Get comprehensive information on kyphosis, including causes, symptoms, types, and physiotherapy options. Learn about thoracic kyphosis and Scheuermann's kyphosis

Kyphosis

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ZAKA CLINIC GULBERG LAHORE

Saad Ullah Siddiqui

Overview

Kyphosis is a medical condition characterized by an abnormal curvature of the spine, causing a forward rounding of the upper back. 
&nbsp;

The term kyphosis comes from the Greek word &quot;kyphos,&quot; meaning &quot;hump&quot;.

Normally, the spine has 20-45 degrees of a forward bend. In kyphosis, the curvature of the spine exceeds 45 degrees, causing an abnormally curved or hunched back. Therefore, the condition is sometimes called &lsquo;hunchback&rsquo; or &lsquo;round back&rsquo;. This excessive forward curvature is also referred to as hyperkyphosis.

Although it can affect people of any age, teenagers are more commonly affected due to their rapidly growing bones. In older adults, age-related changes in the vertebrae cause the spine to tilt forward. Moreover, some people may be born with the condition.

&nbsp;

The prevalence of kyphosis is approximately 20%-40% in adults aged 60 years or more<a href="#accordion">[2]</a>. Although both genders are at risk, females report more cases, especially during <a href="https://merisehat.pk/disease/menopause">menopause</a>.

In general, the altered spinal alignment in kyphosis can result in changes in the distribution of weight and pressure in the spine, which can lead to increased stress on certain structures such as the intervertebral discs, facet joints, and spinal ligaments. This can in turn cause pain, stiffness, and decreased mobility in the affected areas. Approximately 40% of people with hyperkyphosis develop vertebral fractures<a href="#accordion">[3]</a>. 
&nbsp;

According to the American Academy of Orthopaedic Surgeons, there are several types of kyphosis, including<a href="#accordion">[1]</a> <a href="#accordion">[3]</a>: 
&nbsp;

<ol>
	<li>Postural Kyphosis: This is the most common type of kyphosis, which is usually seen in adolescents and young adults. It is caused by poor posture, slouching, or carrying heavy backpacks. The curve can be corrected by asking the patient to stand up straight. Postural kyphosis can also occur in older adults, due to reduced muscle strength.</li>
	<li>Scheuermann&#39;s Kyphosis: This type of kyphosis is caused by a structural problem in the spine. It usually develops during adolescence and affects the thoracic spine (upper back). The cause is unknown, but it may be due to genetics or environmental factors. Unlike postural kyphosis, Scheuermann&rsquo;s kyphosis can result in severe deformity.</li>
	<li>Congenital Kyphosis: This type of kyphosis is present at birth and is caused by a developmental abnormality in the spine. It typically worsens with age.</li>
	<li>Age-related Kyphosis: This type of kyphosis is caused by the wear and tear of the spine due to aging or other conditions, such as osteoporosis. 
	&nbsp;</li>
</ol>
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Signs and Symptoms

The signs and symptoms of kyphosis can vary depending on the severity of the curvature and the underlying cause of the condition. Some common signs and symptoms of kyphosis include: 
&nbsp;

<ol>
	<li>A Visible Hump On The Back: The most obvious sign of kyphosis is a visible hump on the upper back. This hump is caused by the forward curvature of the thoracic spine. 
	&nbsp;</li>
	<li>Back Pain: People with kyphosis may experience back pain, particularly in the upper back and neck. The pain may be worse with activity or prolonged sitting. 
	&nbsp;</li>
	<li>Stiffness: Kyphosis can cause stiffness and limited mobility in the spine, making it difficult to move or bend. 
	&nbsp;</li>
	<li>Fatigue: People with kyphosis may experience fatigue and decreased endurance due to the added effort required to maintain a proper posture. 
	&nbsp;</li>
	<li>Breathing Difficulties: Severe kyphosis can compress the lungs and make it difficult to breathe deeply. This can cause shortness of breath, wheezing, or chest pain. 
	&nbsp;</li>
</ol>
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Causes

Kyphosis refers to the excessive curvature of the spine, which can be caused by a variety of factors such as poor posture, spinal degeneration, or certain medical conditions. The exact mechanism of action of kyphosis depends on the underlying cause of the condition. However, the common feature of all forms of kyphosis is an alteration in the normal alignment of the spine, which can result in changes in the biomechanics of the spine and surrounding structures.

In postural kyphosis, for example, the mechanism of action is primarily related to habitual poor posture, which can result in a forward position, rounded shoulders, and increased thoracic curvature. Over time, these changes in posture can lead to muscle imbalances, joint stiffness, and decreased mobility in the spine, which can exacerbate the curvature.

In contrast, in Scheuermann&#39;s kyphosis, the mechanism of action is thought to involve structural changes in the vertebrae themselves. This condition is characterized by wedging of the vertebrae in the thoracic spine, which can increase kyphotic curvature. The exact cause of this wedging is not well understood, but it may be related to abnormal growth patterns in the spine during adolescence.

Kyphosis can be caused by a variety of other factors, including: 
&nbsp;

<ol>
	<li>Congenital: Kyphosis can be present at birth due to abnormal development of the spine.</li>
	<li>Neuromuscular Conditions: Conditions that affect the nerves and muscles, such as cerebral palsy or muscular dystrophy, can lead to kyphosis.</li>
	<li>Osteoporosis: Kyphosis can develop in individuals with osteoporosis, a condition in which bones become weak and brittle.</li>
	<li>Spinal Tumors: Tumors that develop in the spine can cause kyphosis.</li>
	<li>Trauma: Injuries to the spine, such as fractures or dislocations, can cause kyphosis.</li>
	<li>Degenerative Changes: Degenerative changes in the spine due to aging, such as spinal stenosis or arthritis, can lead to kyphosis. 
	&nbsp;</li>
</ol>
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There are no specific screening tests for kyphosis. However, forward bending of the spine is often visible in children and adolescents, especially when sitting. The doctor may perform the following tests during a physical exam to look at the child&rsquo;s spine: 
&nbsp;

<ol>
	<li>Adam&#39;s Forward Bend Test: During this test, the individual is asked to bend forward at the waist with arms hanging loosely, feet together, and knees straight. The examiner observes the spine from behind for any asymmetry or hump formation.</li>
	<li>Spinal Extension Test: In this test, the individual is asked to lie on their stomach with their hands at their sides. The examiner then lifts the individual&#39;s chest off the ground to observe the curvature of the spine.</li>
	<li>Plumb Line Test: This test assesses the alignment of the spine and pelvis. The individual stands with their back against a wall and a plumb line is dropped from the center of the ear down to the floor. The examiner observes the alignment of the spine and pelvis with the plumb line. 
	&nbsp;</li>
</ol>

It is important to note that screening tests for kyphosis are not diagnostic and should be used in conjunction with a comprehensive medical evaluation. A thorough medical history, physical examination, and imaging studies may be necessary to accurately diagnose and treat kyphosis. 
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Diagnosis

The diagnosis of kyphosis involves a comprehensive medical evaluation that includes a detailed medical history, physical examination, and imaging studies. Imaging studies are used to confirm the presence of kyphosis and to determine the severity of the curvature. The most commonly used imaging studies for diagnosing kyphosis include: 
&nbsp;

<ol>
	<li>X-rays: X-rays are the most commonly used diagnostic test for kyphosis. They can provide a detailed image of the spine and help determine the degree and severity of the curvature. 
	&nbsp;</li>
	<li>Magnetic Resonance Imaging (MRI): MRI is a non-invasive imaging test that uses a magnetic field and radio waves to create detailed images of the spine. It is often used to evaluate the underlying cause of kyphosis, such as a spinal cord injury or degenerative disc disease. 
	&nbsp;</li>
	<li>Computed Tomography (CT) Scan: CT scans use X-rays and computer technology to create detailed cross-sectional images of the spine. They are often used to evaluate the bony structures of the spine and can help identify any abnormalities that may be causing kyphosis. 
	&nbsp;</li>
	<li>Bone Densitometry: Bone densitometry is used to measure bone density and can help identify any bone loss that may be contributing to the development of kyphosis. 
	&nbsp;</li>
</ol>
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Treatment

The treatment plan for kyphosis depends on the severity of the curvature, the underlying cause, and the age and overall health of the patient. Mild cases of kyphosis may not require any treatment, while more severe cases may require surgery. The following are some common treatment options for kyphosis: 
&nbsp;

<ol>
	<li>Observation And Monitoring: In mild cases of kyphosis, observation, and monitoring may be all that is needed. Regular follow-up visits with a healthcare provider may be recommended to monitor the progression of the curvature. Pain medications may be prescribed to relieve any back pain. 
	&nbsp;</li>
	<li>Physical Therapy And Exercise: Physical therapy and exercises that focus on strengthening the muscles supporting the spine may be recommended. This can help improve posture and reduce pain. 
	&nbsp;</li>
	<li>Bracing: Bracing may be recommended for patients with moderate to severe kyphosis to prevent further progression of the curvature. The type of spine brace used will depend on the location and severity of the curvature. Children with Scheuermann&rsquo;s disease are usually given a spine brace while their bones are growing to stop the progression of the disease. 
	&nbsp;</li>
	<li>Surgery: Surgery may be recommended for patients with severe or progressive kyphosis that is causing pain, difficulty breathing, or other complications. The goal of surgery is to straighten the spine and prevent further curvature. Spinal fusion is most commonly performed for kyphosis. 
	&nbsp;</li>
</ol>
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Kyphosis can lead to several complications, especially if left untreated or if it is severe. Some of the most common complications of kyphosis include: 
&nbsp;

<ol>
	<li>Chronic Pain: Kyphosis can cause chronic pain, especially in the neck, shoulders, and back.</li>
	<li>Limited Mobility: Severe kyphosis can lead to limited mobility and difficulty performing daily activities, such as walking or bending.</li>
	<li>Digestive Problems: Severe kyphosis can compress the stomach and intestines, leading to digestive problems, such as <a href="https://merisehat.pk/disease/constipation">constipation </a>and indigestion.</li>
	<li>Neurological Complications: In rare cases, severe kyphosis can compress the spinal cord, leading to neurological complications, such as weakness, numbness, or tingling in the arms or legs.</li>
	<li>Emotional Distress: Kyphosis can also cause emotional distress, especially in children and adolescents who may be self-conscious about their appearance. 
	&nbsp;</li>
</ol>

It is important to note that not everyone with kyphosis will experience these complications, and the severity of complications can vary depending on the degree and location of the spinal curvature. Early diagnosis and appropriate treatment can help prevent or reduce the risk of complications. 
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There are several risk factors associated with the development of kyphosis. Some of the most common risk factors include: 
&nbsp;

<ol>
	<li>Age: Kyphosis is more common in older adults, as the spinal column can degenerate over time, leading to curvature of the spine.</li>
	<li>Gender: Women are more likely than men to develop kyphosis, especially after menopause.</li>
	<li><a href="https://merisehat.pk/disease/osteoporosis-80">Osteoporosis</a>: Osteoporosis, a condition characterized by low bone density and increased risk of fractures, can contribute to the development of kyphosis.</li>
	<li>Poor Posture: Poor posture can put excessive strain on the muscles and bones of the back, leading to curvature of the spine over time.</li>
	<li>Congenital Or Developmental Conditions: Some congenital or developmental conditions, such as <a href="https://merisehat.pk/disease/scoliosis">scoliosis</a>, can increase the risk of developing kyphosis.</li>
	<li>Spinal Cord Injuries Or Diseases: Spinal cord injuries or diseases, such as spinal tumors, can affect the alignment of the spine and contribute to the development of kyphosis.</li>
	<li>Certain Medications: Long-term use of certain medications, such as steroids, can weaken the bones and increase the risk of developing kyphosis. 
	&nbsp;</li>
</ol>

While there is no guaranteed way to prevent kyphosis, there are several factors that may help reduce the risk of developing the condition. Some preventive factors include: 
&nbsp;

<ol>
	<li>Maintaining A&nbsp;Good Posture: Practicing good posture can help reduce the strain on the muscles and bones of the back, which can help prevent kyphosis.</li>
	<li>Engaging In Regular Exercise: Regular exercise can help improve posture, strengthen the muscles supporting the spine, and improve overall bone health.</li>
	<li>Eating A&nbsp;Healthy Diet: Eating a diet rich in calcium, vitamin D, and other nutrients necessary for bone health can help reduce the risk of developing osteoporosis, which can contribute to the development of kyphosis.</li>
	<li>Quitting Smoking And Alcohol Consumption: Smoking and excessive alcohol consumption can contribute to the weakening of bones and increase the risk of developing osteoporosis.</li>
	<li>Seeking Treatment For Underlying Conditions: Treating underlying conditions that can contribute to the development of kyphosis, such as scoliosis or osteoporosis, can help reduce the risk of developing the condition. 
	&nbsp;</li>
</ol>

Key Points

<ul>
	<li>Kyphosis is a medical condition characterized by an abnormal curvature of the spine, causing a forward rounding of the upper back.</li>
	<li>&nbsp;The exact mechanism of action of kyphosis depends on the underlying cause of the condition.</li>
	<li>&nbsp;In postural kyphosis, for example, the mechanism of action is primarily related to habitual poor posture, which can result in a forward head position, rounded shoulders, and increased thoracic curvature.</li>
	<li>The most obvious sign of kyphosis is a visible hump on the upper back. This hump is caused by the forward curvature of the thoracic spine.</li>
	<li>People with kyphosis may experience fatigue and decreased endurance due to the added effort required to maintain a proper posture.</li>
	<li>&nbsp;Compression of the internal organs in the chest can also cause digestive issues such as abdominal pain, bloating, and constipation.</li>
	<li>Conditions that affect the nerves and muscles, such as cerebral palsy or muscular dystrophy, can lead to kyphosis.</li>
	<li>X-rays are the most commonly used diagnostic test for kyphosis.</li>
	<li>&nbsp;In mild cases of kyphosis, observation, and monitoring may be all that is needed.</li>
	<li>Bracing may be recommended for patients with moderate to severe kyphosis to prevent further progression of the curvature.</li>
	<li>Kyphosis can cause chronic pain, especially in the neck, shoulders, and back.</li>
	<li>&nbsp;Severe kyphosis can compress the stomach and intestines, leading to digestive problems, such as constipation and indigestion.</li>
	<li>Women are more likely than men to develop kyphosis, especially after menopause.</li>
	<li>Some congenital or developmental conditions, such as scoliosis, can increase the risk of developing kyphosis.</li>
	<li>Eating a diet rich in calcium, vitamin D, and other nutrients necessary for bone health can help reduce the risk of developing osteoporosis, which can contribute to the development of kyphosis. 
	&nbsp;</li>
</ul>