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| Caption = X-ray of a kyphosis of 70°| | | Caption = X-ray of a kyphosis of 70°| |
| ICD10 = {{ICD10|M|40|0|m|40}}-{{ICD10|M|40|2|m|40}}, {{ICD10|M|42|0|m|40}}, {{ICD10|Q|76|4|q|65}} | | | ICD10 = {{ICD10|M|40|0|m|40}}-{{ICD10|M|40|2|m|40}}, {{ICD10|M|42|0|m|40}}, {{ICD10|Q|76|4|q|65}} | |
| ICD9 = {{ICD9|732.0}}, {{ICD9|737.0}}, {{ICD9|737.1}} | | | ICD9 = {{ICD9|737.0}}, {{ICD9|737.1}} | |
| ICDO = | | | ICDO = | |
| OMIM = | | | OMIM = | |
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| {{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}} | | {{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}} |
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| ==Overview==
| | {{SK}} Gibbus |
| '''Kyphosis''' (Greek - ''kyphos'', a hump), in general terms, is a curvature of the upper [[spine (anatomy)|spine]]. It can be either the result of bad posture or a structural anomaly in the spine.
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| Many [[radiologist]]s will detect kyphosis with a ''scolie'' or an ''AP-Lateral'' — two types of [[X-ray]]. A scolie ''(pictured to the right)'' is an X-ray taken from the rear. An AP-Lateral is taken from the side, where the X-ray machine is programmed to show the spine with high definition.
| | ==[[Kyphosis overview|Overview]]== |
| | ==[[Kyphosis classification|Classification]]== |
| | ==[[Kyphosis pathophysiology|Pathophysiology]]== |
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| In the sense of a deformity, it is the pathological curving of the [[spine (anatomy)|spine]], where parts of the [[vertebral column|spinal]] column lose some or all of their lordotic profile. This causes a bowing of the [[back]], seen as a slouching posture. Symptoms of kyphosis, that may be present or not, depending on the type and extent of the deformity, include mild [[back pain]], [[Fatigue (physical)|fatigue]], appearance of round back and breathing difficulties. Severe cases can cause great discomfort and even lead to death.
| | ==[[Kyphosis differential diagnosis|Differentiating Kyphosis from other Diseases]]== |
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| ==Classification== | | ==[[Kyphosis epidemiology and demographics|Epidemiology and Demographics]]== |
| There are several kinds of kyphosis ([[ICD|ICD-10]] codes are provided):
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| ===Postural kyphosis (M40.0)=== | | ==[[Kyphosis risk factors|Risk Factors]]== |
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| The most common type, normally attributed to slouching, can occur in both the old<ref>[http://taylorandfrancis.metapress.com/link.asp?id=m653630285934807 Annals of Human Biology], Volume 1, Number 3 / July 1974.</ref> and the young. In the young, it can be called 'slouching' and is reversible by correcting muscular imbalances. In the old, it may be called hyperkyphosis or dowager’s hump. About one third of cases have vertebral fractures.<ref name="pmid17785488">{{cite journal |author=Kado DM, Prenovost K, Crandall C |title=Narrative review: hyperkyphosis in older persons |journal=Ann. Intern. Med. |volume=147 |issue=5 |pages=330–8 |year=2007 |pmid=17785488 |doi=|url=http://www.annals.org/cgi/content/full/147/5/330}}</ref> Otherwise, the aging body tends towards a loss of musculoskeletal integrity<ref name="pmid12616157">{{cite journal |author=Keller TS, Harrison DE, Colloca CJ, Harrison DD, Janik TJ |title=Prediction of osteoporotic spinal deformity |journal=Spine |volume=28 |issue=5 |pages=455–62 |year=2003 |pmid=12616157 |doi=10.1097/01.BRS.0000048651.92777.30}}</ref>, and kyphosis can develop due to aging alone.<ref>[http://www.healthy.net/scr/article.asp?Id=1866 Osteopathy: A Complete Health Care System], by [http://www.healthy.net/scr/bio.asp?Id=54 Leon Chaitow N.D., D.O., M.R.O.]</ref><ref name="pmid17785488"/>
| | ==[[Kyphosis natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| ===[[Scheuermann's disease|Scheuermann's kyphosis]] (M42.0)===
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| Scheuermann's kyphosis is significantly worse cosmetically and can cause pain. It is considered a form of juvenile [[osteochondrosis]] of the spine, and is more commonly called Scheuermann's disease. It is found mostly in teenagers and presents a significantly worse deformity than postural kyphosis. A patient suffering from Scheuermann’s kyphosis cannot consciously correct posture<ref>http://www.back.com/causes-developmental-scheuermann.html and http://www.emedicine.com/pmr/topic129.htm</ref>. The apex of the curve, located in the thoracic vertebrae, is quite rigid. The patient may feel pain at this apex, which can be aggravated by physical activity and by long periods of standing or sitting. This can have a significantly detrimental effect on their lives, as their level of activity is curbed by their condition; they may feel isolated or uneasy amongst peers if they are children, depending on the level of deformity. Whereas in postural kyphosis the vertebrae and disks appear normal, in Scheuermann’s kyphosis they are irregular, often herniated and wedge shaped over at least three adjacent levels. [[Fatigue (medical)|Fatigue]] is a very common symptom, most likely because of the intense muscle work that has to be put into standing and/or sitting properly. The condition seems to run in families.
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| ===Congenital kyphosis (Q76.4)===
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| Congenital kyphosis can result in infants whose spinal column has not developed correctly in the womb. Vertebrae may be malformed or fused together and can cause further progressive kyphosis as the child develops. <ref>http://www.ejbjs.org/cgi/content/abstract/81/10/1367</ref>. Surgical treatment may be necessary at a very early stage and can help maintain a normal curve in coordination with consistent follow ups to monitor changes. However, the decision to carry out the procedure can be very difficult due to the potential risks to the child. A congenital kyphosis can also suddenly appear in teenage years, more commonly in children with cerebral palsy and other neurological disorders.
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| ===Nutritional kyphosis===
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| Nutritional kyphosis''' can result from nutritional deficiencies, especially during childhood, such as vitamin D deficiency (producing [[rickets]]), which softens bones and results in curving of the spine and limbs under the child's body weight.
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| ===[[Gibbus deformity]]===
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| [[Gibbus deformity]] is a form of structural kyphosis, often a sequela to [[tuberculosis]].
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| ==Natural History, Complications, and Prognosis==
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| The risk of undergoing spinal fusion surgery for kyphosis, like in scoliosis, is estimated to be 5%. Possible complications may be inflammation of the soft tissue or deep inflammatory processes, breathing impairments, bleeding, and nerve injuries. However, according to the latest evidence, the rate of complications is far beyond that rate. As early as five years after surgery another 5% require reoperation and today it is not yet clear what to expect from spine surgery in the long-term.<ref name="Hawes2006">Hawes M. 2006. ''Impact of spine surgery on signs and symptoms of spinal deformity.'' Pediatr Rehabil. Oct-Dec;9(4):318-39.</ref><ref>Weiss HR, Goodall D: ''Rate of complications in scoliosis surgery - a systematic review of the Pub Med literature.'' Scoliosis. 2008 Aug 5;3:9.</ref> Taking into account that signs and symptoms of spinal deformity cannot be changed by surgical intervention, surgery remains to be a cosmetic indication.<ref name="Hawes2006"/><ref>Hawes MC, O'Brien JP. 2008. ''A century of spine surgery: What can patients expect?'' Disabil Rehabil. 30(10):808-17.</ref> Unfortunately, the cosmetic effects of surgery are not necessarily stable.<ref name="Hawes2006"/> In case one decides to undergo surgery, a specialised centre should be preferred.
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| ==Diagnosis== | | ==Diagnosis== |
| ===Physical Examination===
| | [[Kyphosis history and symptoms|History and Symptoms]] | [[Kyphosis physical examination|Physical Examination]] | [[Kyphosis chest x ray|Chest X Ray]] | [[Kyphosis MRI|MRI]] |
| Images shown below are courtesy of Cafer Zorkun MD PhD and copylefted.
| | ==Treatment== |
| | | [[Kyphosis medical therapy|Medical Therapy]] | [[Kyphosis non surgical therapy|Non surgical Therapy]] | [[Kyphosis surgery|Surgery]] | [[Kyphosis primary prevention|Primary Prevention]] | [[Kyphosis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Kyphosis future or investigational therapies|Future or Investigational Therapies]] |
| <gallery>
| | ==Case Studies== |
| Image:Kifoskolyoz 001.jpg|Chest x-ray: A 53 years old patient with severe kyphosis
| | :[[Kyphosis case study one|Case #1]] |
| Image:Kifoskolyoz clin pic 001.JPG|A 53 years old patient with severe kyphosis
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| </gallery>
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| <gallery>
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| Image:Kifoskolyoz 002.jpg|Chest x-ray: A 53 years old patient with severe kyphosis
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| Image:Kifoskolyoz clin pic 003.JPG|A 53 years old patient with severe kyphosis
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| Image:Kifoskolyoz clin pic 002.JPG|A 53 years old patient with severe kyphosis
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| </gallery>
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| ==Treatments== | |
| ===Orthosis (brace)===
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| [[Image:kyphosis brace1.jpg|thumb|left|Modern brace for the treatment of a thoracic kyphosis. The brace is constructed using a CAD / CAM device. At this stage, this is the only CAD / CAM brace designed to treat a thoracic kyphosis. It is called kyphologic.<ref name="cirrie.buffalo.edu">Weiss HR, Turnbull D. 2010. Kyphosis (Physical and technical rehabilitation of patients with Scheuermann's disease and kyphosis). In: JH Stone, M Blouin, editors. International Encyclopedia of Rehabilitation. Available online: http://cirrie.buffalo.edu/encyclopedia/article.php?id=125&language=en</ref>]] | |
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| [[Body brace]]s showed benefit in a [[randomised controlled trial]].<ref name="pmid15043351">{{cite journal |author=Pfeifer M, Begerow B, Minne HW |title=Effects of a new spinal orthosis on posture, trunk strength, and quality of life in women with postmenopausal osteoporosis: a randomized trial |journal=American journal of physical medicine & rehabilitation / Association of Academic Physiatrists |volume=83 |issue=3 |pages=177–86 |year=2004 |pmid=15043351 |doi=10.1097/01.PHM.0000113403.16617.93}}</ref> | |
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| The [[Milwaukee brace]] is one particular body brace that is often used to treat kyphosis in the US. Modern CAD / CAM braces are used in Europe to treat different types of kyphosis. These are much easier to wear and have better in-brace corrections than reported for the Milwaukee brace. Since there are different curve patterns (thoracic, thoracolumbar and lumbar) different types of braces are in use. The advantages / disadvantages of different braces are discussed in a recent review article.<ref name="cirrie.buffalo.edu"/>
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| [[Image:kyphosis brace 3.jpg|thumb|left|Modern brace for the treatment of a lumbar / thoracolumbar kyphosis. The brace is constructed using a CAD / CAM device. At this stage this brace is the only CAD / CAM brace designed to treat a lumbar kyphosis and is called physio-logic brace. Restoration of the lumbar lordosis is the major aim.<ref name="cirrie.buffalo.edu"/>]] | |
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| ===Specialised physical therapy===
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| 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.<ref>Lehnert-Schroth, Christa (2007). ''Three-Dimensional Treatment for Scoliosis: A Physiotherapeutic Method for Deformities of the Spine''. (Palo Alto, CA: The Martindale Press): 185-187 and passim.</ref>
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| ===Surgery===
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| Surgical treatment can be used in severe cases. In patients with progressive kyphotic deformity due to vertebral collapse, a procedure called a [[kyphoplasty]] may arrest the deformity and relieve the pain. The procedure is serious and consists of fusion and can cause a risk to the abnormal vertebrae.<ref>[http://www.spineuniversity.com/public/spinesub.asp?id=48 SpineUniversity.com]</ref>
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| ==References== | | ==Related Chapters== |
| {{Reflist|2}}
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| ==See also ==
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| *[[Lordosis]] | | *[[Lordosis]] |
| *[[Kyphoscoliosis]] | | *[[Kyphoscoliosis]] |
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| [[pt:Cifose]] | | [[pt:Cifose]] |
| [[fi:Kyfoosi]] | | [[fi:Kyfoosi]] |
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