9. Scoliosis. Kyphosis. Lordosis

Kyphosis

Definition

• Increase in the forward curvature of the spine that is seen along the sagittal plane!

Etiology

• There are 3 main types of kyphosis:
• Postural- due to constant slouching (seen in adolescents)
• Scheuermann disease (juvenile)- structural deformity that occurs before puberty
• Due to discordant mineralization of the vertebral endplate!
• Congenital- further divided into failure of formation (type 1) and failure of segmentation (type 2)
• Can also be localised and generalised!

Symptoms

• Cosmetic deformity- rounded back due to excessive forward curvature of spine
• Back pain ranging from mild to severe
• Fatigue
• Increased forward posture of the head
• Uneven shoulder height
• In more severe cases, patients can have chest pain, shortness of breath, weakness, and/or loss of sensation, and bowel/bladder incontinence

Diagnosis

• Physical examination
• X-ray:
• Standard lateral X-ray
• Cobb's angle must be calculated!

Treatment

• First step is conservative treatment:
• Observation
• Physical therapy
• Use of NSAIDs
• Bracing for adolescents with kyphosis greater than 50 degrees!
• Indications for surgery:
• Pain not improving with a conservative approach
• Progressing curve
• Neurological deficits
• Cardiopulmonary compromise
• Worsening trunk deformity