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PubMed2004

Nonsurgical treatment of kyphosis.

An increase in thoracic kyphosis in children and adolescents is usually the result of postural kyphosis or Scheuermann's kyphosis. Although no structural deformity of the spine is observed in postural kyphosis, wedging of vertebral bodies and disk space narrowing are noted radiographically in patients with Scheuermann's kyphosis. Effective interventions for adolescents with postural kyphosis include exercises to relieve lower extremity contractures and strengthen abdominal musculature coupled with practiced normal posture in stance and in sitting. Skeletally immature patients with Scheuermann's kyphosis benefit from a similar exercise program but also require the use of a spinal orthosis. Bracing of the spine in patients with Scheuermann's kyphosis results in permanent correction of vertebral deformity, unlike bracing in patients with idiopathic scoliosis. The evaluation of children and adolescents with increased thoracic kyphosis is an important aspect of the decision process used to determine appropriate interventions.

Adolescent↗
PubMed2001

Single stage decompression, anterior interbody fusion and posterior instrumentation for tuberculous kyphosis of the dorso-lumbar spine.

STUDY DESIGN: To evaluate the role of single stage decompression with anterior interbody fusion with posterior instrumentation and deformity correction of tuberculous kyphosis of the dorso-lumbar spine in patients with/without neurological deficit. OBJECTIVES: (1) To evaluate the amount of kyphosis correction with single stage surgery and its progression with time. (2) To evaluate the neurological recovery. (3) To evaluate the bony anterior interbody fusion. SETTING: King Edward Memorial Hospital, Bombay, India. METHODS: Twenty-eight patients with post-tuberculous kyphosis deformity averaging 64.3 degrees (range 17 to 105) were treated by a single stage posterolateral decompression, correction of kyphosis, anterior interbody fusion and posterior instrumentation. RESULTS: The mean kyphosis correction obtained was 62.5% with the mean post-operative kyphosis angle reducing to 24.1 (range 5-60). At a mean follow-up of 5.8 years (4-7 years) the mean kyphosis angle loss was 3.2 degrees (range 0-5 degrees ). Of the 23 patients with neurological deficit, recovery was seen in 21 cases (91.3%) while deterioration was seen in one case (4.3%). The remaining five patients were neurologically intact pre-operatively. Bony fusion was seen in all cases at 9 months. One patient with subpulmonary function died post-operatively (mortality 3.5%). CONCLUSION: The results of our series are encouraging. However single stage decompression with fusion and kyphosis correction is a very demanding surgery and should be performed after taking into account the risks and benefits involved. This surgery perhaps prevents progression of neurological deficit and recurrence of late onset paraplegia in these complex cases in developing countries.

Adolescent↗
PubMed2001

Prediction of thoracic kyphosis using the Debrunner kyphometer.

The Debrunner kyphometer is an accepted tool for detecting and evaluating thoracic kyphosis. This prospective study was conducted to create a mathematical formula that provides, with high approximation, the roentgenographic angle of thoracic kyphosis (T4-T12) using only the kyphometer. Several clinical (kyphometer value, age, and sex) and radiographic (Cobb angle [T4-T12]) parameters from 90 consecutively screened adolescents (44 male and 46 female) were correlated using simple and multiple linear regression analyses. The reliability of measurement using the Debrunner kyphometer was high. The kyphometer value was strongly correlated with the roentgenographically measured thoracic Cobb angle (simple linear regression analysis; probability range, 0.0026 to 0.0002). There was no correlation between age or sex and thoracic kyphosis. The predicted kyphosis angle using the kyphometer and the mathematic formula was 44.66 degrees +/- 2.68 degrees, (range 27 to 62 degrees), and the real roentgenographic kyphosis angle was 47.5 degrees +/- 3.53 degrees, (range, 24 to 70 degrees). The kyphometer and formula were more reliable and accurate when kyphosis less than 50 degrees was measured. In this study, the authors constructed a mathematical formula that accurately provides the roentgenographic T4-T12 kyphosis angle in adolescents using only the Debrunner kyphometer with a deviation of less than 3 degrees. The authors recommend that all physicians engaged in kyphosis screening programs use the kyphometer combined with the recently constructed simple mathematic formula. This method will reduce the cost of school screening programs, overdiagnoses, and unnecessary exposure of adolescents to irradiation.

Adolescent↗
PubMed2001

Kyphosis in active and sedentary postmenopausal women.

UNLABELLED: EAGAN, M. S., and D. A. SEDLOCK. Kyphosis in active and sedentary postmenopausal women. Med. Sci. Sports Exerc., Vol. 33, No. 5, 2001, pp. 688-695. PURPOSE: This study examined kyphosis in relation to self-reported activity level (sedentary, active) and activity type (weight-bearing land, nonweight-bearing water) in 61 postmenopausal women aged 60-78 yr. METHODS: Specifically, we measured kyphosis, muscle strength (defined as back extensor (BES) and grip (GS) strength), total calcium intake, body fat, height lost since age 30 (HtLost), current activity level for household, leisure and sport activities and their total, as well as occupational and physical activity history and their total. RESULTS: No significant differences (P > 0.05) were found for any variables when subjects were divided into sedentary (N = 18), land (N = 29), and water (N = 14) groups; exercisers (N = 43) and nonexercisers (N = 18); or between the top and bottom tertiles of lifetime active (N = 20) and inactive (N = 20) women. Stepwise multiple regression yielded body fat as the single best predictor of kyphosis accounting for 6.9% of the total variance (P < 0.04) with the resulting equation: kyphosis (degrees) = 22.919 + 0.627*body fat (%) + 0.852*HtLost (cm) + 2.881E-0.03*total calcium intake (mg) (r2 = 0.22, SEE = 7.7). Significant relationships (P < 0.05) included kyphosis with body fat (r = 0.26) and HtLost with age (r = 0.50). Relationships (P < 0.05) regarding muscle strength included: GS and BES with age (r = -0.38, -0.30), HtLost (r = -0.39, -0.36), and occupational activity history (r = 0.28, 0.35), as well as BES with household activity and total activity history (r = 0.28, 0.30). Physical activity history was related (P < 0.05) to current sport, leisure, and total activity history (r = 0.37, 0.42, 0.93, respectively). CONCLUSION: Women who are active when younger seem to be active and stronger as older adults. However, this does not seem to impact kyphosis. The measured variables accounted for a small proportion of kyphosis variance, suggesting that more potent causative factors of this spinal malformation exist.

Activities of Daily Living↗
PubMed1998

Interrater and intrarater reliability in the measurement of kyphosis in postmenopausal women with osteoporosis.

STUDY DESIGN: A reliability study was performed using repeated random measurements involving three observers, 26 subjects and three instruments. OBJECTIVES: To determine the most reliable, cost-effective, noninvasive, and clinically feasible method of measuring spinal kyphosis. SUMMARY OF BACKGROUND DATA: The most clinically useful, noninvasive and reliable method of measuring postural deformity in spinal osteoporosis (kyphosis) remains unqualified. Despite traditional use of costly, invasive roentgenographs for the evaluation of spinal kyphosis, the reliability of this method remains questionable. METHODS: Twenty-six postmenopausal women with known bone mineral density and a diagnosis of osteoporosis were recruited from the Osteoporosis Program at Women's College Hospital, Toronto, Canada. Non-invasive measurements of thoracic kyphosis were obtained by three trained examiners using the DeBrunner's kyphometer and the flexicurve ruler. The intrarater and interrater reliability of and between each method was compared, using roentgenographic films obtained in the sagittal plane. Spinal posture was classified according to the method of Itoi (1990). Statistical computations were performed using SAS statistical software. RESULTS: Consistent measurements were obtained with the DeBrunner's kyphometer and the flexicurve ruler by each observer, according to the results of critical two-way analysis of variance (Intraclass Correlation Coefficient 2, 1). Measurements in two subgroups, healthy backs (n = 11) and rounded backs (n = 13), showed consistent use of each noninvasive instrument with some examiner preference for specific tools. There was marginally better intrarater and interrater reliability using the DeBrunner's kyphometer compared with that obtained with the flexicurve ruler. Two-way analysis of variance (Intraclass Correlation Coefficient 2, 1) of collapsed data showed no significant difference in the reliability of the kyphometer, flexicurve ruler, or roentgenographs in the measurement of thoracic kyphosis. CONCLUSIONS: The flexicurve ruler and DeBrunner's kyphometer had the closest agreement in the measurement of spinal kyphosis. The kyphometer demonstrated the least variation in intrarater and interrater reliability when compared with the flexicurve ruler and roentgenographs. The flexicurve ruler permits qualitative assessment of posture, however, and is the most cost-effective instrument. The results of this study challenge the traditional belief that roentgenographic analysis is the best method for evaluating spinal kyphosis. The DeBrunner's kyphometer and flexible ruler may represent viable, cost-effective and noninvasive alternatives to roentgenographic evaluation of spinal kyphosis.

Aged↗
PubMed2004

Scheuermann kyphosis: safe and effective surgical treatment using multisegmental instrumentation.

STUDY DESIGN: A retrospective review was conducted on 23 consecutive patients who underwent surgical correction of Scheuermann kyphosis using modern multisegmental instrumentation. OBJECTIVE: To evaluate Scheuermann kyphosis correction and complication rates. SUMMARY OF BACKGROUND DATA: The surgical treatment of Scheuermann kyphosis remains a topic of debate. The literature of the 70s and 80s on the surgical management of this disorder using Harrington instrumentation demonstrated that operative correction is quite effective but associated with significant complications. This literature, however, may be less applicable to current clinical situations. The use of modern multisegmental instrumentation and increased awareness of potential complications may decrease the risks of current operative treatment. METHODS: Hospital charts, office charts, and radiographs on 23 consecutive patients who underwent operative treatment using multisegmental instrumentation for Scheuermann kyphosis were reviewed to identify complications of surgery. Complications were classified as minor, major, or life threatening. RESULTS: The mean follow-up was 38 months (range 10-123 months). Preoperative kyphosis ranged from 63 degrees to 104 degrees with an average of 83 degrees. Twenty of the 23 patients (87%) underwent combined anterior release/arthrodesis with posterior arthrodesis/multisegmental instrumentation. The remaining 3 patients underwent posterior arthrodesis/multisegmental instrumentation. Postoperative total kyphosis ranged from 32 degrees to 67 degrees with an average of 46 degrees. At final follow-up, the total kyphosis ranged from 37 degrees to 75 degrees with an average of 51 degrees. Overall, we had 43% minor complications, 17% major complications, and 0% life-threatening complications. CONCLUSIONS: Surgical correction of Scheuermann kyphosis can be performed safely and effectively using modern multisegmental instrumentation.

Adolescent↗
PubMed2005

Differences in thoracic kyphosis and in back muscle strength in women with bone loss due to osteoporosis.

STUDY DESIGN: Cross-sectional. OBJECTIVES: To determine if thoracic kyphosis was different in older women grouped based on their bone mineral density (BMD) and back extensor strength (BES), and to determine if an association between and these variables exist. SUMMARY OF BACKGROUND DATA: Changes in kyphosis might be related to back extensor weakness in patients with osteoporosis. Disproportionate weakness in back extensor musculature considerably increases the possibility of deformities in the fragile osteoporotic spine. METHODS: A total of 189 female subjects 50 to 80 years of age were grouped by their BMD and additionally by their BES. All were evaluated for thoracic kyphosis, maximal isometric strength of the back extensors, and BMD of the lumbar spine and the hip. RESULTS: There was no significant difference in thoracic kyphosis among all groups. Multivariate analyses of BES and BMD showed that only BES might influence thoracic kyphosis (P = 0.02). There was no correlation between BES and BMD. Statistically significant deficit in BES was observed only between the osteoporotic and osteopenic group (P < 0.05). The importance of BES in maintaining posture was observed when the study population was divided according to their BES level. With respect to thoracic kyphosis and BMD values, there were no statistical differences between strong women (BES more than 60 N) and those with medium BES (BES between 60 and 35 N). But the weakest group (BES less then 35 N) had significantly higher (P < 0.05) mean values of thoracic kyphosis in comparison to strong women (BES more than 60 N) and those with medium BES (BES between 60 and 35 N). CONCLUSION: The severity of thoracic kyphosis may be influenced especially by changes in BES. Therefore, provision of strong, natural extrinsic support for the spine seems to be important to decrease the incidence of spinal deformity.

Aged↗
PubMed2005

Experience with combined video-assisted thoracoscopic surgery (VATS) anterior spinal release and posterior spinal fusion in Scheuermann's kyphosis.

STUDY DESIGN: Retrospective. OBJECTIVES: To determine whether anterior endoscopic release and posterior spinal fusion could achieve stable correction in Scheuermann's kyphosis. SUMMARY OF BACKGROUND DATA: The initial treatment of choice of Scheuermann's kyphosis is thoracic hyperextension and postural exercises and/or Milwaukee brace. Milwaukee bracing is most efficacious in the early stages when the curvature is flexible and in the skeletally immature. However, it is known that larger curves, vertebral wedging greater than 10 degrees, and skeletally mature patients will not usually respond to this treatment. Surgery is indicated in the skeletally immature with severe deformity where brace treatment has failed to prevent progression. Posterior spinal instrumentation can achieve adequate correction in the less rigid curves. However, the more rigid curves have been shown to be resistant to posterior spinal fusion alone, therefore needing anterior spinal release. METHODS: Between 1995 and 2001, 19 patients underwent video-assisted thoracoscopic surgery and posterior spinal fusion for the treatment of Scheuermann's kyphosis. The average age was 17.4 years with closed triradiate cartilage in all. Average follow-up was 2.7 years. An average of 8.3 discs were released anteriorly; an average of 13 levels were fused posteriorly. RESULTS: Average preoperative kyphosis was 84.8 degrees. Average postoperative kyphosis was 43.7 degrees. Average kyphosis at follow-up was 45.3 degrees. Only 1.6 degrees of correction loss was noted. No junctional kyphosis was present. Two patients developed pleural effusion; one required thoracocentesis. Two patients developed pneumothorax. One patient underwent revision surgery for inferior hook pullout. One required mechanical ventilation. CONCLUSIONS: Combined video-assisted thoracoscopic surgery release and posterior spinal fusion for the treatment of Scheuermann's kyphosis is a viable option for the treatment of the more severe and rigid curves.

Adolescent↗
PubMed2006

Comparison of Scheuermann kyphosis correction by posterior-only thoracic pedicle screw fixation versus combined anterior/posterior fusion.

STUDY DESIGN: Retrospective comparison review. OBJECTIVE: Compare posterior-only treatment results with segmental thoracic pedicle screw constructs versus combined anterior/posterior fusion in patients with Scheuermann kyphosis. SUMMARY OF BACKGROUND DATA: Traditionally, operative Scheuermann kyphosis has been treated with combined anterior/posterior spinal fusion, with the anterior portion being performed via an open thoracotomy or a video-assisted thoracoscopic approach. METHODS: There were 18 patients with Scheuermann kyphosis who underwent a posterior-only thoracic pedicle screw (P/TPS) fusion and 21 who underwent an anterior/posterior fusion who were followed for a 2-year minimum. The 2 groups were well matched according to average age (anterior/posterior fusion 18.0 degrees and P/TPS 17.3 degrees; P = 0.60), maximum preoperative kyphosis (anterior/posterior fusion 89.1 degrees and P/TPS 84.4 degrees; P = 0.21), flexibility index (anterior/posterior fusion 0.408 degrees and P/TPS 0.407 degrees; P > 0.99), and posterior fusion levels (anterior/posterior fusion 12.1 degrees and P/TPS 12.2 degrees; P = 0.95). Of 21 patients with anterior/posterior fusions, zero versus 12 of 18 (67%) patients in the P/TPS group underwent apical Smith-Petersen osteotomies. Fixation in the anterior/posterior fusion group was achieved with hybrid hook/screw constructs. Posterior fixation in the P/TPS group was performed using segmental thoracic pedicle screw constructs. Both groups had posterior iliac bone autografting. Operating time and blood loss were noted, and radiographs were evaluated before surgery, after surgery, and at final follow-up. At final follow up, Scoliosis Research Society-30 questionnaire data and complications were recorded. RESULTS: At surgery, operating time and blood loss were significantly less in the P/TPS group (P = 0.009 and P = 0.05, respectively). The mean residual kyphosis of the P/TPS group averaged 38.2 degrees after surgery and 40.4 degrees at final follow-up versus anterior/posterior fusion group (51.9 degrees and 58.0 degrees, P < 0.001 and P = 0.001, respectively). Even without an anterior release, kyphosis correction in the P/TPS group averaged 54.2% after surgery and 51.8% at final follow-up versus the anterior/posterior fusion group (41.2% and 38.5%, P = 0.001 and P < 0.001, respectively). Scoliosis Research Society-30 outcome scores at final follow-up were comparable between the 2 groups (P/TPS = 120 and anterior/posterior fusion = 128; P = 0.14). The anterior/posterior fusion group had 8/21 (38%) patients with complications, including paraplegia in 1, proximal junctional kyphosis in 1, proximal hook pullout in 1, and infection in 2. The P/TPS group had no complications (P = 0.003). CONCLUSIONS: With less operating time and intraoperative blood loss, posterior-only Scheuermann kyphosis treatment with thoracic pedicle screws achieved and maintained better correction, and had significantly less complications than with circumferential fusion.

Adolescent↗
PubMed1997

Correlates of kyphosis in older women. The Fracture Intervention Trial Research Group.

OBJECTIVE: To determine the association between kyphosis (degree of forward curvature of the thoracic spine) and measures of spinal osteoporosis (height loss and vertebral fractures) and chronic back pain and disability in older women. DESIGN: A cross-sectional study. SETTING: Eleven clinical centers in the United States. PARTICIPANTS: A total of 6439 community-dwelling osteoporotic women aged 55-80 enrolled in the Fracture Intervention Trial (FIT), a multicenter clinical trial of alendronate. MEASUREMENTS: Thoracic curvature was measured at baseline using a Debreuner Kyphometer. Height loss was determined by subtracting current height measured with a Harpenden stadiometer from self-reported height at age 25. Vertebral fractures were defined by morphometry and semiquantitative reading of lateral thoracic and lumbar spine radiographs, and chronic back pain and back-related disability were assessed by questionnaire. RESULTS: After adjustment for age, a 15 degrees increase in kyphosis was associated with losing more than 4 cm of height (OR, 1.88; 95% CI, 1.79-2.03) and having a vertebral fracture (OR, 1.57; 95% CI, 1.46-1.69). Kyphosis was more strongly related to thoracic fractures than to lumbar fractures, and kyphosis was most prominent in women with multiple thoracic wedge fractures. Kyphosis was also associated with upper back pain (OR per 15 degrees increase, 1.62; 95% CI 1.47-1.79) and middle back pain (OR per 15 degrees increase, 1.24; 95% CI 1.12-1.36), but it was not related to lower back pain (OR per 15 degrees increase, 0.98; 95% CI 0.90-1.05). Women with greater degrees of kyphosis were only slightly more likely to report back-related disability (OR per 15 degrees increase, 1.18; 95% CI 1.03-1.35) and poorer health status (OR per 15 degrees increase, 1.19; 95% CI 1.03-1.37). CONCLUSIONS: Older women with greater degrees of kyphosis are likely to have other manifestations of spinal osteoporosis such as height loss and thoracic fractures and to suffer chronic upper and middle back pain. Measurement of kyphosis may be useful in assessing the severity of spinal osteoporosis.

Age Factors↗
PubMed2004

Thoracic kyphosis and ventilatory dysfunction in unselected older persons: an epidemiological study in Dicomano, Italy.

OBJECTIVES: To assess whether kyphosis is associated with ventilatory dysfunction in older community dwellers. DESIGN: Cross-sectional study. SETTING: The unselected population of Dicomano, Italy aged>or=65 years. PARTICIPANTS: A total of 323 nonheart failure participants underwent clinical evaluation for the presence of kyphosis and spirometry. The severity of kyphosis was estimated from the difference between standing stature and knee-height-derived stature and from the occiput-wall distance. MEASUREMENTS: Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and prevalence of obstructive and restrictive ventilatory pattern. RESULTS: The 130 kyphotic participants (40.2%) had an adjusted 2.5 prevalence odds ratio (POR) for dyspnea (95% confidence interval (CI)=1.1-5.8). FVC% and FEV1% were lower in the presence of kyphosis (P<.01); their deficit was proportional to kyphosis severity. The ventilatory dysfunction was underestimated when reference spirometric parameters were calculated based on standing stature, compared with knee-height derived stature. Of the kyphotic participants, 56.2%, 26.9%, and 16.9% had spirometric normal, obstructive, and restrictive patterns, respectively. Kyphosis was associated with a restrictive (adjusted POR=2.3, 95% CI=1.1-4.8; P=.021) and an obstructive ventilatory pattern (adjusted POR=3.3, 95% CI=1.7-6.5; P<.001). CONCLUSION: In unselected older persons, kyphosis is associated with dyspnea and ventilatory dysfunction of a restrictive and an obstructive type. Kyphosis should be included in the differential diagnosis of dyspnea and ventilatory dysfunction in the elderly.

Aged↗
PubMed2006

Timing of osteotomy for thoracolumabar or lumbar kyphosis secondary to ankylosing spondylitis.

OBJECTIVE: Ankylosing spondylitis may lead to a rigid thoracolumbar kyphotic deformity. Several authors have reported the results of patients treated by a lumbar osteotomy, but there is no consensus on the level of the osteotomy and on timing of osteotomy. The purpose of this study is to explore timing of osteotomy for thoracolumabar or lumbar kyphosis secondary to ankylosing spondylitis by analyzing the natural history of 78 AS patients. METHOD: To analyze the factors related to influence the timing of osteotomy for thoracolumabar or lumbar kyphosis secondary to ankylosing spondylitis. Patient Sample There were 78 patients including 69 male and 9 female; the mean age at the time of surgery was 38 years (range, 22-56 years). The characteristic of natural history of these 78 patients is lumbar pain stage, slowly progressive kyphosis stage, accerlated progressive kyphosis stage, stabilized kyphosis stage. The average preoperative deformity was 61 degrees (range, 40 degrees to 87 degrees). Twenty-eight patients underwent V shape osteotomy, and 50 patients underwent transpedicular osteotomy. RESULT: The average age of occurrence of lumbar pain symptom is 21 years,the average duration of slowly progressive kyphosis stage is 3 years (range, 1 to 8 year), and the average duration of accerlated progressive kyphosis stage is 4 (range, 2 to 10 year). The patients were followed up for a period of 4-60 months (mean 49 months). The total correction postoperatively was 40 degrees +/-11 degrees, the average loss of correction was 5 degrees at the final follow-up. Excellent results were obtained in 74 patients (95%), and good results were obtained in 4 patients (5%), there were no fair or poor results. CONCLUSION: Lumbar pain arrests for more than 6 months (exclusive of mechanical pain of lumbar), normal blood sedimentation rate continues for two times, and reactive protein is negative. These factors must be considered in timing of osteotomy for thoracolumabar or lumbar kyphosis secondary to ankylosing spondylitis.

Adult↗
PubMed2006

Balance impairment is related to vertebral fracture rather than thoracic kyphosis in individuals with osteoporosis.

INTRODUCTION: Balance impairments have been identified in people with osteoporosis. Although an association between thoracic kyphosis and impaired balance has been reported, the specific role of vertebral fractures has not been considered. This study aimed to investigate the independent effects of osteoporotic vertebral fracture and thoracic kyphosis on balance characteristics in an osteoporotic population. METHODS: Twenty-two individuals with osteoporosis were divided into groups with (n=10) and without (n=12) radiologically diagnosed fracture, and into groups with low (n=11) and high (n=11) thoracic kyphosis. Force-plate-derived balance parameters were recorded during three static standing tasks of 70-s duration. Balance measures were compared between fracture and kyphosis groups, and significant differences were further explored through subgroup analyses, to tease out the relationships between confounded independent variables (fracture and kyphosis) and balance measures. RESULTS: In the anterior-posterior direction, the range and root mean square of shear forces (p=0.048 and p=0.032, respectively), and range of displacement of the centre of pressure (p=0.049) were greater in the fracture group. There were no differences between groups when comparison was based on the magnitude of thoracic kyphosis (all p>or=0.264). Analyses of subgroups supported these findings. DISCUSSION: Vertebral fracture but not thoracic kyphosis is associated with impaired balance characteristics in the osteoporosis population. This finding has important implications for fracture prevention and conservative management regimes.

Aged↗
PubMed1999

The relative influence of vertebral body and intervertebral disc shape on thoracic kyphosis.

OBJECTIVE: The aim of this study was to quantify the morphology or shape of thoracic vertebral bodies and intervertebral discs, and to examine the ex vivo association of thoracic kyphosis with these shape parameters. DESIGN: A quantitative, retrospective study design was applied to define vertebral body and disc influences on thoracic kyphosis. BACKGROUND: Age-related progression of thoracic kyphosis is a well-defined process that is influenced by the morphology of vertebral bodies. However, little is known about the contribution of intervertebral disc shape to the thoracic curvature. METHODS: Vertebral and disc morphology, as represented by antero-posterior height ratios, were quantified in 93 lateral spine radiographs and midsagittal computed tomography films of ex vivo spines. Kyphosis was indicated by the Cobb angle. Linear and stepwise regression were applied to examine relationships for cumulative (T1-T12) and regional (T4-T9) analyses. RESULTS: Vertebral morphology was highly predictive of thoracic curvature, while a poorer association was noted for disc morphology. The combined influence of both accounted for >85% of the variability in kyphosis. There was a trend for a more pronounced anterior wedge configuration of the midthoracic vertebral bodies and discs. Higher associations between variables were also noted in this region. CONCLUSIONS: The normal kyphosis of the thoracic spine reflects the morphological adaptation of both the vertebral bodies and intervertebral discs. RELEVANCE: This study contributes new data on the thoracic spine, particularly the characteristics of thoracic discs and their contribution to kyphosis genesis. Future directions for morphology studies should encompass more detailed examination of the thoracic discs and greater emphasis on the midthoracic segments, considering the prevalence of osteoporosis related fractures and subsequent deformity at these levels.

Adult↗
PubMedDate not supplied

Scheuermann kyphosis: long-term follow-up.

BACKGROUND CONTEXT: There is considerable controversy as to the optimal treatment of Scheuermann kyphosis. Proposed modalities have included exercise, bracing and surgery. PURPOSE: The purpose of this study was to document the functional capacity and radiographic findings in adults who have been previously treated for Scheuermann kyphosis. STUDY DESIGN: A cohort study of all patients with Scheuermann kyphosis treated in a single institution using three different treatment modalities: exercise and observation, Milwaukee bracing and surgical fusion using the Harrington Compression System. PATIENT SAMPLE: Sixty-three patients were evaluated at a mean of 14 years after treatment (10 to 28 years). OUTCOME MEASURES: Two different functional evaluation instruments were used. Radiographic evaluation was carried out in 38 patients (60%). METHODS: Patient interviews were conducted using a specially designed questionnaire. Patients were then asked to undergo standing radiographs. Patients were divided into groups depending on the location of their kyphosis and the manner in which they had been treated. Standard statistical analysis was then carried out. RESULTS: At time of follow-up evaluation there were no differences in marital status, general health, education level, work status, degree of pain and functional capacity between the various curve types, treatment modality and degree of curve. Patients treated by bracing or surgery did have improved self-image, which they attributed to their treatment. Patients with kyphotic curves exceeding 70 degrees at follow-up had an inferior functional result. At time of final follow-up there were no statistical differences in degree of kyphosis and mode of treatment. CONCLUSIONS: By carefully selecting the appropriate treatment for patients with Scheuermann kyphosis on the basis of the patient's age, spinal deformity and the severity of back pain, it is possible to achieve a similar functional result at long-term follow-up. Despite different treatment protocols, patients with Scheuermann kyphosis tend to achieve a similar functional result at long-term follow-up.

Adult↗
PubMed1993

Prevalence of kyphosis in a healthy sample of pre- and postmenopausal women.

Kyphosis, initially modest, progresses to the well recognized dowager's hump of the postmenopausal osteoporotic woman. Kyphosis is not only associated with relatively altered vertebral body shape (anterior wedging), but also with reduced bone density and fitness, as well as decreased muscle strength, and is associated with reduced survival. We found an unexpectedly high (35%) incidence of kyphosis in a healthy sample of well women 20 to 64 years of age. The correlation between normal postural index of kyphosis (I/K) and upright postural I/K was substantial (r = 0.799). Among the postmenopausal women, normal postural I/K was inversely correlated with age. Upright postural kyphosis was not related to age, nor was normal postural I/K in the premenopausal woman. There was no direct relationship demonstrated between current calcium consumption and I/K. Similarly, neither estrogen levels nor follicle-stimulating hormone levels were related to current posture. Women with satisfactory exercise habits had significantly lower I/K. Because the capacity to stand up straight was consistently higher than the normal postural score, yet closely correlated to it, there may be a role for postural kyphosis in changing the architecture of the vertebral column. As normal posture becomes kyphotic, an individual can no longer straighten the vertebral column. The surveyor's flexicurve, which we employed for this study, provided a simple and inexpensive method for assessing postural index. This measurement can be routinely included in the comprehensive health examination. Assessment of bone health in women should be made within the context of a fixed postural kyphosis.

Adult↗
PubMed2001

The sagittal profile of the cervical and lumbosacral spine in Scheuermann thoracic kyphosis.

The sagittal profiles of the cervical and lumbar spine have not been studied in Scheuermann kyphosis. The purpose of this study was to investigate these profiles. Standing lateral radiographs of the spine in 34 children with Scheuermann kyphosis were reviewed. Cervical lordosis, lumbar lordosis, thoracic kyphosis, sagittal vertebral axis, and sacral inclination were measured. The relations between these variables were explored using the Pearson correlation. The average patient age was 15.5 +/- 1.8 years, thoracic kyphosis was 65 degrees +/- 12 degrees, lumbar lordosis 71 degrees +/- 13 degrees, and cervical lordosis 4 degrees +/- 15 degrees (Cobb angle), and 9 degrees +/- 14 degrees (posterior vertebral body angle [PVBA]). No correlations were noted between cervical lordosis and thoracic kyphosis. Correlations were noted between cervical lordosis and lumbar lordosis (r2 = 0.17, Cobb angle; r2 = 0.16, PVBA) and between cervical lordosis and the residual sagittal difference (thoracic kyphosis minus lumbar lordosis; r2 = 0.32, p = 0.001 [Cobb angle], and r2 = 0.19, p = 0.01 [PVBA]). In Scheuermann kyphosis, the flexible cervical and lumbar spine is linked by the intermediate rigid thoracic segment. As the residual sagittal difference becomes more kyphotic, lordosis of the cervical spine increases as the patient strives to maintain a forward visual gaze.

Adolescent↗
PubMed1994

An analysis of sagittal curves and balance after Cotrel-Dubousset instrumentation for kyphosis secondary to Scheuermann's disease. A review of 32 patients.

STUDY DESIGN: This study compared preoperative and postoperative saggittal curves and spinal balance in patients undergoing spinal fusion with Cotrel-Dubousset instrumentation for severe kyphosis secondary to Scheuermann's disease. Also determined was patient satisfaction regarding relief of pain and correction of the deformity. Thirty two patients with kyphosis > 75 degrees underwent spinal fusion with Cotrel-Dubousset instrumentation. OBJECTIVES: To evaluate the initial and long-term correction of the primary kyphosis and changes in lumbar lordosis and sagittal balance, and to determine the incidence and etiology of junctional sagittal deformities. SUMMARY OF BACKGROUND DATA: The average preoperative kyphosis was 85 degrees (range, 75 degrees to 105 degrees) with an average correction at final follow-up of 43 degrees (range, 26 degrees to 65 degrees). Preoperative lumbar lordosis averaged 75 degrees (range, 58 degrees to 100 degrees) and at final follow-up averaged 55 degrees (range, 23 degrees to 74 degrees). Most of the patients demonstrated negative sagittal balance and became slightly more negatively balanced postoperatively. RESULTS: Maintenance of correction postoperatively was excellent, with only a 4 degree average loss of correction. There was spontaneous reduction in lumbar lordosis of varying degrees. Proximal junctional kyphosis was associated with over-correction (> 50%) of the kyphotic deformity or a fusion starting short of the proximal vertebra in the measured kyphosis. Distal junctional kyphosis developed in patients whose fusion ended short of the first lordotic segment. CONCLUSIONS: This procedure appeared to yield good results when proper levels of fusion were selected and correction > 50% was not attempted.

Adult↗