Causes of kyphosis
Pathology can occur due to disorders of intrauterine development, unfavorable heredity, injuries and operations on the spine, weakness of the back muscles with insufficient physical exertion, etc. In elderly people (especially women), kyphosis often develops due to pathological compression fractures of the thoracic vertebrae. The cause of such fractures is osteoporosis - a decrease in bone density.
In addition, kyphosis can form in some infectious and non-infectious diseases: spondylitis, ankylosing spondylitis (ankylosing spondylitis) and spinal tumors. Very rarely, the cause of pathological kyphosis is radiation therapy, carried out for the treatment of malignant neoplasms in childhood.
Excessive curvature of the thoracic region has an adverse effect on both the anatomical structures of the spine itself and the organs located nearby. The volume of the chest and lung capacity decrease with maximum inspiration. Insufficient oxygen supply to the blood causes disorders of the circulatory system and other systems.
The diaphragm puts more pressure on the abdominal cavity, which disrupts the normal operation of the organs located there, in particular, constipation develops. Due to the redistribution of the load, intervertebral discs suffer, osteochondrosis occurs. With severe kyphosis, compression of the spinal cord and nerve roots is possible, accompanied by loss or weakening of sensitivity, muscle weakness and pelvic organ disorders.
Taking into account the causes of occurrence in orthopedics and traumatology , the following types of pathological kyphosis are distinguished:
- functional kyphosis (slouching);
- dorsal juvenile kyphosis (develops with Sheyerman-Mau disease);
- congenital kyphosis;
- paralytic kyphosis;
- post-traumatic kyphosis;
- degenerative kyphosis.
Taking into account the angle of curvature, normal, enhanced (with an increased angle) and straightened (with a reduced angle) kyphosis are distinguished.
Enhanced kyphosis, in turn, is divided into three degrees:
- 1 degree at which the bending angle is 35 degrees or less.
- 2 the degree at which the angle of curvature ranges from 31 to 60 degrees.
- 3 degree at which the bending angle is 60 degrees or more.
Types of kyphosis
Functional kyphosis is a manifestation of incorrect posture. It occurs due to the weak development of the back muscles or a non-physiological position during study or work. In some cases, such kyphosis is caused by psychological factors (usually in adolescents who are shy of their height). The body tends to compensate for the excessive bending of the thoracic spine posteriorly, therefore, with such kyphosis, concomitant lumbar hyperlordosis often develops (excessive bending of the lumbar spine anteriorly).
Unlike other types of kyphosis, with this pathology, excessive curvature disappears when trying to straighten your back or laying on a hard flat surface. No anomalies are detected on the radiographs. Treatment of functional kyphosis is conservative. The patient is trained to maintain the correct position while sitting, standing and walking. To strengthen the back muscles, specially designed exercise complexes (exercise therapy) are prescribed. Wearing corsets is not shown.
Dorsal juvenile kyphosis
The causes of the development of this form of kyphosis (Sheyerman-Mau disease) have not been fully studied, but it is precisely established that a certain role in its development is played by hereditary predisposition. It is assumed that kyphosis in this case occurs either due to avascular necrosis (necrosis) of the end plates (layers of hyaline cartilage between the vertebra and the intervertebral disc), or due to excessive growth of bone tissue in the vertebral bodies. There is also an assumption that kyphosis develops due to multiple micro-fractures of the vertebrae due to osteoporosis.
The bodies of three or more thoracic vertebrae in Sheyerman-Mau disease deform, become wedge-shaped (on lateral radiographs they look almost triangular). Due to the change in the shape of the vertebrae, kyphosis increases. The bend in the thoracic spine reaches 45-75 degrees.
In the early stages, patients, as a rule, do not make any complaints. As kyphosis progresses and the curvature of the spine increases, pain appears in the affected part. Due to the concomitant deformation of the chest, the act of breathing becomes difficult over time. Cardiac disorders may occur. Neurological symptoms are usually absent.
The diagnosis of dorsal juvenile kyphosis is made on the basis of anamnesis, clinical and radiographic examination. In some cases, electroneuromyography and MRI of the spine are additionally performed. Treatment is usually conservative. Massage, physiotherapy, physical therapy and manual therapy are prescribed, sometimes wearing a corset. Indications for surgery are a large angle of curvature (more than 75 degrees), persistent pain syndrome, as well as respiratory and circulatory disorders.
Congenital kyphosis is a consequence of impaired embryonic development. It occurs when anomalies appear at the stage of vertebral formation, as a result of which butterfly-shaped or wedge-shaped vertebrae, posterior half-vertebrae, micro-vertebrae, etc., are formed. Less often there are violations of segmentation (separation) into separate vertebrae.
Both "pure" kyphosis is possible, in which the spine bends only in the antero-posterior direction, and kyphoscoliosis, accompanied by curvature in the antero-posterior and lateral directions. The top of the kyphotic curvature can be located at any level - from the cervical-thoracic to the lumbar spine. Kyphosis in this disease is often progressive.
Often (in about 13% of cases) there is a combination of kyphosis with other anomalies of the spinal canal (dermoid cysts, fibrous constrictions, dermal sinuses, abnormal spinal roots, etc.), and with disorders of the development of various organs and systems (urinary, cardiopulmonary, as well as limbs, abdominal and chest walls). Usually curvature of the spine is accompanied by neurological disorders.
Radiography (survey and sighting images in various projections), CT, MRI are used as additional research methods. An X-ray contrast examination of the spinal canal may be prescribed. A neurological examination is required. Conservative treatment of congenital kyphosis is ineffective. Surgical intervention in childhood is recommended to eliminate pathological kyphosis, stabilize the spine and prevent its further deformation.
Paralytic kyphosis is caused by diseases accompanied by paresis and paralysis of the back muscles (cerebral palsy, polio, etc.). With cerebral palsy, there is an increase in thoracic kyphosis and an increase in its extent (the bend extends to the upper part of the lumbar region). Kyphosis can be combined with scoliosis. A gradual progression of deformation is characteristic. Treatment is usually conservative, complex, long-term.
The diagnosis is made on the basis of anamnesis, clinical and X-ray examination. According to the indications, patients are referred for CT and MRI. Patients are prescribed massage, physical therapy, physiotherapy, manual therapy. The operation is indicated for severe pain syndrome and violations of the function of organs located in the chest.
Fractures of the thoracic and lumbar vertebrae are the most common cause of kyphotic deformity (about 40% of all kyphoses). The risk of kyphosis depends on the severity of the injury, disorders of the musculoskeletal system (osteoporosis, weakness of the back muscles) and compliance with medical recommendations during treatment. The basis for the diagnosis is an appropriate anamnesis, clinical and radiological signs of posttraumatic kyphosis.
In some cases, kyphosis is combined with neurological disorders. Treatment is mainly surgical. In the presence of contraindications to surgery (old age, severe concomitant diseases, etc.), conservative therapy is carried out, wearing a corset is prescribed.
Degenerative kyphosis occurs as a result of degenerative disorders (osteoporosis, osteochondrosis). It is more often observed in elderly and senile women. It is often combined with previous injuries (pathological compression fractures of the vertebral bodies). Kyphosis contributes to the aggravation of degenerative changes in the spine and is progressive. Treatment is mostly conservative.
Diagnosis begins with a detailed interview and examination of the patient. The doctor (traumatologists-orthopedists are engaged in the treatment of kyphosis) studies the history of the disease, clarifies the features of the pain syndrome, pays attention to the absence or presence of neurological disorders. The examination includes palpation of the back and neck, determination of muscle strength and skin sensitivity. The specialist examines tendon reflexes and conducts special tests to assess the neurological status, performs auscultation of the heart and lungs.
A mandatory stage of the examination is radiography of the spine, which can include both direct and lateral survey images, as well as targeted radiographs in non-standard projections and with a specially selected position of the patient (for example, in conditions of stretching of the spine).
To detect pathology from the soft tissues, an MRI may be prescribed. To assess pathological changes on the part of bone structures, the patient may be referred for computed tomography.
Treatment of kyphosis
Treatment is more often conservative, includes physical therapy to strengthen the muscular corset of the back, massage and physiotherapy. Manual therapy is indicated for some patients. Wearing corsets is prescribed mainly to reduce pain. However, the constant use of corsets in most cases is not recommended, because by themselves they do not correct posture and, moreover, can cause weakening of the back muscles with subsequent aggravation of kyphosis.
The indication for surgical intervention is:
- Persistent pain syndrome that cannot be eliminated by conservative methods.
- Rapid progression of kyphosis, especially accompanied by neurological disorders, as well as impaired lung and heart function.
- A cosmetic defect that significantly reduces the quality of life of the patient and hinders the performance of professional duties.
The purpose of the operation is to correct the angle of curvature of the spine as much as possible and stop the progression of deformation, as well as eliminate compression of nerve trunks and protect them from damage in the future. Surgical operations on the spine belong to the category of complex, large-scale interventions and are performed under general anesthesia only after a full examination of the patient. Sometimes several operations are required to achieve the desired result.
Various constructions made of inert metals (titanium, titanium nickelide) are used to fix the spine. They do not cause a rejection reaction and can remain in the body without consequences for many years.