KYPHOSIS - Curving of the spine that causes a bowing of the back, such that the apex of the angle points backwards leading to a hunchback or slouching posture. - a curvature of the spine measuring 45 degrees or greater on x-ray . - Also called “ Kelso’s hunchback” or “roundback”. TYPES OF KYPHOSIS: Postural Kyphosis - Attributed to poor posture, usually presenting a smooth curve, which can be corrected by the patient. Structural Kyphosis - Caused by an abnormality affecting the bones, intervertebral discs, nerves, ligaments, or muscles. Gibbus deformity - A form of structural kyphosis. The posterior curve presents sharply angled; the curvature is not smooth. - This deformity may result in a humpback found more prominent when bending forward. Hyperkyphosis - Used to describe ‘excessive’ curvature exceeding the normal range. - Occurs in thoracic spine - Osteoporosis is a common cause in adults Scheuermann’s disease - A juvenile thoracic kyphosis. - The cause is unknown.
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KYPHOSIS- Curving of the spine that causes a bowing of the back, such that the apex of the angle
points backwards leading to a hunchback or slouching posture.- a curvature of the spine measuring 45 degrees or greater on x-ray .
- Also called “ Kelso’s hunchback” or “roundback”.TYPES OF KYPHOSIS:
Postural Kyphosis- Attributed to poor posture, usually presenting a smooth curve, which can be corrected by
the patient. Structural Kyphosis- Caused by an abnormality affecting the bones, intervertebral discs, nerves, ligaments, or
muscles. Gibbus deformity - A form of structural kyphosis. The
posterior curve presents sharply angled; the curvature is not smooth.
- This deformity may result in a humpback found more prominent when bending forward.
Hyperkyphosis- Used to describe ‘excessive’
curvature exceeding the normal range.
- Occurs in thoracic spine
- Osteoporosis is a common cause in adults
Scheuermann’s disease- A juvenile thoracic kyphosis.
- The cause is unknown.
- can caused decrease intervertebral disc space and vertebral wedging resulting in an excessive curve described as stiff or rigid.
ETIOLOGY
Kyphosis can be caused by trauma, developmental problems, or degenerative disease. Some specific causes of kyphosis are:
Infection (such as tuberculosis) Scoliosis Neurofibromatosis Connective tissue disorders Muscular dystrophy Spina bifida Disk degeneration
` The Spinal Cord is connected to the brain and is about the diameter of a human finger. From the brain the spinal cord descends down the middle of the back and is surrounded and protected by the bony vertebral column. The spinal cord is surrounded by a clear fluid called Cerebral Spinal Fluid (CSF), that acts as a cushion to protect the delicate nerve tissues against damage from banging against the inside of the vertebrae.
PHARMACOLOGICAL MANAGEMENTS: Acetaminophen – detects bone fractures and different abnormalities. NSAIDS – help to reduce swelling and inflammation
DIAGNOSTIC PROCEDURES : Bone Scan – a nuclear imaging method to evaluate any degenerative and/or arthritic
changes in the joints. X-ray - X-rays of the spine will show if there are any bony abnormalities. X-rays will also
help measure the degree of the kyphotic curve. A kyphotic curve that is more than 50° is considered abnormal.
Magnetic resonance imaging (MRI)
- a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
Computed tomography scan (Also called a CT or CAT scan.)
- a diagnostic imaging procedure that uses a combination of x-rays and that uses a combination of x-rays and computer technology to produce crosshorizontally and vertically of the body.
TREATMENT:
Orthosis (brace)
The Milwaukee brace is one particular body brace that is often used to treat kyphosis in
the US. Modern CAD / CAM 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, thoracolumbar and lumbar)
different types of braces are in use. The advantages / disadvantages of different braces are
discussed in a recent review article.[7]
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
CONSERVATIVE MANAGEMENT:
Surgery may be recommended if the kyphotic curve exceeds 75°. The goals of surgery are:
To reduce the degree of curvature by straightening and fusing the abnormal spinal segments together
To maintain the improvement over time
To alleviate significant back discomfort, if present preoperatively
Vertebroplasty and Kyphoplasty
Vertebroplasty
Percutaneous injection of polymethylmethacrylate (PMMA) into a fractured vertical body. ‡
Insertion of balloon that is inflatede in vertebral body before injection of PMMA
NURSING RESPONSIBILITIES:
1. Teach or encourage exercise as ordered.2. Provide care for patients with brace3. Provide cast/traction care4. Provide care for patients with Harrington insertion5. Promote comfort with proper fit of brace/cast6. Advise the patient to rest in bed on firm mattress or with bedboards beneath mattress for
support7. Keep pillow between flexed knees while in side-lying position-minimizes strain on back
muscles.8. Avoid prolonged periods of sitting9. Asses skin integrity and fit of brace or cast.10. Provide positive body image with brace.
