Kyphosis in adults : the types , causes, diagnosis , treatment , complications
Diseases Of The Spine / / April 28, 2016
word "kyphosis" describes the type of the curve in the spine.Kyphotic curve is normally present in the thoracic spine (this part of the spine in the chest area).Kyphotic curve looks like the letter "C".Although human thoracic spine should be bent if it is a curve of 40 to 45 degrees is considered abnormal (spinal deformity).
Adult kyphosis can have different symptoms and severity, from minor changes in the form of back - severe deformity, nerve problems, chronic pain.Kyphosis is the most common in the thoracic spine, although it may also affect the cervical and lumbar spine.
There are several causes of kyphosis in adults.First, the cause of congenital, which means a state of a person - with his birth.Congenital problems of the spine affect its development.The second reason - "traumatic", which means that it is caused by injury or damage to the spine.The third - "iatrogenic factors" - from the effects of treatment or surgery.
Finally, kyphosis in adults can lead to osteoporosis.Osteoporosis - a condi
kyphosis can be treated effectively.Treatments have evolved over time.Over time, they began to turn to surgery.Today there are many effective methods of treatment for the correction of severe kyphotic deformities.
As mentioned above, there is some kyphosis in the thoracic spine.Kyphotic deformity of the spine does mean that there is too much kyphotic curves in the spine.
thoracic spine consists of 12 vertebrae of the spine."Normal" curve in the thoracic spine is considered the curve from 20 to 40 degrees throughout the thoracic spine.The number of "normal" curve varies.
In order to understand the symptoms and choose the treatment, the patient should start with some fundamentals common understanding of spine anatomy, familiarize yourself with the different parts that make up the spine and work together.
Different types of kyphosis and the reasons for its development
There are many types of adult kyphosis.The main types and causes of kyphosis:
- Postural kyphosis. Postural kyphosis, or "round back", is the result of poor posture.It is most common among adolescents and young people, as they are often slouch when standing and sitting, resulting in the curve of the spine directed forward.
Postural kyphosis is often accompanied hyperlordosis (strain in the lumbar spine from the anterior bulge that occurs most often as a result of injury, disease or spinal disorders habitual posture) of the lower part of the spine.The lumbar spine, of course, has a "lordosis» «C» -shaped.Hyperlordosis mean lumbar spine compensates for excessive thoracic kyphosis by a curved line in the opposite direction.
Postural kyphosis is corrected in a prone position on a flat surface, or when the spine hyperextension.On the x-ray will not show any abnormalities of the vertebrae, as structural damage or deformation causes kyphosis.In fact, postural kyphosis is quite easy to fix with the establishment of the correct posture and the patient's learning to sit and stand.Treatment should not include restorative drugs or exercise.However, the strengthening of the back muscles can help with correct posture.
- Scheuermann kyphosis.When Scheuermann kyphosis thoracic curve, usually ranges from 45 to 75 degrees.There will also be a vertebrate seizing more than five degrees from three or more vertebrae, which are located next to each other.Vertebrae in these cases have a triangular appearance, so that they together become a wedge, and the normal space between vertebrae is reduced.
When Scheuermann's disease at the end of the victims (wedge-shaped) of the vertebrae there is also the presence of nodules SHmorlja.It hosts small hernias of intervertebral discs (cushions between each vertebra) in the vertebral endplates.A herniated disc occurs when the outer fiber disc (ring) is damaged, and soft inner material of the gelatinous nucleus pulposus escapes from its normal space.Also, there is a thickening of the anterior longitudinal ligament.The tightness of the ligaments can lead to spinal deformity.Ligaments connect bones together, including the bones of the spinal vertebrae.
reason Scheuermann kyphosis was not found, but there are many possible theories about its development.Radiologist Scheuermann suggested that the problem - in a process of "avascular necrosis" of the cartilage rings of the vertebral body.This means that the cartilage of vertebral ring breaks down due to lack of blood supply needed it.It is believed that this interrupts the bone growth in the development process, which results in tapered vertebrae.And, according to most researchers, this process is detrimental to the growth of the vertebral space.Abnormal growth that follows it, causes excessive kyphosis.For example, with a quick burst of adolescent human growth can be a vertebrate disorder, which then leads to abnormal bone growth.Many spine experts also suspect that with the mechanics of the spine problems (its structure and functioning) play a role in the occurrence of kyphosis Scheuermann.Others suggest that mild osteoporosis may contribute to bone deformities.Violations of the muscles examined as a possible cause.A high genetic predisposition to the disease means that it "works" in the family.
- Congenital kyphosis. Congenital kyphosis refers to a hereditary abnormality of the spine.This means that a person is born with some defect - such as incomplete formation of the spine, which can lead to serious abnormal kyphosis.It is also the most common non-traumatic kyphosis, with infectious paraplegia (paralysis of the lower body).
There is a large (20-30%) the association of congenital kyphosis with congenital anomalies of the urinary system of the body.If this type of kyphosis is suspected, your doctor may suggest that the patient should TTI (X-ray type, which examines the kidneys), and also to do myelogram or MRI.Myelogram and MRI are done to make sure that the spine works properly.
usually severe congenital kyphosis deformity surgery heals.If necessary, early surgery usually provides the best results, and may prevent the progression of the curve.Type of surgical procedure will depend on the nature of the anomalies.
conservative (non-surgical) treatment is planned less successful in correcting this type of kyphosis.If you choose non-surgical treatment, there is an urgent need for supervision and careful medical supervision to prevent serious problems in the future.
- Kyphosis paralytic disorder. Conditions which cause paralysis may result in kyphosis.Kyphosis is a secondary result of paralysis.The causes paralysis may include: polio, spinal muscular atrophy (deterioration, leading to paralysis) and cerebral palsy (paralysis can be caused by trauma at birth or developmental defects in the brain).Development kyphosis in these cases occurs gradually, not abruptly.
- posttraumatic kyphosis. spinal injuries can lead to progressive kyphosis and nerve problems in the spine.When there is trauma of spinal fractures in the thoracic or lumbar spine in 90% of cases this leads to varying degrees of kyphosis.Treatment of posttraumatic kyphosis may include fixing or surgery.The choice will depend on the severity of the condition.
- postoperative kyphosis. kyphosis may develop after spinal surgery, during which fixes other problems.This usually happens when the incision does not heal as expected.For example, the fusion can not heal.Unstable merger could lead to the collapse of the spine and kyphosis.spinal ligaments can heal not strong enough to support the spine and allow the spine to form a kyphotic curve.These conditions may require re-operation to try to solve the problem.
- degenerative kyphosis. There are also cases of kyphosis, which is caused by degeneration or deterioration of the lumbar (lower) spine.Over time, the degenerative process may lead to the collapse of the intervertebral disc, changing the shape of the vertebrae and the weakening of the ligaments that support the spine.This can lead to the gradual development of kyphosis for many years.After that, kyphosis begins to form even worse, because the imbalance of power is constantly increasing wear.
Other causes of kyphosis
Different types of systemic diseases can cause kyphosis, which will evolve over time.This spinal infection, cancer or tumors, which are associated with different types of spinal and systemic arthritis.This type of kyphosis is caused by changes in the spine by tissue inflammation in the area surrounding the thoracic spine.Kyphosis can also develop in people who are treated for a malignant (cancerous) disease of children's exposure of the axial skeleton.
Symptoms of kyphosis in adults
kyphosis Symptoms can range from just plain ugly to pain, a detrimental effect on the function of the lungs and heart.Kyphosis can be painful and cause pain.If a large degree of the curve, it can begin to put pressure on the spinal cord and cause problems due to compression of the spinal cord nerves.This can cause weakness in the lower extremities.Finally, if the kyphosis is in the thoracic spine, the curve may hinder breathing and also affect on heart function.
If the kyphosis is suspected in adults, the diagnosis should be made to the appropriate treatment plan.
- The history of the disease. In order to make the correct diagnosis and rule out other possible conditions, the first step is to take the history of kyphosis.The doctor may ask the following:
- Family History.Some types of kyphosis usually progresses in the family, so that it may have a genetic cause.The doctor will want to know if there is someone in the patient's family the same problems.
- Date of occurrence.When the patient first noticed the change in the state of the back?
- curve measurements.Progress.If the X-ray translucent patient's spine in the past, your doctor will want to make sure that the curve is getting worse.This can be measured by comparing the new with the old X-ray, the size of the measurement curve or by measuring changes in altitude.
- The presence or absence of pain.Not all pain are due to kyphosis.However, if there is pain, the doctor needs to know where something that gives or enhances pain, radicular pain is there, which emits the spine.This usually occurs by stimulation of nerves, as they leave the spine.
- bowel or bladder dysfunction.The doctor will inquire, whether the patient has trouble urinating or defecating?This is extremely important because it may indicate a serious nerve damage.
- Motor function.Were there any changes in the muscles?This may be the result of pressure on the spinal cord or nerves.
- Previous experience of surgery.If the patient has had any spinal surgery, they might have called kyphosis due to weakened muscles or other problems?In order to evaluate the patient's condition properly, it is important that the doctor was aware of any operation on the spine of the patient in the past.
- Physical exam. spine specialist will perform a physical examination, during which he will try to understand how to affect the patient's curve in his spine.This means that he will try to get a "mental picture" of how the spine is curved, the back and see her motor functions.The doctor will look at the patient's flexibility in certain directions.Finally, the nerves will be tested: sensation, reflexes and muscle strength of the patient.
- Additional tests . Typically, after examination of the X-rays are ordered, which allows the doctor to see the structure of the spine and measure the curve.During X-ray the patient is invited to hold certain postures - standing or lying on the table until the entire spine will be photographed.With kyphosis can have the following picture:
- Front View.This x-ray of the whole spine, taken from the front.
- Side view.This x-ray of the whole spine taken from the side.
- Side bend.This x-ray of the patient, bent to the side.
Depending on the patient's history of results, it can be assigned a physical examination and X-rays and other tests, indicating specific aspects of the spine.The most common tests - is: MRI - to see the nerves and spinal cord imaging - to get a better idea of the vertebral bone, as well as special test of nerves - to determine the nerves are irritated or pinched.
kyphosis treatment in adults
Adult kyphosis has a variety of treatment options.When possible, the first treatment option for adult kyphosis always conservative.Spine surgery - always the most extreme method of treatment, due to the risk.Conservative treatment is usually recommended include: medication, exercise, and certain types of braces for the spine support.
If osteoporosis is present, its treatment can also slow the progression of degenerative kyphosis.This can be achieved in several ways.To date, the recommendations are as follows: increase in calcium and of vitamin D, hormone replacement therapy and exercises with load.
use of spinal staples may give some relief from the pain.However, in adults, it does not straighten the spine.Once a person has reached skeletal maturity, bracing is used to relieve pain, but not for the prevention of disease.If there is a difference in leg length (or, if scoliosis causes the patient to walk a few crooked), the special shoe inserts, called "orthotics", or just comfortable shoes can reduce back pain.
- Physiotherapy. Physiotherapy and exercises are an important part of the treatment of adult kyphosis.A well-designed exercise program can also provide many patients relief from pain.A physical therapist will develop appropriate training for each specific case.It is important that the patient follow the plan.Gymnastics is useful in correcting posture and strengthening the muscles of the spine.It also contributes to improve the flexibility and range of motion of the spine.Corsets or special brackets are the treatment of choice for structural kyphosis, such as Scheuermann's disease.Types of brackets to be used depend on the nature of the curvature of the spine,
- proper body mechanics training to maintain upright posture, which counteracts aggravation kyphosis;.
- regular and harsh exercise (such as swimming);
- maintaining a high level of activity;
- daily stretching exercises.
- drug therapy. Pharmacological treatment is best administered to patients suffering from pain, simultaneously paying attention to the solution of other signs and symptoms associated with kyphosis.Typically prescribed pain relievers, such as acetaminophen, ibuprofen and naproxen.Preparations for the treatment of osteoporosis are called predotvatschat fractures of the spine, which can contribute to or worsen kyphosis.However, no treatment can not cure or directly kyphosis slow but can certainly help to alleviate the symptoms and to provide relative comfort for the patient.