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PubMed1981

Juvenile kyphosis: histological and histochemical studies.

UNLABELLED: Histological and histochemical studies of the spine of a sixteen-year-old boy with juvenile kyphosis who was killed in an automobile accident showed abnormal cartilage in extensive areas of the vertebral and growth plates of the involved vertebrae. In these areas the cartilage matrix was loose, strongly positive when stained with alcian blue and weakly positive to periodic acid-Schiff, and it contained numerous chondrocytes. Some chondrocytes were irregularly shaped and others were in clusters. Vertebral bone growth was stunted under the areas of abnormal vertebral and growth plates. The ossification in the ring apophyses was irregular in areas of abnormal cartilage plate, but necrotic bone was not seen. Schmorl nodes had formed where areas of abnormal cartilage plate adjoining the nucleus pulposus had collapsed, allowing the disc material to herniate into the vertebral body. CLINICAL RELEVANCE: The defective vertebral-bone formation in juvenile kyphosis appears to result from abnormal vertebral and growth-plate cartilage. The kyphosis and presumably also the cartilage abnormality can be improved during the florid stage of the disease by decreasing the postural load on the anterior part of the vertebrae with the use of a proper brace.

Adolescent↗
PubMed1995

Scheuermann's kyphosis. The Portuguese technique of surgical treatment.

Between 1969 and 1989, we performed posterior segmental instrumentation on 38 patients with thoracic Scheuermann's kyphosis. We used a dynamic system without sublaminar fixation, and a kyphosis of 50 degrees was the main indication for surgery. The mean initial angle was 68 degrees (50 to 100) and the mean final kyphosis was 43 degrees at five-year follow-up, with a mean final loss after surgery of 3.7 degrees. Reconstruction of the vertebral bodies, vertebral wedging and the anterior-body height ratio were observed even in skeletally mature patients. There were no medical complications. There were three cases of loss of correction by more than 10 degrees and one of rod fracture with pseudarthrosis. The role of non-operative treatment is evaluated and early surgical treatment is advocated.

Adolescent↗
PubMed1994

Kyphectomy and segmental spinal instrumentation in young children with myelomeningocele kyphosis.

For children with myelomeningocele kyphosis, the ideal timing for spinal correction or the correct stabilization technique for preventing the recurrence of deformity are controversial issues. From 1988 to 1992, vertebral kyphectomy and long segment spinal fixation with a special lower-end contouring around the anterior aspect of the sacrum through the sacral foramina (the modified Gillespie's technique) were carried out on six young children with ages ranging from three years and four months to five years and 11 months (average, five years). The indications for surgery were recurrent skin breakdown and/or increasing functional deficits due to curve progression. A mean preoperative kyphosis of 126.3 degrees was reduced to 21.8 degrees postoperatively. There was one case of pseudarthrosis seen at the osteotomy site which was treated with anterior interbody grafting. With a mean follow-up period of 35 months (range, 10-48 months), all patients showed good maintenance of correction and no implant failure. The average loss of correction was 2.7 degrees. We believe that in these young, severely handicapped children, long segment fixation using the modified Gillespie's technique with full or partial segment fusion allows a quick resumption of upright activities, achieves satisfactory correction of kyphosis and minimizes the risk of recurrent deformity.

Child, Preschool↗
PubMedDate not supplied

Scheuermann's juvenile kyphosis.

OBJECTIVE: Two cases are discussed to illustrate two different presentations, progressions and treatments of Scheuermann's juvenile kyphosis. CLINICAL FEATURES: In one case, a 13-yr-old boy suffered from a 2-yr history of lower back pain. Radiographs demonstrated irregularity of the upper lumbar vertebral endplates, associated with Schmorl's nodes. The second case is one of a 14-yr-old boy who was seen in an orthopedic outpatient clinic. Radiographs revealed wedging of the anterior border of T6, T7, and T8 vertebrae with a thoracic spine kyphotic deformity measuring 72 degrees. INTERVENTION AND OUTCOME: The first case was treated conservatively. The patient maintained his improvement at 6 month follow-up. The second case was initially treated with a brace that the patient did not wear regularly as directed. The kyphotic deformity progressed from 72 degrees to 92 degrees. An operation was performed to reduce the kyphotic curve and prevent further progression. On review 6 yr later, the patient was well without back pain or other complications. The kyphotic curve measured 65 degrees. CONCLUSION: Scheuermann's juvenile kyphosis is a common spinal deformity in the adolescent. A radiographic appearance of wedging of the anterior portion of the vertebral bodies with marked kyphotic deformity suggests the diagnosis of classical Scheuermann's disease. However, the lumbar type of Scheuermann's disease should be considered in young patient with radiographic evidence of irregular vertebral endplates, Schmorl's nodes and a decreased disc space without wedging. Nevertheless, significant progression of the curve in both the typical and atypical types of Scheuermann's disease is rare, but can occur. An algorithm is presented to facilitate decision making in the management of Scheuermann's juvenile kyphosis.

Adolescent↗
PubMed1996

The value of the measurement from T5 to T12 as a screening tool in detecting abnormal kyphosis.

Because vertebral endplates above T5 are not consistently seen on standard lateral radiographs, we assessed the reliability of measuring from T5 to T12 to detect abnormal kyphosis in children. Sixty-nine subjects were included, with 43 normal controls. Propst-Proctor and Bleck reported the normal measurement of T5-T12 to be between 20 and 33 degrees. All 69 patients with abnormal kyphosis measured > 33 degrees from T5 to T12. Twenty-four normal subjects had measurements < or = 33 degrees, and 19 measured > 33 degrees. Sensitivity, specificity, and accuracy were 100, 56, and 83%, respectively, when using 33 degrees as the upper limit of normal. In conclusion, a measurement from T5 to T12 of > 33 degrees on lateral thoracolumbar radiographs as a screening for abnormal kyphosis had a sensitivity of 100%. For patients with a measurement > 33 degrees, additional lateral radiographs to visualize the entire thoracic spine above T5 would be warranted.

Adolescent↗
PubMedDate not supplied

Prevention of fixed, angular kyphosis in achondroplasia.

Transient kyphotic deformity arises in most infants with achondroplasia. In a minority, a fixed and angular kyphosis develops, which can cause serious neurologic sequelae later in life. We assessed a protocol for preventing development of such fixed kyphosis in a sequential, unselected series of 66 infants with achondroplasia. This study demonstrates the efficacy of early prohibition of unsupported sitting and, in those in whom such prohibition proves insufficient, use of bracing. When the proposed algorithm was followed, none of the infants had development of a progressive kyphotic deformity. On this basis, it appears that the secondary risks of angular kyphosis, previously estimated to be between 10 and 15% in individuals with achondroplasia, can be completely eliminated.

Achondroplasia↗
PubMed1995

Basicranial flexion, relative brain size, and facial kyphosis in Homo sapiens and some fossil hominids.

Comparative work among nonhominid primates has demonstrated that the basicranium becomes more flexed with increasing brain size relative to basicranial length and as the upper and lower face become more ventrally deflected (Ross and Ravosa [1993] Am. J. Phys. Anthropol. 91:305-324). In order to determine whether modern humans and fossil hominids follow these trends, the cranial base angle (measure of basicranial flexion), angle of facial kyphosis, and angle of orbital axis orientation were measured from computed tomography (CT) scans of fossil hominids (Sts 5, MLD 37/38, OH9, Kabwe) and lateral radiographs of 99 extant humans. Brain size relative to basicranial length was calculated from measures of neurocranial volume and basicranial length taken from original skulls, radiographs, CT scans, and the literature. Results of bivariate correlation analyses revealed that among modern humans basicranial flexion and brain size/basicranial length are not significantly correlated, nor are the angles of orbital axis orientation and facial kyphosis. However, basicranial flexion and orbit orientation are significantly positively correlated among the humans sampled, as are basicranial flexion and the angle of facial kyphosis. Relative to the comparative sample from Ross and Ravosa (1993), all hominids have more flexed basicrania than other primates: Archaic Homo sapiens, Homo erectus, and Australopithecus africanus do not differ significantly from Modern Homo sapiens in their degree of basicranial flexion, although they differ widely in their relative brain size. Comparison of the hominid values with those predicted by the nonhominid reduced major-axis equations reveal that, for their brain size/basicranial length, Archaic and Modern Homo sapiens have less flexed basicrania than predicted. H. erectus and A. africanus have the degree of basicranial flexion predicted by the nonhominid reduced major-axis equation. Modern humans have more ventrally deflected orbits than all other primates and, for their degree of basicranial flexion, have more ventrally deflected orbits than predicted by the regression equations for hominoids. All hominoids have more ventrally deflected orbital axes relative to their palate orientation than other primates. It is argued that hominids do not strictly obey the trend for basicranial flexion to increase with increasing relative brain size because of constraints on the amount of flexion that do not allow it to decrease much below 90 degrees. Therefore, if basicranial flexion is a mechanism for accommodating an expanding brain among non-hominid primates, other mechanisms must be at work among hominids.

Animals↗
PubMed1981

[The treatment of Scheuermann's kyphosis with the Milwaukee brace (author's transl)].

The application of the Milwaukee brace during adolescence is indicated not only in scoliosis, but also in severe forms of Scheuermann's kyphosis. In Basel between 1970 and 1979, 55 patients with severe thoracic kyphosis were treated with the Milwaukee brace. 45 of these patients were followed for a longer period of time. The results of the measurements of the kyphotic angles and of the angles of the wedges vertebral bodies are presented in detail. In those children who were followed to adulthood an average curvature correction from 40 degrees to 32 degrees was found. This represents a correction exceeding 50%, if a physiological angle of 25 degrees is presumed. Also, measurements showed erection of the wedged vertebral bodies after completion of growth. Consequently, the use of the Milwaukee brace for rigid thoracic kyphosis of more than 35 degrees in adolescents is advised.

Adolescent↗
PubMed2003

Effects of bracing on lung function in idiopathic juvenile kyphosis.

Although considerable information is available on the effects of bracing on lung function in kyphoscoliosis, there is a paucity of data on idiopathic juvenile kyphosis (IJK). The present study was designed to investigate the immediate effect of bracing on lung function in children and adolescents with mild-to-moderate IJK. Spirometry, measurement of lung volumes, and arterial oxyhemoglobin saturation (SaO(2)) were performed in 24 patients, 9-17 years of age, who were treated with a corrective brace for mild-to-moderate IJK (Cobb angle, 46-75 degrees ). Children were studied when braced and unbraced. When children were unbraced, mean percent predicted values (+/-standard deviation) for total lung capacity (TLC), vital capacity (VC), functional residual capacity (FRC), and forced expiratory volume in 1 sec (FEV(1)) were 100.0% (+/-13.0%), 92.7% (+/-14.2%), 108.2% (+/-20.4%), and 95.0% (+/-16.3%), respectively. With the brace on, significant reductions occurred in all lung function measurements: TLC decreased by 9.5% (P < 0.001), VC by 9.3% (P = 0.001), FRC by 14.2% (P = 0.005), and FEV(1) by 8.9% (P = 0.009). SaO(2) decreased from 96.2% (+/-1.6%) to 95.2% (+/-1.4%) (P = 0.027). An inverse relationship was observed between pre- and postbracing change in TLC and Cobb angle children (P = 0.021). Our findings indicate that corrective bracing in mild-to-moderate IJK results in mild lung restriction and a clinically insignificant drop in SaO(2). The effect of bracing on TLC decreases as the severity of kyphosis increases in these patients.

Adolescent↗
PubMed1988

Treatment of kyphosis and lumbar stenosis in achondroplasia.

In summary, neurological symptoms in the achondroplast are related to the anatomical spinal canal with degenerative changes and aging altering the delicate biomechanical and microvascular balance. An accurate and detailed history is necessary for diagnosis. Decompression is via a posterior approach with a multi-level wide laminectomy with undercutting of the facets and usually multi-level foraminotomies. Kyphosis when present at the time of decompression, or if angular or progressive, requires treatment. A combined two-stage approach with an anterior disc excision and fusion combined with a posterior and posterolateral fusion is the treatment of choice. In angular deformities anterior strut grafting is indicated. The use of instrumentation posteriorly is contraindicated with the possible exception of transpedicular fixation. The instrumentation stabilizes the spine and does to correct the deformity. Using this approach the kyphosis in the achondroplast and the symptomatic spinal stenosis are adequately treated.

Achondroplasia↗
PubMed1979

Spinal osteotomy to correct kyphosis in spinal tuberculosis.

Twenty-seven patients with severe tuberculous kyphosis have been treated at the National Murayama Hospital between 1966 and 1977. We have undertaken curettage of the foci and vertebral osteotomy through an anterior approach, followed by gradual correction with a halo pelvic distraction apparatus and subsequent vertebral fusion. Choice of this method depends upon the age of the patient, the degree of kyphosis before correction, and the presence of concomitant lesions. Details of postoperative management are given and their importance is emphasized. The major risks of correction are discussed and precautions suggested.

Adolescent↗
PubMed2001

[The biomechanics of kyphosis].

Kyphosis is a dorsally convex curvature of the spine in the sagittal plane. A pathological kyphosis of the thoracic spine has a Cobb angle greater than 50 degrees. It occurs when the anterior and/or posterior load-transferring elements of the spine are overloaded or damaged. Wedge-shaped vertebral bodies may be found at one or several levels. A wedge-shaped vertebral body increases the curvature of the spine and moves the centre of gravity of the body parts above of the corresponding vertebral body in a ventral direction. This increases the flexion-bending moment acting on the spine. In the case of a wedge-shaped deformation of a vertebral body, the relative increase of the flexion moment is a function of the wedge angle and of the original position of the centre of gravity of the upper body.

Biomechanical Phenomena↗
PubMed2005

Kyphosis reduction and the rate of cement leaks after vertebroplasty of intravertebral clefts.

To assess the results of vertebroplasty in patients with intravertebral clefts compared to patients with normal osteoporotic fractures, we evaluated the pre- and postoperative images and pain scores (VAS) of 114 patients with 192 vertebroplasty procedures treated between March 2002 and February 2005. Intravertebral clefts were identified on conventional radiographs, MR or CT images as gas- or fluid-filled spaces adjacent to an endplate of a fractured vertebra. Forty-four vertebrae showed intravertebral clefts. All clefts were filled with PMMA showing a typical filling pattern. Due to the prone positioning of the patient during vertebroplasty, a significant reduction of the kyphosis angle was achieved in the cleft group. Cement leakage occurred in 18.2% of clefts and 46% of regular osteoporotic fractures. In all patients, good filling of the cleft was achieved no matter where the needle tip was placed in the vertebra. The VAS score was 9.1 preoperatively, 3.6 before discharge and 3.9 6 months postoperatively, showing no significant difference between both groups. Patients with intravertebral clefts show a significant reduction of the kyphosis angle compared to non-cleft patients and have a significantly lower risk of experiencing cement leakage during vertebroplasty. Pain reduction is the same in both groups.

Aged↗
PubMed2004

Treatment of fixed thoracolumbar kyphosis in immature achondroplastic patient: posterior column resection combined with segmental pedicle screw fixation and posterolateral fusion.

A 13-year-old male achondroplastic dwarf with fixed thoracolumbar kyphosis was treated by segmental pedicle screw fixation, posterolateral fusion combined with one stage two level posterior column resection. Preoperative and postoperative kyphosis angles were 97 and 32 degrees, respectively. Combination of segmental pedicle instrumentation with posterior column resection is a treatment option even in immature achondroplastic patients.

Achondroplasia↗
PubMed1998

Increased kyphosis by a combination of fractures of the sternum and thoracic spine.

A 67-year-old patient suffered a fall and sustained injuries to the thorax, combined with fractures of the ribs, sternum and thoracic spine. Her pre-existing kyphosis (caused by osteoporotic vertebral collapse) increased in severity. There was a clear relationship between a sternal fracture, deterioration of thoracic kyphosis and a fracture of the thoracic spine.

Accidental Falls↗
PubMed1998

Polysegmental lumbar posterior wedge osteotomies for correction of kyphosis in ankylosing spondylitis.

Between 1984 and 1993 we treated 21 consecutive patients who had progressive thoracic kyphosis due to ankylosing spondylitis by polysegmental posterior lumbar wedge osteotomies. In 19 patients we used the Universal Spinal Instrumentation System and in the last 2 patients the H-frame. The average correction in 20 of 21 patients at follow-up was 25.6 degrees (range 0 degrees-52 degrees), with a mean segmental correction of 9.5 degrees and a mean loss of correction after operation of 10.7 degrees (range 0 degrees-36 degrees). There were no fatal complications, but in one patient no correction could be obtained during surgery and another patient was reoperated due to lack of correction. Breaking out of screws through the pedicle during compressive correction was seen in seven patients. Implant failure, such as breakage of the threaded rods and/or loosening of the junction between the pedicle screw and the rod, occurred in 9 out of 21 patients. Two patients required reoperation at long-term follow-up. Five out of seven deep wound infections required removal of the implant. Polysegmental lumbar wedge osteotomies for correction of progressive thoracic kyphosis in ankylosing spondylitis is only recommended in patients at a mild stage of the disease with mobile discs and in combination with strong instrumentation.

Adult↗
PubMed2003

Incomplete Brown-Séquard syndrome caused by cervical kyphosis secondary to neurofibromatosis: report of a case.

The case of a 17-year-old boy who suffered from incomplete Brown-SEquard syndrome caused by dystrophic cervical kyphosis secondary to neurofibromatosis is presented. He became aware of weakness of his left upper and lower extremities and was unable to walk within 1 month of his first feeling numbness in the right upper and lower extremities. Thereafter his condition deteriorated rapidly. On radiological investigation the entire dural sac was shifted anteriorly and the spinal cord was flattened anteroposteriorly and asymmetrically at the angular kyphosis level, as in Hirayama's disease. Despite morphological similarities to Hirayama's disease, this patient presented with quite different clinical features: incomplete Brown-SEquard syndrome and rapidly progressive symptoms. It is suspected that the myelopathy in this case can be attributed to compression of the spinal cord between the vertebral body and the posterior dural wall on only one side. He was successfully treated with posterior interspinous wiring combined with anterior decompression and fusion. The neurological deficit fully disappeared, and complete bony union was obtained 1 year after the operation.

Adolescent↗
PubMed2002

[Idiopathic scoliosis and Scheuermann's kyphosis. Historical and current aspects of conservative treatment].

Although in practice since antiquity the nonoperative treatment of spinal deformities is still controversial. Giving preference to orthotic treatment and physiotherapy the historical development of nonoperative treatment will be demonstrated by the examples of idiopathic scoliosis and Scheuermann's kyphosis. It is surprising how early essential and still valuable principles of nonoperative treatment had been acquired and how many of the present-day concepts have remarkable forerunners in the 19th century. In the light of previous knowledge and personal experience the indication, practice and realistic capabilities of modern nonoperative treatment of idiopathic scoliosis and Scheuermann's kyphosis are pointed out.

Adolescent↗