KYPHOSIS

There are several types of kyphosis. The three that most commonly affect children and adolescents are:

• Postural kyphosis

• Scheuermann's kyphosis

• Congenital kyphosis

1. Postural Kyphosis

• Postural kyphosis, the most common type of kyphosis, usually becomes noticeable during adolescence. It is noticed clinically as poor posture or slouching but is not associated with severe structural abnormalities of the spine.

• The curve caused by postural kyphosis is typically round and smooth and can often be corrected by the patient when they are asked to stand up straight.

• Postural kyphosis is more common in girls than boys. It is rarely painful, and, because the curve does not progress, it does not usually lead to problems in adult life.

2. Scheuermann's Kyphosis

• Scheuermann's kyphosis is named after the Danish radiologist who first described the condition.

• Like postural kyphosis, Scheuermann's kyphosis often becomes apparent during the teen years. However, Scheuermann's kyphosis can result in a more severe deformity than postural kyphosis.

• Scheuermann's kyphosis is caused by a structural abnormality in the spine. In a patient with Scheuermann's kyphosis, an X-ray from the side will show that, rather than the normal rectangular shape, three or more consecutive vertebrae have a more triangular shape. This irregular shape causes the vertebrae to wedge together toward the front of the spine, decreasing the normal disk space and creating an exaggerated forward curvature in the upper back.

3. Congenital Kyphosis

• Congenital kyphosis is present at birth. It occurs when the spinal column fails to develop normally while the baby is in the uterus. The bones may not form as they should, or several vertebrae may be fused together. Congenital kyphosis typically worsens as the child ages.

• Patients with congenital kyphosis often need surgical treatment at a very young age to stop progression of the curve. Many times, these patients will have additional birth defects that impact other parts of the body, such as the heart and kidneys.

Nonsurgical treatment is recommended for patients with postural kyphosis. It is also recommended for patients with Scheuermann's kyphosis who have curves of less than 70 to 75 degrees.

Nonsurgical treatment may include:

• Observation: The doctor may recommend simply monitoring the curve to make sure it does not get worse. Your child may be asked to return for periodic visits and X-rays until they are fully grown. Unless the curve gets worse or becomes painful, your child may not need any other treatment.

• Physical therapy: Specific exercises can help relieve back pain and improve posture by strengthening muscles in the abdomen and back. Certain exercises can also help stretch tight hamstrings and strengthen areas of the body that may be impacted by misalignment of the spine.

• Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs, including aspirin, ibuprofen, and naproxen, can help relieve back pain.

• Bracing: Bracing may be recommended for patients with Scheuermann's kyphosis who are still growing. The specific type of brace and the number of hours per day it should be worn will depend upon the severity of the curve. The doctor will adjust the brace regularly as the curve improves. Typically, the child wears the brace until they reach skeletal maturity and are finished growing.

Surgery is often recommended for patients with congenital kyphosis.

Surgery may also be recommended for patients with Scheuermann's kyphosis who have curves greater than 70 to 75 degrees or those with severe back pain. Patients with kyphosis in the lower back (thoracolumbar curves) may require surgery for smaller curves of greater than 25 to 30 degrees.

Spinal fusion is the surgical procedure most used to treat kyphosis.

The goals of spinal fusion are to:

• Reduce the degree of the curve

• Prevent further curve progression

• Maintain the improvement over time

• Alleviate significant back pain, if it is present 

Surgical Procedure

Spinal fusion is essentially a welding process. The basic idea is to fuse together the affected vertebrae so that they heal into a single, solid bone. Fusing the vertebrae will reduce the degree of the curve and, because it eliminates motion between the affected vertebrae, may also help alleviate back pain.

During the procedure, the doctor will typically use metal screws and rods to help position the vertebrae in better alignment. Often, the goal is for safe partial correction (making the curve smaller but not always making it normal). Ideally, the curve will be reduced by 50% of its initial magnitude. Once the vertebrae are better aligned, small pieces of bone called bone grafts are then placed into the spaces between the vertebrae to be fused. Over time, the bones grow together, like how a broken bone heals.

Exactly how much of the spine is fused depends upon the size of your child's curve. Only the curved vertebrae are fused together. The other bones in the spine can still move and assist with bending, straightening, and rotation. Larger curves often require more vertebrae to be fused, which means that fewer mobile vertebrae remain to allow spine bending and twisting.