A kyphosis ( Greek κύφωσις , literally “hump”, from κύφος kýphos , “hump”; popularly also called widow's or witch's hump among women ) is a backward ( dorsal ) convex curvature of the spine that is increasingly convex . Naturally, kyphosis occurs in the chest area (breast kyphosis) and at the end of the spine as a small kyphosis, the so-called sacral cyphosis. Only when the kyphosis is pathologically intensified, in this case that of the thoracic spine, one speaks of a hunched back , hyperkyphosis , a hump or, in the case of a circumscribed curvature of the spine in a sharp kink, a gibbus in Latin . The Cobb angle (after John Robert Cobb ) is used as a measure for assessing kyphosis. Often the more clearly defined and thus better reproduced Stagnara angle is used between the base plate TH12 and cover plate TH4. The normal range is 30–50 °.
To speak of kyphosis, the curvature should be present in the thoracic spine while standing . The kyphotic expression of the thoracic spine depends on personal anatomical peculiarities, but is - at least in the population of industrialized countries - generally too developed.
Due to the lack of carefree walking, incorrect sitting and standing, the muscles of the musculoskeletal system are unable to maintain the upright natural posture . Therefore, the vertebral vibrations usually sink ( lordosis - kyphosis). This leads to a curvature of the back, visible as a crooked posture. If this harmful posture is not compensated for by alternative activities, the crooked posture manifests itself and leads to considerable damage in the long term.
In older people, osteoporosis can lead to sintering fractures of the vertebral bodies , so that wedge vertebrae and thus overall hyperkyphosis form. Kyphosis, also called humpback or hunchback, is a common condition of a curvature of the upper back. It can either be the result of degenerative diseases (such as arthritis , ankylosing spondylitis ), developmental disorders ( the most common example of this is Scheuermann's disease ), osteoporosis with compression fractures of the vertebral bodies and / or injuries (post-traumatic kyphosis).
In the sense of a malformation, it is the pathological curvature of the spine, whereby parts of the spine can also lose their lordotic profile, and a flat back or even kyphosis of the lumbar spine develops.
There are different types of kyphosis (according to ICD-10 codes):
- Postural kyphosis (M40.0), the most common form, usually crooked posture, can occur in both old age and adolescence. In youth, it can be called crooked posture and is reversible by correcting muscular imbalances. In old age it can be called hyperkyphosis or widow's hump . Over a third of the most severe cases of hyperkyphosis have vertebral fractures. Otherwise, the aging body is prone to a loss of musculoskeletal integrity and can develop kyphosis from aging alone.
- Scheuermann's kyphosis (M42.0) is significantly worse cosmetically, can cause pain of varying degrees and can also affect different areas of the spine (the most common being the mid-thoracic area). Scheuermann's disease is a form of juvenile osteochondrosis of the spine. It is found mainly in adolescents and presents a significantly worse malformation than postural kyphosis. A patient with Scheuermann's kyphosis cannot consciously adopt a correct posture. The apex of the curve, located in the thoracic spine, is quite rigid. Patients may feel pain at this vertex, which can be aggravated by physical activity and prolonged standing or sitting. This can have a very negative impact on their lives as it reduces the level of activity; Affected children may feel isolated or uncomfortable among their peers, depending on the degree of the deformity. While vertebral bodies and intervertebral discs appear normal in the case of postural damage, in Scheuermann's kyphosis they are irregular, often protruding and wedge-shaped over at least three adjacent levels. Fatigue is a very common symptom, probably because of the intense muscular work it takes to stand and sit properly. The disposition for this seems to run in the families. Most patients who undergo surgery to correct their kyphosis suffer from Scheuermann's disease.
- Congenital kyphosis (Q76.4) in infants can be the result of an incorrect development of the spine in the womb. Vertebrae can be malformed or fused together, which can cause the child to develop progressive kyphosis. Surgical treatment may be necessary at a very early stage and will help maintain a normal curve in coordination with consistent follow-up to monitor changes. However, due to the potential risks to the child, making a decision about performing the procedure can be very difficult. Congenital kyphosis can also appear suddenly in teenagers, more often in children with cerebral palsy and other neurological disorders.
- Nutritional kyphosis can result from malnutrition, especially during childhood, such as vitamin D deficiency (creating rickets ) which leads to softening of bones and, as a result, bending of the spine and limbs below the child's weight.
- Gibbus-forming deformity is a form of structural kyphosis, often a sequela of tuberculosis .
- Post-traumatic kyphosis (M84.0) following untreated or ineffectively treated vertebral fractures.
While many cases of kyphosis only require routine monitoring and conservative treatment, other cases can lead to severe pain and discomfort, difficulty breathing and digestion, cardiovascular irregularities, neurological impairment, and also a significantly reduced life expectancy. These cases usually do not respond well to conservative treatment but almost always warrant spinal fusion in order to successfully restore the body's natural degree of curvature.
“Inadequate repositioning or increasing or recyphosing are difficult or even impossible to compensate muscularly, especially in TLÜ, and even at low Cobb angles (<15–20 °) lead to static loads on the sections of the spine above or below the deformity. These post-traumatic misalignments are therefore an indication for revision surgery "
Corsets showed benefit in a randomized controlled study .
The Milwaukee corset is a special type of corset that is often used in the United States to treat kyphosis. Modern CAD / CAM corsets are used in Europe to treat different types of kyphosis. These are much easier to wear and more corrective than the Milwaukee corset. Since different curves (thoracic, thoracic and lumbar spine) have been known, different types of corsets are in use. The advantages and disadvantages of the different corsets are discussed in an overview.
Regular physiotherapeutic exercises (training of the autochthonous back muscles and chest muscles) contribute significantly to achieving a permanent straightening of the spine. 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 according to Katharina Schroth . This includes three-dimensional exercise techniques for straightening the spine, breathing therapy for increasing the breathing volume and movement strategies for everyday life.
Consequences of kyphosis
Possible consequences of kyphosis and the resulting static imbalance of the spine are (depending on the cause):
- chronic pain, sleep disorders
- structural changes in the vertebral bodies
- Disorders of the internal organs (especially lungs - decrease in breathing volume, heart)
- Risk of secondary fractures (in the case of kyphosis after WK fracture caused by osteoporosis )
- Limited mobility
- Sensory disturbances
- Increase in curvature
- Damage to the spinal cord
- cosmetic disfigurement with psychological stress
Possible complications of spinal fusion in kyphosis can be inflammation of the soft tissues or deep inflammatory processes, impaired breathing, bleeding and nerve injuries. According to the latest research, the actual rate of complications can be significantly higher. Even among those who do not have significant complications, 5% of patients require reoperation within five years.
If a decision is made to have surgery, preference should be given to a specialized center.
- Intervertebral disc
- WS syndrome
- Posture test according to Matthiass
- The hunchback , people named after their kyphosis
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