Understanding Scoliosis Types
The cervical (upper) and lumbar (lower) segments of the spine, are normally curved upward. Curvature in the opposite direction is called kyphosis. Kyphosis comes from the Greek word for “hump” and thus it is also referred to as roundback or hunchback. Hyperkyphosis (too much kyphosis) is the over-curvature of the thoracic (middle) spine.
The individual bones (vertebrae) that make up a healthy spine look like squares stacked in a column. Hyperkyphosis occurs when the vertebrae in the upper back become more wedge-shaped, curving of the spine and causing the spinal column to lose some or all of its lordotic profile. This causes a bowing of the back, which is observable as a slouching posture.
While most cases of kyphosis are mild and only require routine monitoring, serious cases can be debilitating. Severe kyphosis can present with pain and discomfort, issues with breathing and digestion, cardiovascular irregularities, neurological compromise and, in the most severe cases, shortened life-span.
Types of Kyphosis
Postural kyphosis is the most common type and can be found in children and adults. In childhood and adolescence it is commonly attributed to slouching and is reversible by correcting muscular imbalances. This can be accomplished by a combination of neuromuscular re-education and specific exercises. In older patients it is referred to as hyperkyphosis or dowager’s hump and indicates a Cobb angle greater than 40 degrees and is most common in older women. Hyperkyphosis can develop due to aging alone but roughly one third of the most severe hyperkyphosis often occurs after osteoporosis weakens spinal bones to the point that they crack and compress.
Scheuermann’s kyphosis is a visibly worse form of kyphosis and can cause varying degrees of pain. It can also affect other areas of the spine (most commonly the mid-thoracic). More commonly referred to as Scheuermann’s disease, it is found mostly in teenagers. Boys are affected more often than are girls. A patient with Scheuermann’s kyphosis cannot consciously correct posture because the apex of the curve is very rigid. The patient may feel pain at this apex, which can be aggravated by physical activity and long periods of standing or sitting. Their level of activity is significantly diminished by their condition. Whereas in postural kyphosis, the vertebrae and disks appear normal, in Scheuermann’s kyphosis, they are irregular, often herniated, and wedge-shaped over at least three adjacent levels. Fatigue is a very common symptom, most likely because of the intense muscle work required to stand and/or sit properly. The condition appears hereditary. Most patients who undergo surgery to correct kyphosis have Scheuermann’s disease.
Congenital kyphosis can result in rare cases of infants whose spinal column has not developed correctly in the womb. Vertebrae may be malformed or fused together and can cause further progressive kyphosis as the child develops. Surgical treatment may be necessary at a very early stage and can help maintain a normal curve with consistent follow-ups to monitor changes. However, the decision to carry out the procedure can be very difficult due to the potential risks to the child. A congenital kyphosis can also suddenly appear in teenage years, more commonly in children with cerebral palsy and other neurological disorders.
Nutritional kyphosis can result from nutritional deficiencies, especially during childhood, such as vitamin D deficiency which causes Rickets, a softening of the bones that results in curving of the spine and limbs under the child’s body weight.
Gibbus deformity is a form of structural kyphosis, where one or more adjacent vertebrae become wedged. Gibbus deformity can result from advanced skeletal tuberculosis and is caused by collapsed vertebral bodies. This can lead to spinal cord compression causing paraplegia, an impairment in motor or sensory function of the lower extremities.
Post-traumatic kyphosis occurs from untreated or ineffectively treated vertebral fractures.
A physical examination is required, in which the doctor will check your height and may ask you to bend forward from the waist while they veiw the spine from the side. The rounding of the upper back may become more obvious in this position. The doctor will also check your reflexes and muscle strength. Depending on symptoms, you may also need X rays to determine the degree of curvature and detect deformities of the vertebrae to identify the type of kyphosis.
If more detail is required, the doctor may order a CT scan.
If a tumor or infection is suspected, the doctor may order a MRI of your spine. MRI uses radio waves and a very strong magnet to produce detailed images of both bone and soft tissues.
If there is any numbness or muscle weakness, the doctor may recommend several tests that can determine how well nerve impulses are traveling between spinal cord and extremities.
If the kyphosis is severe, the doctor may want to check to see if the curve is interfering with breathing ability and may order tests that measure how much air your lungs can hold and how quickly the lungs empty
Treatment for kyphosis depends age, the causes of the curvature and its effects. Kyphosis can also cause back pain and stiffness in some people. Mild cases of kyphosis may produce no noticeable signs or symptoms.
Postural kyphosis can also be treated with combined neuromuscular re-education and specific exercises. Exercises that strengthen the abdominal muscles may help improve posture. In many older people, kyphosis is a sign of osteoporosis. Osteoporosis medication may help prevent additional spinal fractures that can exacerbate kyphosis.
If the kyphosis curve is very severe, particularly if the curve is pinching the spinal cord or nerve roots, surgery may be prescribed to reduce the degree of curvature. The most common of which is spinal fusion surgery, which connects two or more of the affected vertebrae permanently. Surgeons insert bits of bone between the vertebrae and then fasten the vertebrae together with metal wires, plates and screws. The complication rate for spinal surgery is relatively high and include bleeding, infection, pain, nerve damage, arthritis and disk degeneration. If the surgery fails to correct the problem, a second surgery may be needed.