Kyphosis is the term used to describe a type of abnormal curve in
the spine. The thoracic spine naturally has some kyphosis or "C"-shaped
curve. A kyphotic spinal deformity means there is too much forward
curve in the spine.
Adult kyphosis can have varying symptoms and degrees of severity,
from minor changes in the shape of your back to severe deformity, nerve
problems, and chronic pain. Kyphosis is most common in the thoracic
spine, though it can also affect the cervical and lumbar spine.
Methods of treating kyphosis have evolved over time. Today there are
numerous effective treatment options for correcting a severe kyphotic
deformity.
Learn about adult kyphosis including
- what parts of the spine are affected
- how doctors classify the various types of kyphosis
- what causes the condition
- how kyphosis can be treated
History
In order to make a proper diagnosis and rule out other possible conditions,
the first step is to take a history. If kyphosis is suspected, your doctor will want to know about the following specific things:
- Family History - Some types of kyphosis tend to run in families, so
it may have a genetic cause. Your provider will want to know if anyone
else in the family has the problem.
- Date of Onset - When did you first notice the appearance of the spinal condition?
- Measured Curve Progression - If X-rays have been taken of your
spine in the past, the doctor will want to see if the curve is getting
worse. This can be measured comparing new X-rays with old ones,
measuring the size of the curve, or measuring changes in your height.
- The Presence or Absence of Pain - Not all cases of kyphosis produce
pain. If there is pain, your doctor needs to know where it is, what
brings it on or intensifies it, and if there is any radicular pain
(radiates away from the spine). This usually comes from irritation of
the nerves as they leave the spine.
- Bowel or Bladder Dysfunction - Are you having problems knowing when
you have to urinate or have a bowel movement? This is extremely
important because it could signal the presence of pressure on the
spinal cord or the nerves that go to the pelvis.
- Motor Function - Has there been a change in how your muscles work?
This may be the result of pressure on the nerves or spinal cord.
- Previous Surgery - If you have had any surgery on your spine, it
may have caused the kyphosis due to weakened muscles or other problems.
In order to evaluate your condition properly, it is important that your
physician knows about any spinal surgery you have had in the past.
Physical Exam
You will then be given a physical exam.
Your doctor will want to get an understanding of the curve in your back
and how it is affecting you. This means first trying to get a "mental
picture" of how the spine is curved from examining your back and
watching you move. The doctor will look at the flexibility you have by
asking you to bend in certain directions. Your doctor will generally be
looking for abnormalities in the following areas:
- Spine Movement - Is there pain when you twist, bend, or move? If so, where? Have you lost flexibility?
- Strength - The strength of your muscles will be tested. You
might be asked to try to push or lift your arm, hand, or leg against
resistance.
- Pain - The doctor may try to determine if you have tenderness in certain areas.
- Sensation - Can you feel certain sensations in specific areas of your feet or hands?
- Reflexes - Your tendon reflexes might be tested, such as below the kneecap and in the Achilles tendon behind your ankle.
- Motor Skills - You might be asked to walk on your heels or toes.
- Special Signs - Your doctor will also check for any indicators of
something other than spinal/vertebrae problems. Some signs of other
problems include tenderness in certain areas, a fever, an abnormal
pulse, chronic steroid use (leads to loss of bone mass), or rapid
weight loss.
Diagnostic Tests
Usually after the exam, X-rays
will be ordered that allow your doctor to see the structure of the
spine and measure the curve. You will be asked to hold very still in
certain positions while standing or lying on a table. If thoracic
kyphosis is suspected, the following images may be taken:
- Front view of the entire spine taken from the front
- Lateral view of the entire spine taken from the side
- Extension view of the spine while you are bending backwards
Depending on the outcome of your history, physical exam, and initial
X-rays, other tests may be ordered to look at specific aspects of the
spine. The most common tests that are ordered are: an MRI scan to look at the
nerves and spinal cord; a CT scan
to get a better picture of the vertebral bones; and special nerve tests
to determine if any nerves are being irritated or pinched.
Conservative Treatment
Adult kyphosis has a variety of treatment options. Body casts were
originally used to treat adult kyphosis. Treatment later turned to
surgery. Today, conservative treatments are chosen first whenever
possible. Conservative treatments commonly include medications,
exercise, and certain types of braces to support the spine. Spinal
surgery will generally be the last treatment choice due to the risks
involved.
If osteoporosis
is present, treatment of the condition may also slow the progression of
the degenerative kyphosis. This can be accomplished in several ways.
The current recommendations include increasing calcium and vitamin D
intake, hormone replacement therapy, and weight-bearing exercises.
Learn more about preventative measures for osteoporosis.
The use of a spinal brace may provide some pain relief. However, in
adults, it will not cause the spine to straighten. Once you have
reached skeletal maturity, bracing is used for pain relief rather than
prevention. Learn more about braces used to treat back problems.
Physical Therapy
Your doctor may have you work with a physical therapist. A
well-rounded rehabilitation program assists in calming pain and
inflammation, improving your mobility and strength, and helping you do
your daily activities with greater ease and ability.
Exercise has not proven helpful for changing the kyphotic curve in
the back. However, it can be helpful in providing pain relief. Therapy
sessions may be scheduled two to three times each week for up to six
weeks.
The goals of physical therapy are to help you
- learn correct posture and body movements to counteract the effects of kyphosis
- maintain appropriate activity levels
- maximize your range of motion and strength
- learn ways to manage your condition
Surgical Treatment
Surgery for adult kyphosis has some significant risks. For this
reason, surgery is only recommended when the expected benefits far
outweigh the risks. Surgery will not be recommended for most cases of
kyphosis but may be recommended in the following situations:
Pain
The most common reason for kyphosis surgery is pain relief for
chronic discomfort that keeps getting worse. Most cases of adult
kyphosis surgeries are done to relieve severe pain. However, if the
pain is manageable through conservative treatments, surgery will
probably not be recommended.
Progression of Curve
Progression of the kyphosis deformity is another reason for
considering surgery. If the curvature continues to worsen, surgery may
be suggested. Surgery is recommended in this situation to prevent the
problems that come from severe kyphosis.
Cosmetics
In most cases of kyphosis, surgery will not be recommended merely
for the sake of appearance. However, in some cases, the kyphosis causes
physical deformity that is unbearable to the patient. In these cases,
surgery becomes the only option for correcting the condition. Most
cases of cosmetic kyphosis surgery are in young adults that have very
noticeable curves.
Procedure
When adult kyphosis requires surgery, doctors have many different
procedures from which to choose. Each case of kyphosis is somewhat
different and may require a very specialized approach for optimal
results. Surgery is suggested to solve the problems brought on by the
kyphosis, not just to straighten the spine. The goals of most surgical
procedures for adult kyphosis are to
- reduce the deformity (straighten the spine as much as possible)
- stop the progression of the deformity
- remove any pressure from the nerves and spinal cord
- protect the nerves and spinal cord from further damage
To achieve these goals, your surgeon may suggest an operation on the
back of the spine, the front of the spine-or both. The goal is to first
straighten the spine and then to fuse the vertebrae together into one
solid bone.
Nearly all surgeons will use some type of metal screws, plates, or
rods, in order to help straighten the spine and hold the vertebrae in
place while the fusion heals and becomes solid. The screws are placed
into the vertebrae. The rods or plates then attach to the screws to
connect everything together. Tightened together, they form an internal
brace to hold the vertebrae in alignment while the fusion heals.
