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Kyphosis (Postural roundback)

What is Kyphosis (Postural roundback)?

Known as postural roundback in common, kyphosis is the anterior curvature of the spine. Our spine is naturally curving forward on the back and it is concave in the waist area. Increase of the curvature on spine (being more than 50-60 degrees) or disappearance or flatness of the concavity on the waist (being less than 15 degrees) causes the formation of kyphosis.

What are the symptoms of kyphosis?

Symptoms of kyphosis in infants and children

Being one of the diseases which decrease living standards, kyphosis may also appear during the development in uterus. A genetic error may occur as resulted with a formation or disjunction fault on the frontal area of one or more vertebral bodies and discs in the 6th-8th weeks of the pregnancy. This error causes a sharp edge of the spine while it grows. The anterior curvature of spine is named as kyphosis and accepted as congenital. Congenital kyphosis does not pass among the family members, it occurs without a known reason. There are two main types of congenital kyphosis: formation defect and disjunction defect. Formation defect of one or more vertebral bodies (type 1 deformity) often results with a kyphosis which worsens by growth. A malformation in shape of swelling or bump which may be seen in delivery exists on the spine of baby. Disjunction defect (type 2 deformity) generally occurs with the problem of disjunction between two or more vertebral bones and formation of the round and rectangle shaped vertebral bones. This type of the congenital kyphosis often receives a late diagnosis after the child begins to walk. Whether the baby has kyphosis may be detected with the attention of family. The symptoms of kyphosis in babies are as follows:

Abnormality in arms and legs

Disproportionate body

Inequality between arms, legs and shoulders

Loss of balance

Hunchback which is seen when the child bends down

If one or some of these symptoms are detected, you should consult a doctor and have the necessary examinations immediately.

Congenital kyphosis is a rare anomaly of spine but it may lead serious consequences. When left untreated, it may cause catastrophic deformities. In a small amount of the findings, the deformity is not in progressive character. Being able to be prevented with early diagnosis to a great extent, it can be taken after control after the baby comes to the age 1 with kyphosis surgery. The best way to prevent progressive deformities is early spinal fusion.

Kyphosis in adults and its symptoms

Osteoporosis may be connected with the formation of fractures caused by the pressure in vertebral bones which resulted with kyphosis. Degenerative arthritis of spine may also cause deterioration of the situation of discs in spine. Kyphosis which occurs with aging increases the risk of fall and fracture by restricting movements. The most apparent symptom of kyphosis is anterior curvature, but some other diagnosis may also give clues about the disease:

Light or severe pain on the back

Impression of decrease in height as a result of bending of the bones

Increasing difficulties in posture

  • Feeling of tiredness in muscles
  • Over sensitivity on spine
  • Weight lose

The aim of treatment should be halting the advancement of curvature and ensuring the normal posture if possible. The treatment depends on the reason and size of the postural roundback. Your doctor will inform you about the most appropriate treatment after examining you and investigating your examinations.

Most of the time, a physical therapy to strengthen your waist, back and abdominal muscles is recommended besides pain killers, medications for osteoporosis, an appropriate nutritional regime, regular exercise and sport. In some patients who could not see any benefit of the conservative treatments, surgery may be needed. These operations vary according to the patients. By surgery, our aim is to control pain, fix the deformity and terminate the pressure on the nerve roots and spinal cord.

Symptoms of traumatic kyphosis

Kyphosis may result with restrictive pain. The sources of pain may be:

Spinal muscle tiredness

Chronic inflammation and progressive degeneration

Anterior cord or nerve pressure

Physical findings:

Progressive kyphosis occurs as a result of the loss of continuity of the anterior column and all posterior connective tissues. The problems of sitting and skin alterations of paraplegic patients may be resulted from excessive kyphosis. Late treatment is always risky and hard. The conservative treatment methods like orthosis are unsuccessful in general.

How is the diagnosis of Kyphosis (Postural roundback) made?

For the diagnosis, a specialist doctor of spine health must be consulted. The doctor makes the diagnosis of kyphosis with patient history and physical examination. The natural curvature of the spine must be between 20-45 degrees. If the spine measurement is above 45 degrees, the diagnosis of kyphosis is made. Lungs may be affected in the advanced kyphosis cases; therefore a respiratory function test may be done. Besides, a detailed imaging can be done with Mr if any other problems occurred in the body.

How is Kyphosis treated?

Postural Kyphosis

Parents usually warn their children to posture because they can do so when warned; however, children return to their hunchback position in a short time again. The repetitive warnings may result with obstination.

In order to prevent postural roundback, the underlying reasons must be eliminated. Arranging the sitting habits, ensuring the right position of the desks and chairs of children with respect to location, angle and height, and adjusting the height of monitor and keyboard are important to make them gain the suitable sitting habits. We may ensure their getting used to the ideal positions in which they may hold their spine in physiologic limits.

Another important issue is to encourage our children for doing more sportive activities. Sports will prevent postural roundback by increasing the physical condition of the child and the strength and durability of the muscles which hold the spin straight. A sportive activity of one hour in at least 3 days a week will help to solve the poor posture problem.

Progressive kyphosis

Observation

Observation is generally recommended in the following situations:

Postural kyphosis (which is caused by poor posture)

The curvatures under 60 in the growing patients

The curvatures between 60-80 in the adult patients

For the growing child, a scoliosis graphy is taken once in every 6 months. If the child has pains, an exercise program is usually recommended.

Corset

In the intermediate deformities in completed skeletal development, the recommended therapy is corset with exercise. Corsets do not fix the spine entirely. The best success of corset is prevention of the detected kyphosis from developing and reaching the surgical limit.

What are needed for a successful corset treatment?

 

  • Early diagnosis while the patient is still growing (Curvatures which are detected before the menstruation period in girls)
  • Mild-moderate Scheuermann kyphosis (between 60-75 degrees)
  • Periodical examinations made by a spine doctor
  • A suitable corset
  • An easy going patient and a supportive family
  • Continuation of the normal activities which contain exercise, dance instruction and athleticism and giving an elective break to the corset during these activities

 

Using the corset for more than 20 hours daily

In order to ensure the best healing, the corset must be controlled and adjusted periodically. A partial usage of corset (12-14 hours a day) may be recommended in the final year of the treatment before the skeletal development. Corset usage should continue for at least 18 months for an effective and permanent deformity fixation.

Surgical treatment

When the kyphotic deformity is advanced (more than 80 degrees) and the severe pains become more frequent, surgical treatment may be recommended. The most preferred method for this deformity is posterior instrumentation and fusion. Pedicle screws are placed (as 2 for each level) and tied each other with 2 rodes. This process enables the delicate healing of the spine. Most of the surgical interventions are made from the back. Some surgeons may advise for an additional operation on the front of the spine.

The moderately elastic curvatures are strengthened when the patient is weltered on the operation table. In severe curvatures, readjustments by taking a piece of spine -as called osteotomy- may be added. The backward curvature of each vertebral segment is limited by two facet joints. When these joints are taken out while the disc is active, it is possible to obtain a more backwards curvature of approximately 5-10 degrees.

The patients are made to stand up after the day of operation and discharged in approximately 4-5 days. Corset may be applied on some patients till 3 months. Returning to work or school after the operation is approximately 3 weeks.

What should be noted after kyphosis treatment?

The patients are made to stand up after the day of operation and discharged in approximately 4-5 days. Corset may be applied on some patients till 3 months. Returning to work or school after the operation is approximately 3 weeks. The exercises like walking and swimming are permitted after 3 months. Riding bicycle is permitted after 6 months. Patients can return their normal daily activities in the 4th-6th months after the operation. Contact sports (like football and basketball) are prohibited until the end of the first year. Patients are allowed to return their normal lives entirely at the end of the first year.

Why should I have kyphosis treatment in Memorial Health Group?

Memorial Health group Spine Centres provide services in global standards. We have experienced spine surgeons who can execute the treatments of specific spinal diseases in our Spine Centres. Besides, there are operation rooms with high technology equipments in our centres. Treatment success of spinal diseases is quite high in our centres where the experienced hands are accompanied with technological devices.

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