Kyphosis in a Normal Spine
Normally, the spine appears to be straight when viewed from the back. If it curves to either side, this is due to a disorder known as scoliosis. If it curves from front to back, this is known as kyphosis. Everyone’s spine should have a slight kyphosis, as the spine gently curves inward in the lower back, outward to round out the upper back, and inward again to align the neck over the hips. These natural curves balance the torso.
These normal spinal curves are slight. The lumbar, or lower part of the spine, has a concave curve known as lordosis. It should only curve inwardly between 30 to 50 degrees. In the middle back, the thoracic spine should have a convex or outward curve of only 20 to 40 degrees. The neck, the topmost section of the spine known as the cervical spine, should have an inward curve of 20 to 40 degrees. If the curve in the thoracic spine is greater than 40 degrees, this is a condition known as hyperkyphosis. When discussing deformities of the spine, the term kyphosis is often used in the place of hyperkyphosis.
Types of Kyphosis
A simple type of kyphosis is a postural curve. This means that the cause of the curve can be traced to a patient’s poor posture. The curve is not caused by an abnormality of the vertebrae. It is a flexible curve, and the patient can correct it without any need for surgical treatment. It can usually be corrected if a patient consciously maintains good back posture.
A curve that cannot be corrected by a patient’s posture alone is a structural curve. It may be a smooth curve, or it may have a sharp, angular pattern called a Gibbus. There are three main types of kyphosis that deal with a structural curve:
Congenital kyphosis is a genetic defect that occurs before birth as the embryo forms. The abnormally large curvature of the spine is a result of the front of the vertebrae either failing to form properly, or failing to segment correctly (ie separate from other vertebrae).
Developmental kyphosis occurs after birth, and is a result of the front of the vertebrae growing at a slower rate than the back. While it may begin earlier, this condition usually shows up during adolescence, particularly when the patient experiences growth spurts. The most common form of developmental kyphosis is called Scheuermann’s disease. Scheuermann’s disease does not have a known cause, but it is often hereditary.
Traumatic kyphosis can occur as a result of trauma or other neurological deficiencies, like quadriplegia or paraplegia. A patient may also experience traumatic kyphosis if another back injury is undiagnosed or not treated adequately.
Symptoms of Kyphosis
Sometimes kyphosis does not cause any pain in the back. In these cases, patients might visit their doctor for screening because they noticed a visual abnormality in their back. Kyphosis will cause a patient to bend forward, the neck craning over so that it is situated further forward than the hips. The back may be hunched and the shoulders rounded. The patient may also have a compensatory curve in the lower back as the body attempts to maintain balance.
A patient may also experience mild back pain. This may be associated with stiffness or fatigue. Adolescents and teenagers are the most likely to suffer from mild back pain due to kyphosis, as it usually decreases into adulthood. With or without back pain, a proper diagnosis must be carried out by a physician.
An examination to determine whether or not the patient has kyphosis will begin with a physical, visual assessment. After examining the patient from the sides, front, and back as he or she stands straight, the doctor will then have his or her patient do a forward bending test. This test can reveal an abnormal movement of the spine, as well show how the curves distort the back, shoulders, or neck. The doctor will also examine the patient for hamstring tightness or tenderness in the spinal muscles. These muscular problems are often experienced alongside Scheuermann’s kyphosis.
In addition to the visual check, the doctor will also order x-ray tests to further reveal the condition of the spine. The most common is an x-ray taken from the side, known as a lateral x-ray. This is taken as a patient stands normally and will reveal if the spine bends forward to an abnormal degree.
The doctor may also order an MRI, which stands for Magnetic Resonance Imaging. The MRI is often used in these cases because it also shows abnormalities in the soft tissues around the spinal column. It will reveal any problems with the nerves and discs. By using magnetic fields and radio waves, the MRI will result in a very detailed picture of the spine. The doctor can then evaluate the spine as a whole and take a look at cross sections in greater detail.
Beyond simply determining whether or not the patient has kyphosis, the doctor will also use the x-ray and MRI tests to determine the radius of the curve. If it is a large radius and a rounded curve, it is less likely to progress into a worse problem. A small radius means that the curve is sharp and angular, and this type of kyphosis is more likely to get worse.
Smaller curves that do not cause pain and are not likely to get worse may not require special treatment. The doctor will simply monitor the curve to make sure it does not progress. The patient will also be encouraged to improve his or her posture, increase calcium intake, and strengthen bones by adding an exercise plan to their daily routine.
Some curves can also be treated by using bracing. Braces do not reverse the effects of kyphosis, nor do they cure kyphosis, but they do provide support and may help a patient to develop better posture on his or her own. They may also reduce the progression of the curve as an adolescent grows.
A Milwaukee brace may be recommended; this is a full-torso brace, extending from the top of the neck down to the pelvis. It may be prefabricated or molded to fit the patient individually. It can be worn under clothing and is usually worn for the greater part of the day and often through the night as well.
If other options fail or if the curve progresses to a severe degree, surgery may be recommended. A rigid thoracic curve that exceeds 75 degrees may be cause for surgery, especially if it is progressing. A patient with disabling back pain may find relief only with surgery.
Spinal fusion surgery may be used to straighten the spine and stabilize it in position. It is both corrective and preventative. The surgeon may fuse several vertebrae together to correct the curve and may also use implants such as screws or rods to help maintain that correction. This will also prevent further progression of the curve.
As with all complex types of spine problems, Dr. Rahman has received special training to surgically manage kyphosis, and he has extensive experience performing these types of surgeries.