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Kyphosis is an abnormally excessive convex curvature of the spine as it occurs in the
thoracic The thorax or chest is a part of the anatomy of humans, mammals, and other tetrapod animals located between the neck and the abdomen. In insects, crustaceans, and the extinct trilobites, the thorax is one of the three main divisions of the crea ...
and sacral regions. Abnormal inward concave ''lordotic'' curving of the cervical and lumbar regions of the spine is called lordosis. It can result from degenerative disc disease; developmental abnormalities, most commonly
Scheuermann's disease Scheuermann's disease is a self-limiting skeletal disorder of childhood. Scheuermann's disease describes a condition where the vertebrae grow unevenly with respect to the sagittal plane; that is, the posterior angle is often greater than the an ...
; Copenhagen disease,
osteoporosis Osteoporosis is a systemic skeletal disorder characterized by low bone mass, micro-architectural deterioration of bone tissue leading to bone fragility, and consequent increase in fracture risk. It is the most common reason for a broken bone a ...
with
compression fracture A compression fracture is a collapse of a vertebra. It may be due to trauma or due to a weakening of the vertebra (compare with burst fracture). This weakening is seen in patients with osteoporosis or osteogenesis imperfecta, lytic lesions from m ...
s of the
vertebra The spinal column, a defining synapomorphy shared by nearly all vertebrates, Hagfish are believed to have secondarily lost their spinal column is a moderately flexible series of vertebrae (singular vertebra), each constituting a characteristi ...
;
multiple myeloma Multiple myeloma (MM), also known as plasma cell myeloma and simply myeloma, is a cancer of plasma cells, a type of white blood cell that normally produces antibodies. Often, no symptoms are noticed initially. As it progresses, bone pain, ...
; or trauma. A normal thoracic spine extends from the 1st thoracic to the 12th thoracic vertebra and should have a slight kyphotic angle, ranging from 20° to 45°. When the "roundness" of the upper spine increases past 45° it is called kyphosis or "hyperkyphosis". Scheuermann's kyphosis is the most classic form of hyperkyphosis and is the result of wedged vertebrae that develop during adolescence. The cause is not currently known and the condition appears to be multifactorial and is seen more frequently in males than females. In the sense of a deformity, it is the pathological curving of the
spine Spine or spinal may refer to: Science Biology * Vertebral column, also known as the backbone * Dendritic spine, a small membranous protrusion from a neuron's dendrite * Thorns, spines, and prickles, needle-like structures in plants * Spine (zoolo ...
, where parts of the spinal column lose some or all of their lordotic profile. This causes a bowing of the back, seen as a slouching posture. Kyphosis is distinguished from
scoliosis Scoliosis is a condition in which a person's spine has a sideways curve. The curve is usually "S"- or "C"-shaped over three dimensions. In some, the degree of curve is stable, while in others, it increases over time. Mild scoliosis does not ty ...
, a condition in which the spine has a sideways curve. While most cases of kyphosis are mild and only require routine monitoring, serious cases can be debilitating. High degrees of kyphosis can cause severe pain and discomfort, breathing and digestion difficulties, cardiovascular irregularities,
neurological Neurology (from el, νεῦρον (neûron), "string, nerve" and the suffix -logia, "study of") is the branch of medicine dealing with the diagnosis and treatment of all categories of conditions and disease involving the brain, the spinal c ...
compromise and, in the more severe cases, significantly shortened life spans. These types of high-end curves typically do not respond well to conservative treatment and almost always warrant spinal fusion surgery, which can restore the body's natural degree of curvature. The term is from Greek κυφός ''kyphos'', a hump.


Signs and symptoms


Complications

The risk of serious complications from spinal fusion surgery for kyphosis is estimated to be 5%, similar to the risks of surgery for
scoliosis Scoliosis is a condition in which a person's spine has a sideways curve. The curve is usually "S"- or "C"-shaped over three dimensions. In some, the degree of curve is stable, while in others, it increases over time. Mild scoliosis does not ty ...
. Possible complications include inflammation of the soft tissue or deep inflammatory processes, breathing impairments, bleeding, and nerve injuries. According to the latest evidence, the actual rate of complications may be substantially higher. Even among those who do not develop serious complications, 5% of patients require reoperation within five years of the procedure, and in general it is not yet clear what one would expect from spine surgery during the long-term. Given that the signs and symptoms of spinal deformity cannot be changed by surgical intervention, surgery remains essentially a cosmetic choice. However, the cosmetic effects of surgery are not necessarily stable.


Diagnosis


Classification

There are several kinds of kyphosis (
ICD-10 ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO). It contains codes for diseases, signs and symptoms ...
codes are provided): * Postural kyphosis (M40.0), the most common type, normally attributed to slouching, can occur in both the old and the young. In the young, it can be called "slouching" and is reversible by correcting muscular imbalances. In the old, it may be a case of hyperkyphosis and called "dowager's hump". About one third of the most severe hyperkyphosis cases in older people have vertebral fractures. Otherwise, the aging body does tend towards a loss of musculoskeletal integrity, and hyperkyphosis can develop due to aging alone. * Scheuermann's kyphosis (M42.0) is significantly worse cosmetically and can cause varying degrees of pain, and can also affect different areas of the spine (the most common being the midthoracic area). Scheuermann's kyphosis is considered a form of juvenile osteochondrosis of the spine and is more commonly called Scheuermann's disease. It is found mostly in teenagers and presents a significantly worse deformity than postural kyphosis. A patient with Scheuermann's kyphosis cannot consciously correct posture. The apex of the curve, located in the thoracic vertebrae, is quite rigid. The patient may feel pain at this apex, which can be aggravated by physical activity and by long periods of standing or sitting. This can have a significantly detrimental effect on their lives, as their level of activity is curbed by their condition; they may feel isolated or uneasy amongst peers if they are children, depending on the level of deformity. Whereas in postural kyphosis, the vertebrae and discs appear normal, in Scheuermann's kyphosis, they are irregular, often herniated, and wedge-shaped over at least three adjacent levels.
Fatigue Fatigue describes a state of tiredness that does not resolve with rest or sleep. In general usage, fatigue is synonymous with extreme tiredness or exhaustion that normally follows prolonged physical or mental activity. When it does not resolve ...
is a very common symptom, most likely because of the intense muscle work that has to be put into standing or sitting properly. The condition appears to run in families. Most patients who undergo surgery to correct their kyphosis have Scheuermann's disease. * Congenital kyphosis (Q76.4) can result in infants whose spinal column has not developed correctly in the womb. Vertebrae may be malformed or fused together and can cause further progressive kyphosis as the child develops. Surgical treatment may be necessary at a very early stage and can help maintain a normal curve in coordination with consistent follow-ups to monitor changes. However, the decision to carry out the procedure can be very difficult due to the potential risks to the child. A congenital kyphosis can also suddenly appear in the teenage years, more commonly in children with cerebral palsy and other neurological disorders. * Nutritional kyphosis can result from nutritional deficiencies, especially during childhood, such as vitamin D deficiency (producing
rickets Rickets is a condition that results in weak or soft bones in children, and is caused by either dietary deficiency or genetic causes. Symptoms include bowed legs, stunted growth, bone pain, large forehead, and trouble sleeping. Complications ma ...
), which softens bones and results in the curving of the spine and limbs under the child's body weight. * Gibbus deformity is a form of structural kyphosis, often a ''sequela'' to
tuberculosis Tuberculosis (TB) is an infectious disease usually caused by '' Mycobacterium tuberculosis'' (MTB) bacteria. Tuberculosis generally affects the lungs, but it can also affect other parts of the body. Most infections show no symptoms, ...
. * Post-traumatic kyphosis (M84.0) can arise from untreated or ineffectively treated vertebral fractures.


Grading

Kyphosis can be graded in severity by the
Cobb angle The Cobb angle is a measurement of bending disorders of the vertebral column such as scoliosis and traumatic deformities. Definition and method It is defined as the greatest angle at a particular region of the vertebral column, when measured from ...
. Also, ''sagittal balance'' can be measured. The sagittal balance is the horizontal distance between the center of C7 and the superior-posterior border of the endplate of S1 on a lateral radiograph.


Treatments

A diagnosis of kyphosis is generally made through observation and measurement. Idiopathic causes, such as vertebral wedging or other abnormalities, can be confirmed through X-ray. Osteoporosis, a potential cause of kyphosis, can be confirmed with a bone density scan. Postural thoracic kyphosis can often be treated with posture reeducation and focused strengthening exercises. Idiopathic thoracic kyphosis due to vertebral wedging, fractures, or vertebral abnormalities is more difficult to manage, since assuming a correct posture may not be possible with structural changes in the vertebrae. Children who have not completed their growth may show long-lasting improvements with bracing. Exercises may be prescribed to alleviate discomfort associated with overstretched back muscles. A variety of gravity-assisted positions or gentle traction can minimize pain associated with nerve root impingement. Surgery may be recommended for severe idiopathic kyphosis.


Brace

Body braces showed benefit in a
randomised controlled trial A randomized controlled trial (or randomized control trial; RCT) is a form of scientific experiment used to control factors not under direct experimental control. Examples of RCTs are clinical trials that compare the effects of drugs, surgical te ...
. The
Milwaukee brace {{no footnotes, date=August 2013 The Milwaukee brace, also known as a cervico-thoraco-lumbo-sacral orthosis or CTLSO, is a back brace most often used in the treatment of spinal curvatures (such as scoliosis or kyphosis) in children but also, more ra ...
is one particular body brace that is often used to treat kyphosis in the US. Modern
CAD/CAM CAD/CAM refers to the integration of Computer-aided design (CAD) and Computer-aided manufacturing (CAM). Both of these require powerful computers. ''CAD'' software helps designers and draftsmen; ''CAM'' "reduces manpower costs" in the manufacturi ...
braces are used in Europe to treat different types of kyphosis. These are much easier to wear and have better in-brace corrections than reported for the Milwaukee brace. Since there are different curve patterns (
thoracic The thorax or chest is a part of the anatomy of humans, mammals, and other tetrapod animals located between the neck and the abdomen. In insects, crustaceans, and the extinct trilobites, the thorax is one of the three main divisions of the crea ...
, thoracolumbar, and
lumbar In tetrapod Tetrapods (; ) are four-limbed vertebrate animals constituting the superclass Tetrapoda (). It includes extant and extinct amphibians, sauropsids ( reptiles, including dinosaurs and therefore birds) and synapsids ( pelycosa ...
), different types of brace are in use, with different advantages and disadvantages. Image:kyphosis brace1.jpg, Modern brace for the treatment of a thoracic kyphosis. The brace is constructed using a CAD/CAM device. Image:kyphosis brace 3.jpg, Modern brace for the treatment of lumbar or thoracolumbar kyphosis. The brace is constructed using a CAD/CAM device. Restoration of the lumbar lordosis is the main aim.


Physical therapy

In Germany, a standard treatment for both Scheuermann's disease and lumbar kyphosis is the Schroth method, a system of physical therapy for scoliosis and related spinal deformities. It involves lying supine, placing a pillow under the scapular region and posteriorly stretching the cervical spine. In China, many people use spinal care mattresses to correct kyphosis while sleeping.


Surgery

Surgical treatment can be used in severe cases. In patients with progressive kyphotic deformity due to vertebral collapse, a procedure called a kyphoplasty may arrest the deformity and relieve the pain. Kyphoplasty is a minimally invasive procedure, requiring only a small opening in the skin. The main goal is to return the damaged vertebra as close as possible to its original height.


Society and culture


People affected by condition

*
Şehzade Cihangir Şehzade Cihangir ( ota, شهزاده جهانگير; 1531 – 27 November 1553) was an Ottoman prince, the sixth and youngest child of Sultan Suleiman the Magnificent and his wife Hurrem Sultan. Life Cihangir was born in Constantinople in 1531 ...
*
Mahmud I Mahmud I ( ota, محمود اول, tr, I. Mahmud, 2 August 1696 13 December 1754), known as Mahmud the Hunchback, was the Sultan of the Ottoman Empire from 1730 to 1754. He took over the throne after the Patrona Halil rebellion and he kept go ...
* Godfrey IV, Duke of Lower Lorraine * Benjamin Lay * Georg Christoph Lichtenberg *
Margaret of Bavaria (1442–1479) Margaret of Bavaria (1442–1479), was a Marchioness consort of Mantua, married in 1463 to Federico I Gonzaga, Marquess of Mantua.I. Lazzarini: Margherita di Wittelsbach, marchesa di Mantova. In: Dizionario Biografico degli Italiani. LXX. Istituto ...
* Pepin the Hunchback * Charles Proteus Steinmetz * Konrad II the Hunchback *
Władysław the Hunchback Władysław the Hunchback (pl: ''Władysław Garbaty''; ca. 1303/05 - 5 June 1351/April 1352), was a Polish prince, member of the House of Piast. He was Duke of Dobrzyń during 1312-1327 (until 1316 under the regency of his mother and uncle) and a ...
* Adam the Hunchback * Louis the Hunchback *
Inge the Hunchback Inge Haraldsson (Old Norse: ''Ingi Haraldsson''; 1135 – 3 February 1161) was king of Norway (being Inge I) from 1136 to 1161. Inge’s reign fell within the start of the period known in Norwegian history as the civil war era. He was never the s ...
* Topper Headon


See also

* Ehlers–Danlos syndrome * Copenhagen disease * '' The Hunchback of Notre-Dame'' ** ''The Hunchback of Notre Dame'' (1939 film) ** ''The Hunchback of Notre Dame'' (1996 film) * ''
Igor Igor may refer to: People * Igor (given name), an East Slavic given name and a list of people with the name * Mighty Igor (1931–2002), former American professional wrestler * Igor Volkoff, a professional wrestler from NWA All-Star Wrestling * ...
'' * Loeys–Dietz syndrome * Pott disease


References


External links


Kypho
definition and other related medical terms {{Congenital malformations and deformations of musculoskeletal system Congenital disorders of musculoskeletal system Deforming dorsopathies External signs of ageing