Kyphosis Treatment

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What is Kyphosis?

In the normal human spine, there is a degree of kyphosis in the thoracic spine; there is a degree of lordosis in the cervical and lumbar spine. Kyphosis is defined as an increase in the forward curvature of the spine seen in the sagittal plane (side view of the spine), while lordosis is an increase in the backward curvature seen in the sagittal plane (side view of the spine). When the forward curvature becomes excessive, it is called hypercyphosis. It should be noted that this differs from scoliosis, which is the curvature of the spine along the anterior-posterior plane. Factors that cause curvature can be considered as collapse or disfigurement of one or more vertebral bodies, inter-vertebral disc disorder, or a number of congenital deformities of the spine.
The natural course of kyphosis is not exactly known, but it is more common in women than in men and the amount of curvature in the thoracic spine increases from the age of 40. Kyphosis usually develops in the thoracic spine (back), while it is also possible to develop kyphosis in the cervical spine (neck) or lumbar spine (waist).
The 4 main types of kyphosis usually seen in individuals are postural kyphosis, kyphosis in the elderly, Scheuermann's disease and congenital deformities.
Postural kyphosis usually begins to occur in adolescents, and women are more affected compared to men. Humpback posture increases curvature. This, in turn, stretches the extensor muscles of the back and the posterior ligaments of the spine, thereby weakening the muscles over time. In postural kyphosis, the patient usually has normal vertebral structures and is usually benign.
Kyphosis, which occurs in the elderly, can contribute to impaired muscle integrity and poor posture. This, in turn, can cause an increased stress load on the thoracolumbar spine over time, so that osteoporosis compression fractures can occur.
Scheuermann's disease is a structural deformity of the thoracic / thoracolumbar spine that usually occurs before puberty. Incompatible mineralization and ossification (ossification) of the vertebral end plate during growth and development can cause forward wedge in the vertebra.
Congenital kyphosis typically occurs in infants and young children as a result of a malformation of the spine while in the womb. Unlike other forms of kyphosis, this form usually requires surgery (at a young age) to realign the spine and prevent the progression of deformity.
On the other hand, there are other causes that are effective in the development of the disease, such as aging, nutrition, injuries to the spine, osteoporosis, disc shift and degeneration, syndromes, neuromuscular disorders, infections and malignancies in the spine.
 
What Are The Symptoms Of Kyphosis?
 
In some patients, symptoms are mild and do not require treatment; in cases with severe symptoms that require surgery, they can occur. Depending on the underlying cause of kyphosis, typical symptoms (symptoms) include one or more of the following:
• A forward-leaning appearance is usually more pronounced when viewed from the side while the patient is leaning forward.
* Mild or severe back pain
* Length reduction
* Difficulty standing straight
* Feeling of fatigue
* Back pain
 
How is Kyphosis Treated?
 
The treatment process for kyphosis usually begins conservatively, and surgery is required if the patient's symptoms do not improve with conservative treatment (non-surgical treatments), or if the curvature is very serious.
Conservative management will consist of observation, physical therapy, and the use of non-steroidal inflammatory drugs (NSAIDs). Indications for conservative treatment are for patients with kyphosis below 60 degrees. Physical therapy should be performed to balance the anterior and posterior muscle groups of the back.Nov. This will reduce the pressure on the spine, help improve posture and reduce discomfort. Non-surgical treatments can be effective in people with postural kyphosis. We also recommend stretching exercises and planned physical therapy to help relieve back pain and fatigue in postural kyphosis. But these methods of treatment may not fully correct kyphosis itself.
 
In kyphosis above 50 degrees, corset can be used in addition to physical therapy. In some cases, corset can be effective. The number of patients who benefit with uses not less than 15 hours a day is not small. Corset growth shows a corrective effect in patients of age, while adult patients do not expect improvement with corset.
In some cases, surgery may be required. These conditions: conservative treatment with pain does not heal, curvature continues to progress, curvature due to the formation of nerve and spinal cord tightness, unacceptable cosmetic appearance, lung and heart signs can be said as the formation. These findings can be seen if the kyphotic angle is 75 degrees and above.
 
Sometimes kyphosis can also occur as a result of traumatic fractures that disrupt the integrity of the spine, or a spontaneous osteoporosis ( due to bone resorption) fracture or collapse in older people. In this case, it is primarily conservative; in very old patients, closed surgical methods are at the forefront.
Scheuermann's disease, on the other hand, is another cause of kyphosis, which is accompanied by collapse in the anterior parts of the vertebrae, which have a genetic origin that can be encountered in young adults and late childhood. In Scheuermann's disease, treatment is also conservative and, if necessary, surgical.
Congenital kyphosis disease occurs as a result of the progression of deformities formed in the spine due to growth while genetically in the mother's womb. Early treatment of this group of patients is very important. Conservative treatment may not prevent possible deformities and neurological hazard that occur in these patients. Therefore, it may be necessary to plan early surgical treatment by taking into account the age of the patient, the type of deformity and the location and type of abnormality.
 
With proper treatment and follow-up, a very large proportion of kyphosis patients can be treated without surgery. But in patients who have not been properly treated in time, both neurological (nervous system) and cardiopulmonary (heart and lung diseases) and poor cosmetic appearance may be inevitable. It should be kept in mind that the negative effects of advanced kyphosis can also affect other articulated structures of the spine (such as the neck, hip joint, knee joint, ankle).

Prof. MD. Hayati AYGÜN

Orthopedics and Traumatology Specialist