Adult Kyphosis
Kyphosis of the Back
What Is It?
Our spine, when observed from the side, presents a forward curvature at the thoracic level. Kyphosis is defined as the forward bending of the thoracic spine beyond normal, commonly known as a hump. It is classified into two main categories: kyphosis that develops during childhood/adolescence and persists into adulthood, and kyphosis that develops in adulthood, mainly after middle age.
Adult kyphosis is due to the deformation of the thoracic vertebrae caused by osteoporosis and is more common in postmenopausal women.
What Are the Causes of Kyphosis?
Kyphosis in adults may be aggravated by poor posture and is frequently observed in physically inactive individuals. Idiopathic kyphosis is also very common, meaning the presence of thoracic curvature without a medical explanation. If kyphosis appears at an advanced age, it is mainly due to osteoporosis and arthritis. Particularly challenging to manage is the forward bending of the entire trunk, scientifically referred to as “loss of sagittal balance.” This may result either from significant degeneration and straightening of the lumbar spine or from failed surgeries that caused straightening. Finally, one or more osteoporotic fractures may also be a cause of kyphosis.
How Does Kyphosis Progress Over Time?
As the years pass, the likelihood of kyphosis worsening increases, and the cervical lordosis may increase correspondingly (to restore balance). When this occurs, kyphosis can also wear down the neck, leading to symptoms of cervical syndrome.
Kyphosis
What Are the Symptoms?
In adult kyphosis, the primary symptom is pain, which is quite intense and worsens during the day (fatigue-related pain).
The most common symptoms of kyphosis are:
1.
Back pain
2.
Low back pain
3.
Cervical syndrome
4.
Difficulty standing upright
An adult may have functional kyphosis that developed over time due to poor posture and dorsal muscle inactivity caused by lack of exercise.
The appearance of intense pain is the main reason someone may seek treatment, both to improve their external appearance and to relieve distressing symptoms. Patients report that, to hide the hump, they make great effort to improve their posture, which they are unable to maintain for long. There is particular strain in women with large breasts, whose weight pulls the thorax further downward.
How Is Kyphosis Diagnosed and What Is the Clinical Picture?
Kyphosis presents a specific appearance in the upper torso. The shoulders fall forward and during the forward bending test (Adam’s test), the hump becomes evident. Patients report significant difficulty standing for long periods and general stiffness of the spine.
In full-spine standing X-rays, a kyphotic angle greater than 45 degrees is visualized (which may exceed 100 degrees) in specific vertebrae. Also noted are any wedge-shaped vertebral deformities, Schmorl’s nodes, or other degenerative changes. Sagittal alignment and any deformities in the coronal plane (scoliosis) are also evaluated.
MRI is essential in adults, as it can reveal additional coexisting spinal conditions such as intervertebral disc herniation or spinal stenosis with spinal cord compression.
Kyphosis
What Is the Treatment?
Pain relief from kyphosis and posture improvement is achieved only through a specific exercise regimen based on active spinal elongation, scapular mobilization, muscle strengthening, and overall training in adopting all necessary corrections in daily life for a person with kyphosis. These exercises are determined after the physician assesses the needs, age, and capabilities of each individual.
In adults, brace application is selected only in certain cases (e.g., recent osteoporotic fracture). In these ages, the brace appears to relax rather than strengthen the muscular system.
Surgical intervention is the last resort and is chosen in cases where the curvature exceeds 65° and the patient is significantly affected in their social life.
The most common techniques are posterior spinal fusion with corrective osteotomies of kyphotic deformity, vertebroplasty – kyphoplasty, or correction of complex adult deformities with removal of part of the anterior column. These methods do not result in significant postoperative stiffness that affects daily life because this spinal segment does not have substantial motion to begin with.
Kyphosis
Surgical Treatment
Vertebroplasty – Kyphoplasty
Vertebroplasty is a method where special cement is injected to stabilize the fracture that has formed. Kyphoplasty is the same method with additional elements aiming to restore vertebral height.
Main indications for selecting these methods are osteoporotic fractures, metastatic disease, aggressive multiple myeloma, and hemangioma.
Posterior Spinal Fusion with Corrective Osteotomies of Kyphotic Deformity
This is a common surgery that begins with the placement of screws and rods to stabilize the spine and correct any deformity. Before the correction, osteotomies are performed at selected levels to achieve deformity correction. Then, bone grafts are placed on the lateral side of the spine. Over time, these grafts fuse with the spine, ensuring a unified bone mass.
Correction of Complex Adult Deformities
In this case, the spine surgeon, having completed a thorough diagnosis, chooses a combination of methods to correct complex spinal deformities. This treatment strategy typically applies to adults.
What Is Scheuermann’s Kyphosis?
In Scheuermann’s kyphosis, a wedge-shaped vertebral deformity is observed, likely due to genetic etiology. In this case, the kyphosis is markedly stiff. It is more common in boys and adolescents. Pain in advanced stages can be intense.
What Are the Key Features of Kyphosis?
The chin projects forward, while the cervical curvature is directed backward. The shoulders protrude forward, and the shoulder blades are distant from the spine.
What Does Kyphosis Treatment Depend On?
To find the appropriate treatment plan, the doctor will assess the severity of kyphosis, the intensity of the pain, and will seriously consider comorbidities and whether the patient is of advanced age or not.
