients with severe kyphosis, particularly those with respiratory compromise, pulmonary function tests may be necessary to evaluate lung function and determine the risk of respiratory complications during and after surgery.

Neurological Assessment

A detailed neurological examination is essential to assess the presence of nerve compression or spinal cord involvement. This evaluation helps determine the urgency of surgery and guides the surgical approach.

Patient Education and Counseling

Patient education is a critical component of preoperative care. Patients and their families should be informed about the risks and benefits of surgery, the expected outcomes, and the recovery process.

Informed Consent

Obtaining informed consent involves explaining the surgical procedure, potential complications, and alternative treatment options. Patients should have a clear understanding of the goals of surgery and the possible outcomes.

Psychological Support

Given the potential impact of kyphosis surgery on body image and self-esteem, psychological support may be beneficial. Patients should be encouraged to discuss their concerns and expectations with their healthcare team.

Optimization of Health Status

Optimizing the patient’s health status before surgery is essential to reduce the risk of complications.

Management of Comorbidities

Chronic conditions such as diabetes, hypertension, or osteoporosis should be managed and stabilized before surgery. This may involve coordinating care with other healthcare providers.

Nutritional Support

Adequate nutrition is vital for wound healing and bone fusion. Patients may require nutritional support or supplementation, particularly if they have underlying conditions such as osteoporosis.

Intraoperative Considerations

Anesthesia and Positioning

Kyphosis surgery is typically performed under general anesthesia. Proper patient positioning on the operating table is crucial to minimize pressure on the spine and facilitate surgical access.

Prone Position

For posterior spinal fusion, the patient is positioned prone (lying face down). Special padding and supports are used to protect the bony prominences and prevent pressure sores.

Supine Position

For anterior spinal fusion, the patient is positioned supine (lying face up). A rolled towel or bolster may be placed under the shoulders to elevate the chest and improve surgical access.

Intraoperative Monitoring

Intraoperative neuromonitoring is often used during kyphosis surgery to assess spinal cord and nerve root function in real time. This helps reduce the risk of neurological complications.

Somatosensory Evoked Potentials (SSEPs)

SSEPs monitor the sensory pathways of the spinal cord by measuring the electrical activity in response to stimuli. Changes in
the SSEP signals during surgery can indicate potential injury to the spinal cord or nerve roots, allowing the surgical team to make immediate adjustments.

Motor Evoked Potentials (MEPs)

MEPs monitor the motor pathways of the spinal cord by stimulating the brain and recording the resulting muscle activity. Like SSEPs, changes in MEP signals can indicate potential neurological injury, prompting intraoperative interventions to prevent permanent damage.

Electromyography (EMG)

EMG is used to monitor nerve root function by measuring electrical activity in the muscles. This can help detect nerve irritation or damage during the placement of screws or other instrumentation.

Blood Loss Management

Kyphosis surgery can involve significant blood loss due to the extensive nature of the procedure. Effective blood management strategies are crucial to minimize complications and improve outcomes.

Preoperative Blood Donation and Anemia Management

Patients may be encouraged to donate their own blood before surgery for autologous transfusion if needed. Preoperative anemia should be corrected with iron supplementation, erythropoietin, or other appropriate therapies.

Intraoperative Blood Conservation Techniques

Techniques such as controlled hypotension, cell saver technology (which recycles the patient’s own blood), and the use of antifibrinolytic agents like tranexamic acid can help reduce intraoperative blood loss.

Postoperative Blood Management

Postoperative blood loss can be managed with continued monitoring, the use of drains, and appropriate transfusion practices if necessary.

Care and Recovery After Surgery

Immediate Postoperative Care

The immediate postoperative period focuses on monitoring for complications, managing pain, and initiating early mobilization.

Pain Management

Effective pain management is critical for patient comfort and early mobilization. A multimodal approach, combining opioids, non-steroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, and regional anesthesia techniques, may be used.

Monitoring for Complications

Patients are closely monitored for potential complications, including wound infections, neurological deficits, respiratory issues, and deep vein thrombosis (DVT). Vital signs, neurological status, and incision sites are regularly assessed.

Rehabilitation

Rehabilitation is a crucial component of recovery after kyphosis surgery, helping patients regain mobility, strength, and function.

Physical Therapy

Physical therapy typically begins within the first few days after surgery and focuses on gentle exercises to improve mobility and prevent complications like pneumonia or DVT. As healing progresses, therapy will focus on strengthening the back and core muscles, improving posture, and gradually increasing activity levels.

Occupational Therapy

Occupational therapy may be introduced to help patients adapt to daily activities during recovery, particularly if the surgery has impacted their ability to perform tasks like dressing, bathing, or driving.

Long-Term Follow-Up

Long-term follow-up is essential to monitor the success of the surgery, assess for complications, and guide continued rehabilitation.

Imaging Studies

Postoperative imaging, including X-rays or CT scans, is typically performed to assess the stability of the fusion, the position of instrumentation, and the correction of the curvature.

Monitoring for Complications

Long-term complications such as hardware failure, pseudoarthrosis (non-union of the bone), or adjacent segment disease (degeneration of spinal segments above or below the fusion) are monitored during follow-up visits.Patient Education and Lifestyle Modifications

Patients are educated on lifestyle modifications to protect their spine, such as avoiding high-impact activities, maintaining a healthy weight, and practicing good posture. Continued participation in exercise and physical therapy may be recommended to maintain strength and flexibility.

Complications and Risks

While kyphosis surgery can be highly effective, it carries inherent risks and potential complications. Understanding these risks is crucial for patient education and informed consent.

Neurological Complications

Neurological complications, although rare, can occur during or after kyphosis surgery. These may include:

Spinal Cord Injury

Intraoperative damage to the spinal cord can result in permanent neurological deficits, including paralysis or loss of bowel and bladder function. The use of intraoperative neuromonitoring helps reduce this risk.

Nerve Root Injury

Injury to the spinal nerve roots during surgery can lead to radiculopathy, characterized by pain, numbness, or weakness in the limbs. This may be temporary or permanent, depending on the extent of the injury.

Mechanical Complications

Mechanical complications involve issues with the surgical hardware or fusion process:

Hardware Failure

Pedicle screws, rods, or other instrumentation may fail or loosen over time, potentially requiring revision surgery. Factors contributing to hardware failure include poor bone quality, excessive physical activity, or inadequate fusion.

Pseudoarthrosis

Pseudoarthrosis occurs when the bones fail to fuse as intended, leading to persistent pain and spinal instability. This complication may require additional surgery to achieve proper fusion.

Infection

Infection is a potential complication of any surgical procedure, including kyphosis surgery. A patient’s Infections can range from superficial wound infections to deep infections involving the spinal hardware.

Superficial Infections

Superficial infections may present with redness, swelling, and drainage at the incision site. These infections are typically treated with antibiotics and local wound care.

Deep Infections

Deep infections are more serious and may require surgical debridement, removal of the hardware, and prolonged antibiotic therapy. Surgeons are aware that deep infections can jeopardize the success of the fusion and may lead to additional surgeries.

Respiratory Complications

Respiratory complications are a particular concern in patients with kyphosis, especially those with pre-existing pulmonary issues or those undergoing anterior approaches.

Pneumonia

Reduced lung capacity and prolonged immobility after surgery increase the risk of pneumonia. Early mobilization, respiratory therapy, and incentive spirometry can help prevent this complication.

Atelectasis

Atelectasis, or the collapse of part of the lung, can occur due to shallow breathing or immobility. Postoperative respiratory exercises and pain management are crucial in preventing this condition.

Vascular Complications

Vascular complications, although rare, can occur during spinal surgery, particularly during anterior approaches or osteotomies.

Major Vessel Injury

Injury to major blood vessels, such as the aorta or vena cava, can lead to significant blood loss and may require emergency vascular surgery. Preoperative imaging and careful surgical technique are essential to minimize this risk.

Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE)

The risk of DVT and PE is increased in patients undergoing spinal surgery due to immobility and the use of anesthesia. Prophylactic measures, including anticoagulants, compression devices, and early mobilization, are essential to reduce this risk.

Outcomes and Prognosis

Short-Term Outcomes

Short-term outcomes of kyphosis surgery typically involve relief from pain, improvement in spinal alignment, and enhanced quality of life. Most patients experience significant pain reduction and are able to resume normal activities within a few months of surgery.

Long-Term Outcomes

Long-term outcomes vary depending on the severity of the kyphosis, the success of the fusion, and the presence of any complications. Successful surgery can result in long-term pain relief, stable spinal alignment, and improved physical function.

Quality of Life

Many patients report an improvement in quality of life after kyphosis surgery, including better posture, increased physical activity levels, and enhanced self-esteem. However, outcomes may be less favorable in patients with pre-existing neurological deficits or significant comorbidities.

Functional Outcomes

Improved functional outcomes, such as increased mobility and reduced disability, are common following kyphosis surgery. Patients are often able to return to work, engage in recreational activities, and perform daily tasks with greater ease.

Factors Influencing Outcomes

Several factors can influence the outcomes of kyphosis surgery, including the patient’s age, the severity of the curvature, the presence of comorbidities, and adherence to postoperative rehabilitation.

Age

Younger patients generally have better outcomes due to greater bone healing capacity and fewer comorbidities. However, older patients with good overall health can also achieve favorable results with appropriate surgical planning and care.

Severity of Curvature

Patients with less severe curvatures may have better outcomes, as the surgery is less extensive and the risk of complications is lower. However, even patients with severe kyphosis can experience significant improvements with successful surgery.

Comorbidities

The presence of comorbid conditions, such as osteoporosis, diabetes, or cardiovascular disease, can impact surgical outcomes. Proper management of these conditions before and after surgery is crucial to improving prognosis.

Conclusion

Surgical treatment for kyphosis is a complex but often necessary intervention for patients with severe spinal deformity, intractable pain, or neurological symptoms. The decision to undergo surgery requires careful consideration of the patient’s symptoms, overall health, and the risks and benefits of the procedure. Advances in surgical techniques, instrumentation, and postoperative care have improved the outcomes of kyphosis surgery, allowing many patients to experience significant relief from symptoms and improved quality of life.

Despite the potential risks and complications, kyphosis surgery remains a highly effective treatment for many patients, particularly when conservative treatments have failed. Successful surgical outcomes depend on thorough preoperative planning, meticulous surgical technique, comprehensive postoperative care, and long-term follow-up. As our understanding of spinal deformities and surgical techniques continues to evolve, the prognosis for patients with kyphosis will likely continue to improve, offering hope for those affected by this challenging condition.

Hospitalization and Anesthesia

General anesthesia is used during these surgeries, and hospitalization typically lasts between four to six days depending on the extent of the surgery and the patient’s age.

Physical Therapy

Physical therapy is generally started once the bones have had some time to heal, usually between three to six months post-surgery.

Success and Outcomes

In patients with good bone quality, excellent results can be achieved. Success is defined as a solid fusion that reduces pain and decreases the magnitude of the curve while maintaining a balanced spine. This comprehensive recovery plan ensures that patients are well-informed about what to expect throughout their healing journey.

Spinal fusion is a surgical technique used to join two or more vertebrae, eliminating motion between them. Intervertebral cages, also known as spinal cages, are devices inserted into the intervertebral space to help maintain the space and promote fusion.

Potential Risks and Complications

While spinal fusion with intervertebral cages can be highly effective, it carries several potential risks and complications, as with any major surgery.
Infection:

• Post-operative infections can occur at the incision site or deeper within the spine. Antibiotics are administered to prevent and treat infections.

Bleeding:

• Significant blood loss may occur during surgery, sometimes necessitating a blood transfusion.

Nerve Damage:

• The proximity to spinal nerves means there’s a risk of nerve injury, potentially leading to pain, numbness, or weakness.

Non-Union (Pseudoarthrosis):

• In some cases, the bone graft does not fully fuse, leading to persistent instability and pain, possibly requiring additional surgery.

Implant Complications:

• Hardware failures, such as breakage or dislodgement of screws and rods, can occur, necessitating revision surgery.

Adjacent Segment Disease:

• Fusion can place additional stress on the vertebrae above and below the fusion site, potentially leading to degeneration of these segments over time.

Chronic Pain:

• Despite successful fusion, some patients may experience ongoing pain, requiring further treatment.

Respiratory Complications:

• Given the thoracic involvement in kyphosis surgery, there is a risk of respiratory issues, especially if the surgery is extensive.

Anesthetic Risks:

• General anesthesia carries risks such as allergic reactions, breathing problems, and cardiovascular complications.

Dural Tears:

• Accidental tears in the dura mater (the outer membrane of the spinal cord) can lead to cerebrospinal fluid leaks, which might cause headaches and other complications.

Conclusion

The list of complications provided here is not intended as a complete list of complications and is not a substitute for discussing the risks of surgery with your doctor. It is essential that you are fully informed about what surgery entails, including both the potential benefits and risks.  Spinal fusion using intervertebral cages is a robust treatment option for severe kyphosis, offering the potential for significant improvement in spinal alignment and quality of life. However, patients and their medical teams need to weigh the benefits against the potential risks and complications to make informed decisions about undergoing this complex surgery.

Before proceeding with surgery, patients should consider the following:

• Risks of Serious Complications: Engage in a thorough discussion with your doctor about the risks specific to spine surgery. Only your doctor can evaluate your condition and inform you of the risks of any medical treatment he or she may recommend.
• Long-Term Impact: Understand that while surgical interventions can provide relief, they come with their own set of challenges that may include long-term management of pain and mobility.
• Need for Further Interventions: Be aware that complications arising from the initial surgery could require subsequent interventions.

Long-Term Prognosis

Upon early diagnosis, the majority of patients get 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 over time as a result of compressed or cracked vertebra, 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. In addition, research needs to learn which treatments provide the best choices for widespread clinical use.

Medicines provide bone-building 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 specially designed bone cement. These surgeries mainly help to relieve pain and increase the range of motion and mobility, and in some cases, surgery can reduce the spine angle as well.

Congenital Kyphosis Treatment

While congenital kyphosis occurs in lots of patients, its growth will cause serious health problems. For instance, the bones may develop in an unusual shape, or several vertebrae may fuse. 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 growth of the curve.

Non-operative Treatment

Our doctors strongly believe in watching our young patients with periodic X-rays to monitor 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 work 100% of the time.

Operative Treatment

After 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 surgery 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, doctors do not usually find spinal cord compression.  However, when it does appear and continues to grow, doctors usually delay surgery 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 the treatment gets delayed. 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 will restore proper alignment.

Kyphosis can also develop after spine trauma or spine surgery. Less common causes of kyphosis include skeletal dysplasias (such as achondroplasia), abnormalities in vertebral development (congenital kyphosis), and neuromuscular disorders. After lumbar fusions for correction of adult scoliosis, kyphosis can occur above the fusion due to the stress between the fused and the non-fused parts of the spine. This is a difficult problem that surgeons have yet to solve in a comprehensive manner.

In the cervical region of the spine (neck), kyphosis can occur after cervical laminectomy (removal of the posterior bony arch in the cervical spine to decompress the spinal cord). This is called “post-laminectomy kyphosis” and was very common before surgeons learned to prevent this complication by performing fusions with the cervical laminectomy. Therefore, post-laminectomy cervical kyphosis is less common today.

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 will restore proper alignment.

Hyperkyphosis

Hyperkyphosis is a medical condition characterized by an excessive forward curvature of the spine, notably more pronounced than the usual curvature. This condition, often referred to as "roundback," can lead to pain and noticeable physical deformity. While a certain degree of curvature is normal and healthy, hyperkyphosis exceeds this norm, creating issues primarily in the thoracic region of the spine, which is the mid-back. However, it can also affect the cervical (neck) and lumbar (lower back) regions. The term hyperkyphosis generally describes the curve itself but is frequently used interchangeably with hyperkyphosis to denote the excessive curvature disorder.

The Link Between Osteoporosis and Kyphosis

The connection between osteoporosis and kyphosis primarily lies in the structural weakening of the spine caused by reduced bone density. When osteoporosis weakens the vertebrae, they are prone to compression fractures. These fractures more commonly occur in the front part of the vertebra, leading to its collapse. As a result, the spine starts to curve forward, producing the dowager’s hump—a common kyphosis manifestation in those with osteoporosis.

Preventing and Managing Osteoporosis and Kyphosis

Prevention plays a critical role in managing both osteoporosis and kyphosis. Regular screening for bone density is vital, particularly for women approaching or undergoing menopause. Detecting osteoporosis early can significantly help in taking appropriate measures to strengthen the bones and prevent fractures.

• Screenings: It’s recommended for women, especially those perimenopausal, to undergo routine bone density tests which can foresee the risk of osteoporosis.
• Specialist Care: For those already affected by or at high risk for osteoporosis, consulting with specialists in bone health is crucial. These professionals can provide targeted treatments and lifestyle strategies to maintain bone health.
• Healthy Practices: Engaging in regular exercise, particularly weight-bearing and strength-training exercises, can fortify bone health. Additionally, ensuring a diet rich in calcium and vitamin D can support bone density.

Understanding and addressing the nuances of kyphosis and osteoporosis with appropriate preventive measures and medical care can significantly reduce the risk of severe spinal deformities and improve quality of life.

Why Patients Choose Southwest Scoliosis and Spine Institute

Orthopedics is a specialty of our doctors and surgeons at the Southwest Scoliosis and Spine Institute. They understand your concerns, can answer your questions regarding your condition, and know how to use their specialized knowledge to assist you.  Richard Hostin, MD, Devesh Ramnath, MD, Ishaq Syed, MD, Shyam Kishan, MD, and Kathryn Wiesman, MD, have many years of training and experience in Spine and Back Pain for kids, adolescents, young adults, and seniors, and can help people of all ages get back to living the life they love.

The following are just a few of the many reasons why patients choose Southwest Scoliosis and Spine Institute.

• Expertise in the spine: The team of specialists at Southwest Scoliosis and Spine Institute is recognized as the very best.  They specialize in the diagnosis and treatment of spinal conditions, ensuring the best possible care for their patients.
• Cutting-edge technology: Our practice uses the latest technology and techniques to diagnose and treat a wide range of conditions.  In addition, we use minimally invasive procedures that reduce pain and promote faster recovery.
• Comprehensive care: Our practice offers a full range of services, from diagnostic imaging and physical therapy to surgery.  We ensure that patients receive complete, seamless care for their spinal conditions.
• Dedicated facilities: Southwest Scoliosis and Spine Institute is dedicated to providing patients with a safe and comfortable environment.

Finally, our board-certified physicians and fellowship-trained orthopedic surgeons use the full range of treatments to treat their spine patients. Southwest Scoliosis and Spine Institute’s experts with offices in Dallas, Plano, and Frisco, Texas offer cutting-edge technology, comprehensive care, and dedicated facilities to ensure the best possible care for their patients. Get in touch with us today and schedule an appointment if you have a problem with Kyphosis.

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NHS of Britain: Kyphosis

Spine-Health – For information on spinal fusion procedures.

MedlinePlus – For general information on spinal fusion.

Johns Hopkins Medicine – For an overview of spinal fusion and associated risks.