Kyphosis

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management | References

Definition

Kyphosis is a spinal deformity characterised by an excessive outward curvature of the thoracic spine, leading to a hunched or rounded upper back. While a slight curve is normal, kyphosis is diagnosed when the curvature exceeds 50 degrees.

Aetiology

The causes of kyphosis vary and can be classified into several types based on their aetiology:

• Postural kyphosis: The most common type, often seen in adolescents, caused by poor posture.
• Scheuermann's kyphosis: A structural deformity seen in adolescents due to abnormal vertebral growth, leading to wedge-shaped vertebrae.
• Congenital kyphosis: Present at birth, caused by malformations in the vertebrae during fetal development.
• Osteoporotic kyphosis: Often seen in older adults, particularly women, due to vertebral fractures caused by osteoporosis.
• Traumatic kyphosis: Resulting from spinal injuries such as fractures.
• Neuromuscular kyphosis: Associated with neuromuscular disorders such as muscular dystrophy or cerebral palsy.

Pathophysiology

The pathophysiology of kyphosis involves:

• An abnormal curvature of the thoracic spine, leading to an exaggerated forward rounding
• In cases of Scheuermann's kyphosis, the anterior wedging of at least three consecutive vertebrae causes the characteristic deformity
• In osteoporotic kyphosis, vertebral compression fractures due to decreased bone density contribute to the curvature
• Postural kyphosis is primarily due to muscular imbalances and poor posture habits, leading to a flexible deformity that often improves with exercises and posture correction

Risk Factors

• Adolescence, particularly during periods of rapid growth (for Scheuermann's kyphosis)
• Female gender, especially in postmenopausal women with osteoporosis
• Poor posture habits, particularly in adolescents and young adults
• History of vertebral fractures, especially due to osteoporosis or trauma
• Presence of neuromuscular disorders, which can lead to spinal deformities
• Congenital spinal anomalies
• Family history of spinal deformities

Signs and Symptoms

The signs and symptoms of kyphosis include:

• Visible rounding or hump of the upper back
• Back pain, which may vary from mild to severe
• Stiffness in the thoracic spine
• In severe cases, breathing difficulties due to reduced lung capacity caused by the spinal deformity
• Fatigue, particularly after prolonged sitting or standing
• Limited spinal mobility and difficulty with physical activities

Investigations

Specific investigations to diagnose kyphosis include:

• Physical examination: To assess the degree of spinal curvature, posture, and any associated symptoms.
• X-rays: To measure the degree of curvature and identify the type of kyphosis. X-rays can also reveal vertebral wedging or fractures.
• MRI or CT scan: Used to assess the spinal cord and nerve roots if neurological symptoms are present or if more detailed imaging is required.
• Bone density scan (DEXA): Recommended for patients with osteoporotic kyphosis to assess bone density and the risk of fractures.
• Pulmonary function tests: May be performed in severe cases to assess the impact of kyphosis on lung function.

Management

Primary Care Management

• Postural correction: Education on proper posture and exercises to strengthen the back muscles and improve spinal alignment, particularly for postural kyphosis.
• Pain management: NSAIDs or other analgesics to relieve back pain associated with kyphosis.
• Physical therapy: Referral to a physiotherapist for exercises to improve posture, strengthen the back muscles, and increase flexibility.
• Bracing: In adolescents with Scheuermann's kyphosis, bracing may be recommended to prevent progression of the curvature during growth spurts.
• Bone health management: For osteoporotic kyphosis, ensuring adequate intake of calcium and vitamin D, and considering medications such as bisphosphonates to improve bone density.

Specialist Management

• Referral to orthopaedics or spinal specialist: For patients with severe kyphosis, significant pain, or neurological symptoms.
• Surgical intervention: Indicated in severe cases or when conservative management fails. Procedures may include spinal fusion or vertebral osteotomy to correct the curvature and stabilise the spine.
• Monitoring: Regular follow-up to monitor the progression of kyphosis, particularly in adolescents or patients with osteoporosis.
• Management of complications: Addressing any complications related to respiratory function, mobility, or quality of life due to the spinal deformity.

References

1. NHS (2024) Kyphosis. Available at: https://www.nhs.uk/conditions/kyphosis/ (Accessed: 24 June 2024).
2. National Institute for Health and Care Excellence (2024) Scoliosis and Kyphosis in Children and Young People. Available at: https://cks.nice.org.uk/topics/scoliosis-kyphosis/ (Accessed: 24 June 2024).
3. British Medical Journal (2024) Kyphosis: Clinical Features, Diagnosis, and Management. Available at: https://www.bmj.com/content/350/bmj.h3300 (Accessed: 24 June 2024).
4. American Academy of Orthopaedic Surgeons (2024) Kyphosis. Available at: https://orthoinfo.aaos.org/en/diseases--conditions/kyphosis/ (Accessed: 24 June 2024).

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