Doctors conducting surgery

THORACIC KYPHOSIS

Doctors refer to the excessive forward rounding of the back as Thoracic Kyphosis. It can affect people of any age, although women get this condition more than men in their forties and fifties. The most common cause of kyphosis in older people emanates from a weakening of the spinal bones, which causes them to compress or crack.

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Thoracic Kyphosis

Thoracic KyphosisThoracic kyphosis refers to the natural curve found in the upper back region, which forms part of the spine encompassing the rib cage. This curvature is essential as it balances the reverse curves seen in both the cervical spine at the neck and the lumbar spine in the lower back. These variations in spinal curves are crucial for maintaining posture, enabling activities like sitting and standing with ease. The normal range of curvature for thoracic kyphosis typically spans from 20 to 50 degrees. This range is considered healthy and provides the necessary balance for efficient movement and structural support of the body.

The human spine is uniquely shaped with alternating curves, a design feature that significantly contributes to our ability to maintain an upright posture whether sitting or standing. These curves, termed the cervical, thoracic, lumbar, and sacral, alternate between forward (lordosis) and backward (kyphosis) directions.

This structuring not only supports the weight of the head and upper body but also provides a natural flexibility and cushioning system that absorbs impact as we move. By balancing these opposing curves: – The forward cervical and lumbar curves help in distributing body weight and facilitating an upright posture. – The reverse thoracic and sacral curves enhance the structural integrity of the spine, supporting the body in both sitting and standing positions.  Together, these curves create a balance that allows for the complex functionality of human movement and support, crucial in maintaining an upright position. This adaptive alignment is essential, not only to sit and stand but also to perform a wide range of motions gracefully and without strain.

QUESTIONS AND ANSWERS

What exactly is thoracic kyphosis, and how does it affect my spine?

Thoracic kyphosis refers to a condition where an excessive curvature of the thoracic spine (the upper and middle part of the back) exists. Normally, the thoracic spine has a slight natural curve, but kyphosis refers to a curve that occurs greater than 40-45 degrees. This can lead to a rounded back appearance, pain, and stiffness. Severe cases might cause breathing difficulties due to the reduced space in the chest cavity .

What causes of thoracic kyphosis?

Thoracic kyphosis is a condition where there is an excessive curvature of the thoracic spine (the upper and middle part of the back). Normally, the thoracic spine has a slight natural curve, but kyphosis refers to a curve that is greater than 40-45 degrees. This can lead to a rounded back appearance, pain, and stiffness. Severe cases might cause breathing difficulties due to the reduced space in the chest cavity .

What symptoms are associated with thoracic kyphosis?

Symptoms of thoracic kyphosis can vary depending on the severity of the curvature. Common symptoms include:

  • Visible Curvature: A noticeable rounding or hump in the upper back.
  • Back Pain and Stiffness: Especially in the thoracic region.
  • Fatigue: Muscles have to work harder to maintain posture.
  • In severe cases: Difficulty breathing, due to the chest cavity being compressed.
  • Neurological Symptoms: Numbness, tingling, or weakness if nerves are compressed .

The Kyphosis Condition

Doctors refer to the excessive forward rounding of the back as Thoracic Kyphosis. It can affect people of any age, although women get it more than men in their forties and fifties. In addition, the most prevalent cause of kyphosis in older people is a weakening of the spinal bones, which causes them to compress or crack. Also, other types of kyphosis can occur in babies or teens as a result of spinal deformity or long-term spinal bone wedging. Mild kyphosis causes minimal consequences. However, severe kyphosis can cause a person to hunch over, not stand up straight, and cause pain. Finally, doctors determine kyphosis treatment by a patient’s age, as well as the source and effects of the curvature.

Doctors may need to intervene if an individual’s curvature becomes too large or causes the spine to become unstable. Kyphosis refers to the medical term denoting an extreme forward curvature. As such, the causes of Kyphosis are linked to postural imbalances, spinal abnormalities, or age-related diseases. Aside from alterations in the appearance of the spine, it may not produce any symptoms.

What Does Kyphosis Look Like?

Kyphosis often first appears during adolescence and is more frequently seen in girls than boys. It manifests as an exaggerated forward curvature of the spine, which can create a noticeable rounded hump or hunch in the upper back.

Common Signs of Kyphosis:

  • Rounded Upper Back: The most obvious sign is a forward curvature, giving the appearance of slouching or a hunchback.
  • Uneven Shoulders: One shoulder may appear higher than the other.
  • Prominent Shoulder Blades: The shoulder blades might stick out more than usual.
  • Forward Head Posture: The head may seem to jut forward compared to the rest of the spine.

Visual Indicators:

Imagine comparing two spines: one that maintains a normal, slightly forward bend and another with an exaggerated forward bend. The latter illustrates kyphosis, where the curve is more pronounced and noticeable, especially when observed from the side.

Parents might spot these signs, or they could be identified during a routine check-up with a healthcare provider. Early detection often occurs during these growth years, making regular check-ups essential.

The Consequences of Leaving Kyphosis Untreated

Kyphosis, characterized by an exaggerated forward curvature of the spine, can worsen if left untreated. The progression largely depends on its underlying cause.

Osteoporosis-related Kyphosis

For individuals with osteoporosis leading to vertebral compression fractures, neglecting osteoporosis treatment can cause kyphosis to worsen. Without measures to increase bone density, such as medication or lifestyle changes, the spinal curvature is likely to become more pronounced.

Scheuermann’s Kyphosis

Scheuermann’s kyphosis, a condition whose unknown cause, shows varied progression patterns. In younger patients, particularly those still growing, the curvature can escalate significantly, and therefore, the need for early detection and treatment is necessary. For instance, a 12-year-old with severe curvature is more likely to experience worsening because of remaining growth potential. Conversely, adults with the same condition typically see minimal progression.

Individual Variation

Each case of kyphosis is unique. Regular follow-ups with a spine specialist or surgeon are essential. Periodic X-rays help track the condition, allowing for timely intervention if necessary.

In summary, untreated kyphosis can lead to increased spinal deformity, particularly for those with osteoporosis or younger patients with <Scheuermann’s Kyphosis>Scheuermann’s disease</Scheuermann’s Kyphosis>. Regular medical monitoring is crucial to manage and possibly mitigate the condition’s progression.

Symptoms of Kyphosis

A noticeable forward bend in the top section of the spine provides the primary symptom of  Thoracic Kyphosis. It causes the shoulders to round forward and the upper back to fold over. In moderate instances, the extra spinal curvature does not show. In some cases, a person appears to lean forward. Kyphosis typically arises without any additional signs or symptoms. Also, other signs and symptoms may include:

  • Postural Changes – The individuals exhibit a notably stooped posture, most prominent when observed sideways during forward bending
  • Back Pain – This ranges from mild discomfort that may not require treatment, to intense pain necessitating surgical intervention.
  • Stiffness in the upper back
  • A rounded back
  • Tight hamstrings
  • Height Reduction – There often appears a noticeable decrease in height due to the curvature.
  • Standing Challenges – Affected persons may find it increasingly difficult to stand up straight, a condition that typically progresses negatively throughout the day.
  • General Fatigue – Daily activities become more taxing, leading to heightened fatigue.

In severe cases of kyphosis, individuals might experience more pronounced and severe symptoms. One common issue includes difficulty in breathing; this happens because the curvature of the spine can compress the lungs, making it challenging to breathe normally. Additionally, this spinal condition can also impact one’s appetite. The discomfort and potential digestive system restrictions caused by the altered spine shape can lead to a decreased desire to eat.

Doctors find vertebral fractures in roughly 40% of patients with hyperkyphosis, according to doctors. The kyphosis angle will increase by about 3.8 degrees with each spinal compression fracture.

Causes and Types of Thoracic Kyphosis

The common causes of kyphosis vary, including congenital issues, degenerative diseases, osteoporosis-related fractures, and poor posture. Each cause influences the treatment approach, making understanding the root cause crucial. The spine consists of vertebrae, which stack on top of one another allowing the spine to provide support and flexibility. However, the spine is very sensitive to injury and will react in a variety of different ways.  One such reaction could result in Kyphosis, which comes in a variety of forms. Depending on the kind of kyphosis, several things contribute to it.

Congenital Kyphosis:

Congenital Conditions When kyphosis is congenital, the spinal bones develop abnormally, often leading to more severe curvature.  Surgical solutions are commonly considered in these cases to correct the alignment before they significantly affect the nervous system.

Age-related Kyphosis – Degenerative Diseases:

This form of kyphosis generates a bend in the spine that worsens with age, usually due to disorders like degenerative spine disease that damage the spine’s bones. Osteoporosis, for example, causes the bones to lose density, become fragile, and cause compression fractures in the vertebrae, leading to kyphosis. In adults, degenerative diseases such as arthritis can contribute to kyphosis. Treatment often focuses on pain relief and managing the degeneration, sometimes involving medication, physical therapy, and, in more severe cases, surgical intervention.

Osteoporosis-related Fractures

Osteoporosis can cause compression fractures in the vertebrae, leading to kyphosis. Treatment typically centers around strengthening the bones and spine to prevent further damage. Options include medication, dietary changes, and exercises specifically aimed at improving bone density and posture.

Postural Kyphosis:

The most prevalent kind of kyphosis is this. It usually begins in adolescence, when the muscles that surround the spine grow abnormally as a result of a postural imbalance, such as slouching. Slouching causes the spine’s forward curvature to expand, straining the extensor muscles and posterior ligaments, and weakening them over time. Due to decreasing muscular strength, this can also happen in elderly persons. Posture-induced Kyphosis can often be treated with non-invasive methods such as physical therapy. Exercises to strengthen the back and core, improve posture, and reduce the curve are common approaches.

Scheuermann’s Kyphosis:

This occurs during adolescence. It can, however, progress to a more severe state than postural kyphosis. Doctors do not know what causes this type of kyphosis. Scheuermann, the Danish radiologist for whom the disease is named, was the first to notice the problem. He proposed that the issue was due to a process called “avascular necrosis” of the cartilage ring of the vertebral body. This means the cartilage in the spinal bone’s ring died because it lacked the necessary blood supply, disrupting bone growth during development and leading to wedge-shaped vertebrae.

Most researchers think that damage to the growth area of the vertebrae initiates the process. The abnormal growth that follows is what causes excessive kyphosis. For instance, vertebral disorders during the rapid growth spurts of adolescence can lead to abnormal bone growth. Additionally, many spine specialists suspect that issues with the mechanics of the spine, such as the way it is structured and functions, play a part in Scheuermann’s kyphosis. Muscle abnormalities have also been considered as a potential cause.

There appears to be a high genetic predisposition to this disease, suggesting it runs in families. Originally, Scheuermann noticed this spinal deformity in agriculture workers who were often hunched or bent over. This led to the question of whether poor posture could result in excessive kyphosis. While this is a logical consideration, the connection between posture and this deformity has never been confirmed. However, poor posture has been shown to exacerbate the problem, and correcting postural issues can help to improve the abnormal kyphosis.

In each scenario above, the cause of kyphosis heavily influences the treatment path. Early diagnosis and tailored treatment plans are vital to effectively manage the condition and improve quality of life.

Systemic Diseases Contributing to Kyphosis Development

Kyphosis, a forward rounding of the back, can arise as a result of various systemic diseases. Understanding these underlying conditions is crucial for both prevention and treatment. Here are some key systemic diseases that can trigger the development of kyphosis:
Spinal Infections:

  • Infections such as tuberculosis or osteomyelitis can damage the vertebrae, leading to structural deformities like kyphosis.

Cancer and Tumors:

  • Tumors that affect the spine, whether malignant or benign, can weaken the vertebrae and contribute to kyphosis.

Systemic Arthritis:

  • Conditions like rheumatoid arthritis cause inflammation and degeneration of spinal joints, often resulting in curvature abnormalities.

Radiation Treatments:

  • Individuals who received radiation therapy for childhood cancers may experience changes in the axial skeleton, which can induce kyphosis over time.

These conditions cause alteration in spinal structure, often due to inflammation, infection, or direct damage to the vertebrae and surrounding tissue. Early diagnosis and management of these diseases are pivotal in mitigating the risk of developing severe kyphotic deformities.

Diagnosis

Patients become extremely motivated to see their doctor when the deformity begins advancing or the pain becomes worse. Doctors can halt the curve progression in Kyphosis when controlled with early therapy, especially in the teen years. However, diagnosing kyphosis in adults involves a comprehensive process.

History Taking

In order to make a proper diagnosis and rule out other possible conditions, the first step is to take a detailed history. The provider may ask about the following:

  • Family History: Some types of kyphosis tend to run in families, so it may have a genetic cause. Your provider will want to know if anyone else in your family has the problem.
  • Date of Onset: When did you first notice the appearance of your spinal condition?
  • Measured Curve Progression: If X-rays have been taken of your spine in the past, the doctor will want to see if the curve is getting worse. This can be measured by comparing new X-rays with old 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. However, if there is pain, your doctor needs to know where it is, what brings on or intensifies the pain, and if there is any radicular pain – pain that radiates away from the spine itself. This usually comes from irritation of the nerves as they leave the spine.
  • Bowel or Bladder Dysfunction: Are you having problems knowing when you have to urinate or have a bowel movement? This is extremely important because it could signal the presence of serious nerve damage.
  • Motor Function: Has there been a change in how your muscles work? This may be the result of pressure on the nerves or spinal cord itself.
  • Previous Surgery: If you have had any surgery on your spine, it may have caused the kyphosis due to weakened muscles or other problems. In order to evaluate your condition properly, it is important that your physician knows about any spinal surgery you have had in the past

Physical Examination

A complete physical exam reveals a great deal about a patient’s health and general fitness. The exam establishes a baseline against which the doctor may track the patient’s development during therapy. The physical exam that will identify kyphosis will involve the following:

  • Observation: A round-back or Gibbus deformity appears by observing the posture. From the side, the sagittal balance, or the equilibrium of the head and trunk, appears straight and directly over the pelvis.
  • Adam’s Forward Bending Test: The patient must bend forward at the waist, which helps in identifying the deformity.
  • Palpation: The deformity is palpated during the range of motion to determine the curve’s flexibility or stiffness. Palpation can also determine anomalies in the spine.
  • Paraspinal Musculature: The paraspinal musculature is frequently sensitive.
  • Hamstring Muscles: When a patient suffers from Scheuermann’s Disease, the hamstring muscles may appear tight.
  • Range of Motion: The degree to which a patient can do flexion, extension, lateral bending, and spinal rotation is measured by a range of motion. It’s also worth noting that there’s some asymmetry.
  • Neurological Tests: Your nerves will be tested by checking your sensation, reflexes, and the strength of your muscles. Pain, numbness, paresthesias, extremities feeling and motor function, muscular spasms, weakness, and bowel/bladder abnormalities get assessed during a neurological evaluation.

Additional Tests

Usually, after the examination, X-rays will be ordered that allow the provider to see the structure of the spine and measure the curve. During the X-rays, you will be asked to hold certain positions while standing or lying on a table. You will need to hold very still while pictures are taken of your spine. With kyphosis, the following images may be taken:

  • Front View: These are X-rays of the entire spine taken from the front.
  • Lateral View: These are X-rays of the entire spine taken from the side.
  • Lateral Bend: These are X-rays taken while you are bending sideways.
  • Traction Films: Traction is when your spine is pulled and held in a particular position to take X-rays. These films are only taken occasionally.

The doctor will ensure that X-rays are taken of the spinal column at full length. For instance, with arms stretched front and head upright, the patient stands. X-ray scans can occur while the patient lies supine to assess curve flexibility. These X-rays help the doctor assess spinal wedging and end plate abnormalities, both of which are common in Scheuermann’s Disease. If the spinal cord appears damaged, the doctor may require an MRI. Using a conventional full-length AP X-ray, the Cobb Angle Method calculates the kyphotic curve in degrees.

Depending on the outcome of your history, physical examination, and initial X-rays, other tests may be ordered to look at specific aspects of the spine. The most common tests that are ordered are:

  • MRI Scan: To look at the nerves and spinal cord.
  • CAT Scan: To get a better picture of the vertebral bones.
  • Special Nerve Tests: To determine if any nerves are being irritated or pinched.

Treatment

Treatment for Kyphosis is determined by the nature and severity of your problem.

Medications

Your doctor can prescribe one or more of the following medicines:

  • Pain relievers. If over-the-counter medications such as acetaminophen (such as Tylenol), ibuprofen (such as Advil, Motrin IB), and naproxen sodium (Alive) do not work, prescriptions provide more powerful painkillers.
  • Osteoporosis medicine. Bone-strengthening medications might help you avoid further spinal fractures, which would exacerbate your kyphosis.

Therapy

Therapy can treat some types of kyphosis. – Exercises. Stretching exercises might help you increase your spinal flexibility and relieve back discomfort.

Physical therapy is an important part of treating adult kyphosis. A well-designed exercise program can provide pain relief and improve spinal health. Here’s how it works:

  • Personalized Plans: A physical therapist will develop an exercise routine tailored to your specific case. This personalized approach ensures that the exercises are both safe and effective for your condition.
  • Consistency is Key: It’s essential to stick to the exercise plan your therapist provides. Regular practice will yield the best results.
  • Correct Body Mechanics: Learning correct body mechanics helps you maintain an erect posture, counteracting the effects of kyphosis.
  • Non-Jarring Exercises: Regular non-jarring exercises, such as swimming, are recommended as they are gentle on the spine.
  • High Activity Levels: Keeping active is crucial. Maintaining a high level of physical activity can aid in managing kyphosis.
  • Daily Stretching: Incorporate daily stretching exercises into your routine to enhance spinal flexibility and relieve discomfort.
  • Bracing: While children’s bones continue to grow, children with Scheuermann’s illness may use a body brace to slow the growth of kyphosis.

By following these guidelines, physical therapy can play a significant role in managing and treating adult kyphosis.

How Effective Are Spinal Braces in Treating Adult Kyphosis?

Spinal braces can offer some relief for adults suffering from kyphosis, particularly in terms of pain management. However, once an individual has reached skeletal maturity, braces won’t correct or straighten the spine. Their primary benefit lies in alleviating discomfort rather than altering the spine’s shape.

Key Points on Bracing Effectiveness:

  • Pain Relief: Braces can help reduce pain by supporting the spine and improving posture.
  • No Structural Changes: In adults, braces won’t change the spine’s alignment once growth is complete.
  • Supplemental Therapy: Often used alongside other treatments like physical therapy for enhanced outcomes.

Ultimately, while spinal braces are a helpful tool for managing pain in adult kyphosis, they aren’t a cure-all and should be part of a broader treatment plan.

Lifestyle Modifications

If osteoporosis is present, addressing it may slow the progression of degenerative kyphosis.

  • Nutrition: Increasing calcium and vitamin D intake can strengthen bones.
  • Hormone Replacement Therapy: This may be recommended to help maintain bone density.
  • Weight-Bearing Exercises: Activities such as walking or light weight training can help improve bone strength.

Additional Supports

  • Orthotics: Special shoe inserts or lifts can help if there is a leg length discrepancy or if scoliosis affects your gait, potentially reducing back pain.
  • Body Mechanics: Learning correct body mechanics to maintain an erect posture can counteract the effects of kyphosis.
  • Activity Levels: Maintaining high levels of activity and incorporating non-jarring exercises like swimming into your routine can be beneficial.
  • Daily Stretching: Regular stretching exercises are recommended to maintain flexibility and alleviate discomfort.

Incorporating these treatments and lifestyle modifications can help manage adult kyphosis effectively, providing relief and improving quality of life.

Surgical and Other Treatment Procedures

Doctors may require surgery if severe kyphosis pinches the spinal cord or nerve roots. To minimize the degree of curvature, surgeons will use spinal fusion. The surgeon puts bone pieces between the vertebrae and holds them together with metal rods and screws until the spine heals in the proper position.

Surgery for adult kyphosis carries with it some risks. For this reason, surgery is only recommended when the risks are far outweighed by the expected benefits. Surgery will not be recommended for most cases of kyphosis. Here are specific situations where surgery may be recommended:

Pain

The most common reason for surgery is pain relief for increasing, chronic discomfort. Most cases of adult kyphosis surgeries are done to relieve severe pain. However, if the pain is manageable through any conservative way, surgery will not usually be recommended.

Progression of Curve

Progression of the kyphosis deformity is another reason for considering surgery. If the curvature continues to worsen, surgery may be suggested. Surgery is recommended in this situation to prevent the problems that come from severe kyphosis.

Cosmetics

In most cases of kyphosis, surgery will not be recommended simply for the sake of appearances. However, in some cases, the kyphosis causes physical deformity that is unbearable to the patient. In these cases, surgery is the only option for correcting the condition. Most cases of cosmetic kyphosis surgery are in young adults that have very noticeable curves.

Goals of Surgical Procedures:

  • Reduce the deformity: Straighten the spine as much as possible.
  • Stop the progression: Prevent further curvature.
  • Remove pressure from nerves and spinal cord: Address nerve compression issues.
  • Protect the spinal nerves and cord: Safeguard against further damage.

Surgical Approaches:

To achieve these goals, the spine surgeon might suggest an operation on the back, the front, or both sides of the spine. This dual approach helps in not only straightening the spine but also ensuring that the vertebrae are fused together into one larger, stable bone.

Use of Metal Hardware:

Nearly all surgeries will involve some type of metal screws, plates, or rods to help straighten the spine and hold the vertebrae in place while the fusion heals and becomes solid. The screws are placed into the vertebrae, and the rods or plates attach to the screws, connecting everything together. When tightened, this “construct” forms an internal brace to maintain alignment during healing.

Your doctor may suggest the following to help you maintain high bone density:

  • Having a calcium- and vitamin-D-rich diet
  • Avoiding tobacco
  • Limiting alcohol

This comprehensive approach ensures that the surgical intervention not only addresses the curvature but also supports overall spinal health and recovery.

What is the Surgery for Kyphosis?

Kyphosis surgery, often necessary for conditions like Scheuermann’s kyphosis, aims to correct the abnormal curvature of the spine. Here’s a detailed look at what the procedure involves:

Key Surgical Procedures

  • Disc Removal: Abnormal discs causing the curvature may be removed.
  • Spinal Fusion: The affected vertebrae are fused to create a solid segment, preventing further curvature.
  • Instrumentation: Metal rods, screws, and other hardware are used to maintain proper spinal alignment during the healing process.

Approaches to Surgery

  • Posterior Approach: This is the most common technique, where the surgeon accesses the spine from the back.
  • Anterior Approach: For patients with a large or rigid spinal curve, an additional anterior approach through the chest may be required.

Each method has its own set of benefits and may be recommended based on the severity and specifics of the individual’s condition. The ultimate goal is to restore proper spinal alignment and alleviate symptoms associated with kyphosis.

Surgical Procedures for Kyphosis Correction

When kyphosis surgery is necessary, orthopedic surgeons use several techniques to correct the spinal curvature and restore natural alignment. Here are the primary procedures involved:

  • Disc Removal: Surgeons begin by removing abnormal discs that are contributing to the spinal curvature. This step is essential for reducing deformity and preparing the spine for the next stages of surgery.
  • Spinal Fusion: The surgeon then fuses the affected vertebrae together. By doing this, they create a solid segment of bone that stops further curvature. Bone grafts are often used to facilitate the fusion process.
  • Instrumentation Placement: Various types of instrumentation, such as rods, screws, and plates, are placed in the spine. These devices maintain correct posture and stability while the vertebrae fuse over time.

Surgical Approaches

  • Posterior Approach: Most commonly, surgeons access the spine from the back. This involves an incision along the posterior aspect of the spine, allowing for direct access to the affected vertebrae.
  • Anterior Approach: For patients with a large, rigid curve, an additional anterior approach may be required. This involves accessing the spine through the chest to achieve better alignment and correction.

Each approach and procedure is selected based on the specific needs and conditions of the patient, ensuring the best possible outcome for kyphosis correction.

What Are the Potential Complications of Kyphosis Surgery?

Undergoing surgery always comes with risks, and this becomes even more significant when the procedures involve areas near the spine and spinal cord. Below, we’ll explore some of the potential complications that can arise from kyphosis surgery, specifically focusing on issues like flat-back deformity and pseudoarthrosis.

General Surgical Risks

Every surgery entails some degree of risk. Complications can lead to postoperative pain, functional impairment, and sometimes the need for additional surgical procedures. It’s crucial to have a detailed discussion with your doctor about these risks beforehand to understand what you might face.

Flat-back Deformity

  • Definition: The natural “C”-shaped curve in the lumbar spine, known as lordosis, may be lost when the vertebrae are fused. This condition is termed flat-back deformity.
  • Onset: The loss of curve might not be immediately apparent and could surface years after the surgery, particularly in younger patients, showing up between the ages of 30 and 50.

Pseudoarthrosis

  • Definition: Pseudoarthrosis refers to a “false joint,” which occurs when a fracture doesn’t heal properly or when an attempted spinal fusion fails.
  • Symptoms: This condition results in continued or worsening pain due to movement between the unhealed bones. The stress from this movement can also damage the metal hardware, like rods and screws, used in the fusion.
  • Treatment: Addressing pseudoarthrosis usually requires further surgical interventions. Options include adding more bone grafts, replacing the damaged hardware, or even using an electrical stimulator to encourage bone healing.

Points to Discuss with Your Doctor

  1. Complete Risk Assessment: Only your healthcare provider can provide a comprehensive evaluation of your specific condition and potential risks.
  2. Informed Consent: Ensure that you understand all possible complications, as the list provided here is not exhaustive.
  3. Post-surgery Plan: Discuss the long-term implications and necessary steps to reduce the risk of complications.

By keeping these considerations in mind and maintaining an open dialogue with your doctor, you can better prepare yourself for the possible risks associated with kyphosis surgery.

Typical Recovery Process and Timeline After Kyphosis Surgery

Recovering from kyphosis surgery has become more manageable thanks to advanced surgical techniques and improved instrumentation. Let’s break down what you can generally expect during the recovery period.

Immediate Post-Surgery

  • Hospital Stay: After surgery, patients usually remain in the hospital for about four to six days, although this can vary based on the surgery’s complexity and the patient’s age.
  • First Day Post-Op: Most patients can get out of bed the day after surgery. This early mobilization helps in speeding up the recovery process.

Short-Term Recovery

  • Anesthesia: General anesthesia is administered during the surgery. Post-operation, pain management is crucial and typically involves a combination of medications.
  • Brace Usage: Interestingly, many patients do not require braces post-surgery, although this can depend on individual circumstances.

Physical Therapy

  • When It Starts: Physical therapy generally begins three to six months after surgery, allowing the bones some time to heal.
  • Goals: The primary aim of physical therapy is to restore mobility, strengthen muscles, and ensure the spine remains balanced.

Long-Term Outcomes

  • Bone Quality Impact: Patients with healthy bone quality often see excellent results. Success is typically gauged by achieving a solid spinal fusion that reduces pain and lessens the spinal curve.
  • Maintaining Balance: A balanced spine is crucial for long-term health and comfort, and the surgery aims to achieve this while reducing the magnitude of the spinal curve.

By understanding these steps and timelines, patients can better prepare for the recovery journey ahead.

Recovery Time for Kyphosis Surgery

Recovery from kyphosis surgery has become more manageable with recent advancements in surgical methods and equipment.

Immediate Post-Surgery

  • Next-Day Mobility: Many patients having a posterior procedure (back incision) are encouraged to get out of bed the day after surgery.
  • Brace-Free: In some cases, patients may not need to wear a brace post-surgery, allowing for greater comfort.

Hospital Stay

  • Duration: Hospitalization typically lasts between four to six days, influenced by the extent of the surgery and the patient’s age.
  • Anesthesia: General anesthesia is administered during the procedure.

Long-Term Recovery

  • Physical Therapy: Rehabilitation usually begins three to six months after surgery, giving bones sufficient time to start healing.
  • Bone Quality Impact: Patients with good bone quality often achieve excellent results, defined by reduced pain, decreased curvature, and maintained spinal balance.

Understanding these stages helps paint a clear picture of the recovery timeline and what to expect post-surgery.

What are the Goals of Surgical Procedures for Kyphosis?

Surgical procedures for kyphosis aim to address several key objectives to improve patient health and quality of life. The primary goals include:

  • Correcting Spinal Alignment: One of the primary aims is to straighten the spine as much as possible, reducing the noticeable curvature that characterizes kyphosis.
  • Halting Deformity Progression: Surgery seeks to prevent the progression of the spinal deformity, ensuring that the condition does not worsen over time.
  • Relieving Nerve Pressure: By removing any compression on the nerves or spinal cord, the surgery helps alleviate pain and prevent further neurological issues.
  • Protecting Neural Structures: Safeguarding the nerves and spinal cord from additional damage is crucial. This helps maintain the functionality and integrity of these critical structures.

By addressing these goals, surgical intervention for kyphosis provides a comprehensive approach to managing and improving the condition.

Thoracic Kyphosis Prevention

Certain types of Kyphosis are avoidable.  Postural kyphosis, for example, is fully reliant on posture, thus, maintaining excellent posture can help you avoid developing this form of kyphosis. You must know how you stand or sit to establish proper posture. For advice on how to maintain proper posture, read the articles on the internet about Posture and Kyphosis.

There are methods to avoid Osteoporosis related kyphosis and spinal fractures. Individuals can avoid Osteoporosis by keeping their bones strong and healthy. You will help your body—and bones—by eating meals high in calcium and other essential elements. There are several other ways to avoid osteoporosis as it is one of the most preventable illnesses. In addition, there is lots of advice on how to keep your bones healthy on the internet.

On the other hand, there are no prevention techniques for Scheuermann’s kyphosis and congenital kyphosis since they are caused by structural flaws that develop regardless of what you do. The earlier you catch Scheuermann’s kyphosis, the better. Make an appointment with your doctor if you see your pre-teen or adolescent maintains bad posture. The doctor will determine if it’s Scheuermann’s kyphosis or postural kyphosis.  If it is the latter, the patient can correct the condition by relearning good posture. You may avoid structural kyphosis from having a severe impact on your spine if you discover it early enough and follow your doctor’s treatment plan.

Outcomes:

Kyphosis, on the other hand, can cause pain, create spinal deformity, and cause breathing issues in extreme cases. Doctors will recommend surgery for patients with severe kyphosis to stop spinal curvature from getting worse and address the causes.

Exercises and Stretches for Thoracic Kyphosis

Exercise, combined with good posture may help to improve a rounded upper back. To observe improvements over time exercise at least three to four times each week. Always get medical advice before starting an exercise program, and pay attention to your body’s signals. Stop if an activity or stretch generates pain.

Conclusion

Adult kyphosis is technically defined as an extreme forward curvature of the spine, notably in the upper back. This condition, in its clinical manifestation, displays a curvature that exceeds 50 degrees, leading to what is commonly described as a stooped forward posture. Hyperkyphosis, on the other hand, refers to an even more exaggerated rounding of this curvature, which is not only a variance in physical appearance but also a significant marker for potential underlying health issues. In medical discussions, kyphosis encompasses various causes including postural imbalances, spinal abnormalities, or age-related diseases.

Despite its visible alteration of the spine’s shape, kyphosis might not always present symptoms. However, doctors find vertebral fractures in roughly 40% of patients diagnosed with hyperkyphosis. Each spinal compression fracture can increase the kyphosis angle by about 3.8 degrees, intensifying the curvature and potentially exacerbating any associated health concerns. Understanding these distinctions and the progression of kyphosis into hyperkyphosis is critical for both medical professionals and patients in managing and treating the condition effectively.

Make an Appointment

The Southwest Scoliosis and Spine Institute doctors are well-versed in the options to treat Thoracic Kyphosis.  Our doctors, surgeons, technicians, and staff specialize in complex spinal conditions and have been continually recognized for their excellence.  We can see patients within 24 hours so if you suffer from pain in your neck or back, we invite you to call us for an appointment.  For our patient’s convenience, our doctors see patients in our offices in DallasPlano, and Frisco, Texas.  For your information, our board-certified, fellowship-trained surgeons have diagnosed and treated more than 100,000 patients. In addition, we have successfully performed more than 16,000 surgeries for scoliosis including complicated spine cases and revision surgeries.

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Footnote:

National Institute of Health: Kyphosis

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If you or your loved one suffers from back pain from a spinal condition, we can help. Call Southwest Scoliosis and Spine Institute at 214-556-0555 to make an appointment today.

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