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Kyphosis (Hunchback): Causes, Symptoms, Treatment And Prevention

Kyphosis (a.k.a Roundback or Hunchback) is a spinal deformity, characterized by abnormal rounding of the back. Symptoms of the disease include back pain and stiffness. It is a self-diagnosable condition. Early diagnosis of kyphosishelps incorrecting the deformity to some extent, either surgically or non-surgically.

Kyphosis

Kyphosis can occur in all age groups. But, its incidence is higher in adolescents and elderly people, and is more common in women than in men.

What is Kyphosis?

The vertebral column forms the backbone of the human body. It is made up of smaller bones called vertebrae. The vertebrae are of three types, cervical, thoracic and lumbar, which align together to form the spine.

The thoracic vertebrae (T1-T12) form the thoracic spine in the upper back, which has a normal spinal (outward) curvature of 20° to 45°. Any deviation in this angle of the spine is called as kyphosis or hyperkyphosis.

Causes of Kyphosis:

The causative factors of kyphosis are wide-spread. The abnormality in the spinal curvature may be due to:

  • Weak bones or osteoporosis
  • Congenital disabilities
  • Severe injury or fracture to the spine
  • Disc degeneration
  • Spinal tumors
  • Compression fractures post-exposure to radiotherapy or chemotherapy
  • Degenerative diseases like ankylosing spondylitis and degenerative arthritis
  • Other conditions like muscular dystrophy and hormone diseases

Types of Kyphosis:

Some of the common types of kyphosis include:

Postural Kyphosis:

This type of kyphosis is most common in adolescent girls. It is a temporary condition, and the curve disappears on standing straight or erect.

Scheuermann’s Kyphosis:

The spinal deformity or the shape of the hump is higher than in the case of postural kyphosis. The abnormal curvature cannot be corrected by standing erect. It is a common condition in teenage boys.

Congenital Kyphosis:

It is a spinal defect present since birth. The bones are formed irregularly or may be fused together. The condition worsens, as the child ages.

Symptoms of Kyphosis:

No symptoms appear in mild cases of kyphosis. But, the following symptoms may appear as the disease progresses:

  • Back pain
  • Stiffness of the spine
  • Rounded shoulders
  • Tightness and weakness in the leg muscles
  • Sensory issues-tingling and numbness

In very severe cases, the symptoms of kyphosis are:

  • Abnormal gait pattern
  • Loss of bowel and bladder control
  • Shortness of breath or breathing difficulties
  • Pulmonary or heart failure

Risk Factors for Kyphosis:

A risk factor often predisposes a person to acquire a particular disease. Common risk factors of kyphosis are listed below:

  • Hereditary: A family history of spinal problems
  • Age: Elderly people and adolescents
  • Sex: Female and in particular elderly female
  • Postural defects: Particularly seen in teenagers
  • Diseases of the bone: Osteoporosis or low bone density
  • Underlying conditions like Marfan syndrome or connective tissue disorders

Complications for Kyphosis:

Kyphosis may lead to complications if the diagnosis and the treatment are not made at the earliest.

Few complications of kyphosis include:

  • Severe and continuous pain in the back
  • Difficulty in daily activities like sleeping and driving vehicles
  • Difficulty in breathing
  • Weakness in legs or paralysis in some cases
  • Loss of bowel and bladder control
  • Psychological depression due to poor body image
  • Social isolation

Diagnosis of Kyphosis:

The diagnosis of kyphosis is essential to understand the progression of the disease. Diagnosis includes:

History-taking:

Detailed medical history of the patient’s present and past health conditions is noted. Any congenital deformities, fractures or injuries involving the spine and any underlying diseases are to be understood, for planning an appropriate method of treatment.

Physical Examination:

Physical examination involves observation of the spinal curves from all the angles, to determine the severity of the disease. The position of the patient during physical examination includes standing and then bending at the waist, to have a clear view of the backbone.

Other things noted during the physical examination include reflexes, muscle strength and the chest expansion capacity.

Imaging Studies:

  • X-rays: X-rays are used to determine any structural abnormalities of the vertebrae. X-rays are taken in different views. They also help in the determination of the angle of the kyphotic curve. Any angle greater than 50° is considered abnormal.
  • Computed Tomography (CT) scan:This test is used to study the vertebrae in different cross-sectional views. The shape of the vertebrae helps in defining the type of kyphosis, that is, postural or Scheuermann’s kyphosis.
  • Magnetic Resonance Imaging (MRI) scan:The test is used to find out any nerve compression along with the bony deformities. It is beneficial in understanding the level of nerve involvement. Any tumors can also be differentiated through these scans.

Other diagnostic tests include bone-density tests to evaluate the bone strength, nerve conduction studies to analyze any neuro-signal transmission issues and pulmonary function tests to understand the capacity of the lungs.

Treatment of Kyphosis:

Treatment of kyphosis aims to stop the progression of the disease and also to prevent the occurrence of permanent deformity.

There are many treatment options available for kyphosis. The treatment for kyphosis depends on the cause and severity of the disease.

Non-surgical Management:

This treatment approach includes:

In mild postural kyphotic cases, no specific treatment is recommended. But, careful and periodic monitoring of the spinal curvature is necessary to avoid any further progression of the disease. If the disease begins to progress further, then other treatment options are considered.

Medications to treat kyphosis include nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen, to relieve back pain.

Physiotherapy is also recommended, along with medicines, for patients with increased kyphotic deformity. The physical therapy management includes stretching and strengthening exercises for the abdomen, back and the lower limbs.

Surgical Management:

Surgery for kyphosis is considered, in cases where there is a severe kyphotic deformity, in cases of nerve compression and post-traumatic injuries.

Common surgeries for kyphosis are listed below:

Spinal reconstruction surgery: Treatment aims to decrease the pain and also to maintain the natural curvature of the spine. The surgical procedure includes placement of metal rods and screws along the spine, to stabilise the spine in an erect position.

Arthrodesis of the spine: The primary purpose of the treatment is to avoid movement between the affected vertebrae and reduce the back pain. The surgery involves fusion of two or more vertebrae into one single strand.

Spinal osteotomy: The treatment aims at improving both spinal stability and mobility. This procedure includes removal of a part of the vertebra and re-alignment of the spine.

Prevention of Kyphosis:

Few types of kyphosis like postural kyphosis may be prevented, by the following measures:

  • Following good postural practices (since childhood)
  • Self-monitoring of position of the backbone, during daily activities
  • Following healthy diet practices to maintain the bone density
  • Avoiding an excessive intake of tobacco and alcohol

Kyphosis can be managed conservatively if the diagnosis of the deformity is made at the early stage itself. Regular follow-up and monitoring are necessary to avoid further irreversible changes of the spine.

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