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PubMed1997

Incidence of postlaminectomy kyphosis after Chiari decompression.

STUDY DESIGN: In this retrospective study, a 5-year series of a pediatric population undergoing Chiari decompressions is reviewed. OBJECTIVES: To review the experience with children treated with suboccipital craniectomy and uni- or multilevel cervical laminectomy for Chiari malformation, to determine the incidence of kyphosis and to identify factors predictive of cervical instability. SUMMARY OF BACKGROUND INFORMATION: Upper cervical laminectomy in the pediatric population has a significant risk of postoperative kyphosis. To decrease the incidence of this complication, a concerted effort was made to avoid violation of the facet joint during cervical laminectomy. METHODS: Thirty-two patients (mean age 4.9 years, range 1 day to 18 years) had surgical decompression of Chiari I or II malformations throughout a 5-year period (1989-1994). Radiographs and operative records were analyzed to determine the number of cervical levels decompressed and extent of laminectomy. RESULTS: Mean follow-up was 3.7 years (range 9 months to 7 years). Only one patient had clinical and radiographic evidence of kyphosis and required C2-C3 fusion. Two others had radiographic signs of mild cervical kyphosis but remained asymptomatic. These three patients had two-level complete laminectomies. Twenty-nine patients had no clinical or radiographic evidence of cervical instability. A mean of three cervical levels were decompressed (range 0-4), including partial laminectomies, complete laminectomies, and one osteoplastic laminotomy to drain a lower cervical syrinx. The overall frequency of kyphosis in this series (9%) was substantially lower than in previous reports. Although the number of cervical levels decompressed did not correlate with cervical instability, the one patient with clinical instability had inadvertent violation of the facet joint, suggesting that overaggressive laminectomy may be a critical factor that predisposes patients to postoperative kyphosis. CONCLUSION: Cervical kyphosis after Chiari decompression is a recognized complication of cervical laminectomy in children, the frequency of which may be decreased by careful attention to operative technique.

Adolescent↗
PubMed2001

Transient paraparesis: a complication of the surgical management of Scheuermann's kyphosis secondary to thoracic stenosis.

STUDY DESIGN: Transient paraparesis during the operative management of a 16-year-old patient with Scheuermann's kyphosis secondary to thoracic stenosis is reported. OBJECTIVE: To describe a treatable cause for paraparesis in a patient with Scheuermann's kyphosis undergoing surgical treatment. SUMMARY OF BACKGROUND DATA: Cord injury in the surgical treatment of Scheuermann's kyphosis is a rare event, yet it is felt to be more common in the surgical correction of kyphosis than in surgery for scoliosis. Suggested etiologies have included vascular insufficiency, hypotension, direct mechanical trauma, and neural element stretch. Concomitant thoracic spinal stenosis predisposing to neurologic injury during surgical manipulation has not been reported. METHODS: A 16-year-old boy with progressive Scheuermann's kyphosis measuring 80 degrees from T7 to T12 underwent an anteroposterior spinal fusion with somatosensory-evoked potential monitoring and wake-up tests. During the instrumentation posteriorly, somatosensory-evoked potential monitoring became markedly abnormal. This was followed by a wake-up test that demonstrated the patient's inability to move either of his lower extremities. All instrumentation was removed. The patient had recovered neurologic function by the time he reached the recovery room. A computed tomography myelogram was performed on the third postoperative day, which demonstrated severe thoracic stenosis from T8 to T10. The patient was returned to the operating room 1 week later to undergo a posterior laminectomy from T7 to T11 and instrumented fusion from T5 to L2. Somatosensory-evoked potential monitoring was stable throughout this procedure, and the wake-up test was normal. RESULTS: The patient's postoperative course and subsequent 2-year follow-up period were unremarkable. He progressed to clinical and radiographic union and maintained a normal lower extremity neurologic examination. CONCLUSIONS: A treatable cause for paraparesis secondary to the surgical treatment of Scheuermann's kyphosis is presented. The author currently obtains a thoracic magnetic resonance image (MRI) before the surgical correction of any patients with Scheuermann's kyphosis.

Acute Disease↗
PubMed2002

The Pediatric Outcomes Data Collection Instrument (PODCI) and functional assessment in patients with adolescent or juvenile idiopathic scoliosis and congenital scoliosis or kyphosis.

STUDY DESIGN: An initial examination of functional assessment scores in scoliosis and kyphosis populations. OBJECTIVE: Examination of scores from the Pediatric Outcomes Data Collection Instrument for patients with idiopathic scoliosis, congenital scoliosis, and congenital kyphosis, comparing scores with those of children without orthopedic disabilities. SUMMARY OF BACKGROUND DATA: Little information has been presented regarding performance of scoliosis patients on the Pediatric Outcomes Data Collection Instrument. METHODS: A total of 102 patients with adolescent idiopathic scoliosis, 47 with congenital scoliosis without kyphosis, and 9 with congenital kyphosis completed the Pediatric Outcomes Data Collection Instrument. Responses were compared with those from a "normal" population. Subgroup analyses were performed for patients with adolescent idiopathic scoliosis. A P value <0.05 was considered statistically significant. RESULTS: Scores in Transfers, Sports, Comfort, and Happiness were significantly lower than "normal" in adolescent idiopathic scoliosis. In congenital scoliosis without kyphosis, scores in all categories except Happiness were significantly lower than "normal." All category scores were significantly lower than "normal" in congenital kyphosis. In adolescent idiopathic scoliosis, age and curve location did not influence Comfort scores. Comfort scores were significantly lower than "normal" for all curve locations and for all ranges of Cobb angle. Happiness scores were significantly lower in adolescent idiopathic scoliosis patients with Cobb angles >50 degrees who had not received surgery when compared with either patients who had received surgery or patients with Cobb angles <50 degrees. CONCLUSION: These findings provide some normative values for the Pediatric Outcomes Data Collection Instrument for three specific diagnoses. Patients with adolescent idiopathic scoliosis, congenital scoliosis, and congenital kyphosis gave responses significantly different from "normal" children. Pain appeared to be a common finding with these diagnoses.

Activities of Daily Living↗
PubMed2006

Effectiveness of posterior decompression for patients with ossification of the posterior longitudinal ligament in the thoracic spine: usefulness of the ossification-kyphosis angle on MRI.

STUDY DESIGN: A reliability study was conducted. OBJECTIVE: To report the utility of the ossification- kyphosis angle of a decompression site in the sagittal view of MRI in the preoperative evaluation of the effectiveness of posterior decompression for patients with ossification of the posterior longitudinal ligament in the thoracic spine. SUMMARY OF BACKGROUND DATA: In patients with ossification of the posterior longitudinal ligament, in the thoracic spine, posterior decompression may not always be effective for those with physiologic kyphosis; however, posterior decompression is sometimes useful for patients with multilevel lesions or with ossification of the ligamentum flavum. Therefore, it is necessary to evaluate the indications or limitations of posterior decompression before surgery. METHODS: The indications or limitations of posterior decompression for this disease were reviewed from the findings of intraoperative ultrasonography and various parameters on preoperative imaging in 22 patients with thoracic myelopathy. RESULTS: Thirteen patients had echo-free space and 9 patients had no echo-free space in intraoperative ultrasonography after posterior decompression. In the kyphosis angle of the decompression site and the configuration of the maximal prominent OPLL, there was no significant difference between the group with echo-free space and the group without echo-free space (P = 0.49, P = 0.55). On the other hand, the ossification-kyphosis angle of the decompression site was more than 23 degrees in all patients with no echo-free space (23 degrees -34 degrees , 28.2 degrees +/- 3.6 degrees ), and it was less than 23 degrees in all patients with echo-free space (10 degrees -23 degrees , 17.4 degrees +/- 4.1 degrees ). There was also significant difference between the groups statistically (P < 0.01, P = 1.50789E-06). In addition, in the occupation rate of the greatest prominence of the OPLL, there was statistically significant difference between the groups (P = 0.032). CONCLUSION: The ossification-kyphosis angle in the sagittal view of MRI has potential as an indicator of the effectiveness of posterior decompression in this disease. It is thought that there is a critical point of posterior decompression at nearly 23 degrees of the ossification-kyphosis angle of the decompression site. When the ossification-kyphosis angle is more than 20 degrees , the presence of echo free space should be carefully confirmed in intraoperative ultrasonography.

Adult↗
PubMed1997

The impact of kyphosis on daily functioning.

OBJECTIVES: To determine whether moderate or severe kyphosis is associated with decrements in physical function, especially mobility. DESIGN: Cross-sectional analysis of a cohort study. SETTING: The Johns Hopkins Functional Status Laboratory, a multidisciplinary, standardized, quantitative assessment center. PARTICIPANTS: A total of 231 community-dwelling volunteers aged 59 and older who participated in a 1-day evaluation. MEASUREMENTS: Age, gender, self report of physical function, standardized measurement of: kyphosis (both qualitatively clinical criteria and quantitative assessment), time to walk 5 meters (0.1 seconds), and time to climb a flight of stairs (0.1 seconds) at usual pace. RESULTS: Using multivariate step-wise regression analysis, the presence and severity of kyphosis, measured qualitatively, was independently associated with time to walk 5 meters and to climb a flight of stairs (P = .015, P < .001, respectively), adjusting for moderate-severe scoliosis, heart rate response to exercise, arthritis, vertigo, age, and gender. Similarly, quantitative kyphosis was associated independently with stair climb time (P = .005). Qualitative kyphosis was also associated with difficulty reaching (OR = 2.21 (95% CI: 1.14 to 4.29)) and difficulty performing heavy housework (OR = 1.64 (95% CI: 1.03 to 2.61)), adjusting for prior diagnosis of moderate-severe scoliosis, prior diagnosis of arthritis, age, and gender. CONCLUSION: Kyphosis, by both clinical and quantitative assessment, is associated with diminished function, especially performance of mobility tasks. This association should be verified prospectively. If predictive, the impact of kyphosis on physical function should be considered in osteoporosis prevention and treatment counseling.

Activities of Daily Living↗
PubMed1983

Thoracic kyphosis and lumbar lordosis during the growth period in children.

The thoracic kyphosis and the lumbar lordosis were studied in 1,101 healthy children in consecutive age-groups between 8 and 16 years of age. The sagittal curves were estimated with a spinal pantograph--a noninvasive device--with the child standing in a relaxed position. The accuracy and the reproducibility of this technique are studied and shown to be acceptable. The thoracic kyphosis varied in both boys and girls. The least pronounced kyphosis was seen at the age of 10-12 years. At the age of 8 and 14-16 the mean range of the kyphosis increased statistically significantly. A positive correlation was also seen between the velocity of growth and the range of the kyphosis. In the lordosis, a similar trend could not be seen, but instead a slow continuous increase. A positive correlation was also observed between the ranges of the kyphosis and lordosis in most of the age-groups. An individual variation was, however, seen and wide ranges of kyphosis as well as lordosis must be accepted as normal variations.

Adolescent↗
PubMed2002

Kyphosis in a Turner syndrome population.

OBJECTIVE: The purpose of this study was to determine the prevalence of kyphosis in a Turner syndrome (TS) population. METHODS: Standing lateral thoracic spine and standing anterior-posterior (A-P) scoliosis radiographs were obtained on all girls with TS between the ages of 5 and 18 years seen in a TS clinic between July 2000 and March 2001. Medical histories were reviewed, and a pediatric orthopedic surgeon evaluated the radiographs of each patient (N = 25). Excessive kyphosis was defined as an A-P curvature >40 degrees, vertebral wedging as any A-P deformity >5 degrees at an individual vertebral body, and scoliosis as a lateral curvature >10 degrees. RESULTS: Fifteen (60%) of 25 patients were found to have abnormal radiographic findings: 10 (40%) of 25 with excessive kyphosis, 10 (40%) of 25 with vertebral wedging, and 5 (20%) of 25 with scoliosis. Forty-eight percent of the girls had both excessive kyphosis and/or vertebral body wedging. Two girls had kyphosis > or =55 degrees, and 5 had scoliosis > or =25 degrees. Girls with excessive kyphosis and/or vertebral body wedging were older (13.6 +/- 3.9 years vs 10.6 +/- 2.8 years). CONCLUSIONS: The prevalence of excessive kyphosis and vertebral body wedging seems to be increased in girls with TS and corresponds with advancing age. Routine radiologic surveillance may facilitate detection of developing deformities so that treatment with a brace can be considered to prevent or slow the process.

Adolescent↗
PubMed2000

[Influence of solid thoracolumbar kyphosis on lumbar spine and surgical treatment].

OBJECTIVE: To investigate the influence of solid thoracolumbar kyphosis on the lumbar spine and surgical treatment. METHODS: 14 had solid kyphosis of the thoracolumbar spine. Cobb angle of kyphosis of the thoracolumbar spine and lordosis between L(2)/S(1), L(2)/L(5), L(2)/L(3), L(3)/L(4), L(4)/L(5), L(5)/S(1) pre- and post-osteotomy was measured respectively, and the amount of vertebrae slipped over 3mm was recorded. The results were compared with those of the normal group respectively. RESULTS: The Cobb angles of lordosis between L(2)/S(1), L(2)/L(5), L(2)/L(3), L(3)/L(4), L(4)/L(5), L(5)/S(1) in the deformity group were increased significantly compared with those that of the normal group respectively; obvious changes in percentage occurred in the segment between L(2)/L(3) and L(3)/L(4). Over lordosis of the lumbar spine was greatly corrected postosteotomy of the thoracolumbar spine, it was still significantly different compared with that of the normal group. In 9 patients with retrolisthesis of 20 vertebrae, 70% occurred in L(2) and L(3) vertebrae. The amount of retrolisthesis of vertebrae decreased to 3 in two patients. No retrolisthesis of vertebra was seen in the normal group. Single-stage procedures combined with anterior releasing and posterior osteotomy through facet joints for kyphosis of the thoracolumbar spine showed a correction. rate of 85.7%, but single-stage osteotomy through the posterior vertebra showed a correction rate of 60.7%. Seven of 8 patients who had had seriously back pain complained of no pain or slight backache after operation. 40% of the patients showed functional improvement in the sphincter of the urinary bladder and anus. 50% of the patients had improvement in muscle strength. CONCLUSIONS: Kyphosis of the thoracolumbar spine may result in over lordosis of the lumbar spine and retrolisthesis of vertebrae, which are obvious in the upper lumbar spine. These changes may lead to back pain. Correction of kyphosis of the thoracolumbar spine may obviously decrease over lordosis of the lumbar spine and inclination of vertebral slip, and may further decrease the overload to the posterior column of the spine and relieve back pain. Osteotomy combined with anterior and posterior procedures is effective and safe in the correction of kyphosis of the thoracolumbar spine.

Adolescent↗
PubMed2002

[Upper thoracic short angular kyphosis: a clinical analysis of 15 cases].

OBJECTIVE: To provide reference for correct clinical treatment by summarizing the characteristics and surgical experience in spinal deformity of the upper thoracic (T(1)-T(4)) short angular kyphosis. METHODS: Medical history was taken in 15 cases are reviewed. The results of X-ray and MRI examinations were analyzed. The kyphotic angles were measured using the Cobb technique. All cases underwent the anterior spinal cord decompression, by posterolateral approach in 4 cases and posterior in 11 cases. RESULTS: Kyphosis was congenital in 7 cases and due to tuberculosis approach in 8 was. The average age at deformity was first noted was 3.6 years in 7 congenital cases and 9.0 years in 8 tuberculosis cases. All cases had neurologic deficits. The mean kyphosis was 86.5 degrees (range, 45 - 100 degrees). The delay between first observation of the deformity and subsequent neurologic loss was 16.5 years and 18.1 years respectively. The operation failed in 1 case. 13 cases were followed up, with an average 42 months. Seven cases showed improvement, 2 no change and 4 deterioration in neurologic deficit. CONCLUSIONS: In cases of or tuberculosis kyphosis, the usual time for kyphosis to occur is during the preadolescent growth spurt. Neurologic deficits may occur without treatment and will be always progressive. The result of operation is not satisfactory. Early diagnosis and adequate management of kyphosis will prevent progression and thus any possible spinal cord compression. Early fusion is usually necessary to control the kyphosis.

Adolescent↗
PubMedDate not supplied

[Orthopedic treatment of Scheuermann's juvenile kyphosis].

The authors establish some indications, depending on several criteria, of the treatment of cases of juvenile kyphosis of the Scheuermann type. These are based on their experience acquired in the therapy of 26 cases of juvenile kyphosis in which orthopaedic procedures have been applied -- plaster cast for recovery in two stages, followed by an orthopaedic corset and careful follow-up for at least one year after the end of the treatment. The criteria suggested as being important are: the severity of the kyphosis, the mobility of the spine, the severity of the kyphosis, the mobility of the spine, the severity of the vertebral structural lesions and the bone age. In cases of kyphosis under 40 degrees with a mobile spine, with minimal radiological lesions, detected before the end of growth, kinesitherapy is indicated and repeated clinico-radiological follow-up. The progression of the kyphosis under treatment or the existance of important vertebral structural lesions make necessary the performance of an orthopaedic treatment, the same as the severe cases of kyphosis, over 40 degrees, with median or severe vertebral lesions.

Adolescent↗
PubMed2004

Kyphosis does not equal vertebral fractures: the Rancho Bernardo study.

OBJECTIVES: Kyphosis is considered a clinical sign of osteoporotic vertebral fractures. We examined the association of radiographically defined kyphosis with vertebral fractures to determine if this belief was true. METHODS: A total of 1407 ambulatory white adults, aged 50-96 years, from the middle-class community of Rancho Bernardo, California, USA, attended a 1992-96 research clinic visit. Bone mineral density (BMD) was measured at the hip and spine, and lateral thoracolumbar spine radiographs were obtained. The degree of kyphosis was determined using the modified Cobb method. RESULTS: A total of 114 of 553 men (20.6%) and 188 of 854 women (22.0%) had one or more thoracic vertebral fractures. Degenerative disc disease was observed in 45.4% of men and 56.7% of women. The mean age-adjusted Cobb angle was significantly higher (p < 0.001) in men and women with vertebral fractures in comparison to those without vertebral fractures: men 51.3 degrees vs 41.5 degrees, respectively, and women 56.4 degrees vs 46.3 degrees. The prevalence of vertebral fracture increased with higher Cobb angles and there was no significant difference by sex. The proportion of women with osteoporosis increased with the increase of Cobb angle. In the upper quartile of the Cobb angle distribution (> or = 55.5 degrees ), only 36.2% of men and 36.9% of women had prevalent thoracic vertebral fractures; and osteoporosis using WHO BMD criteria was present at the total hip in 9.7% of men and 32.7% of women. CONCLUSION: The majority of men and women with exaggerated kyphosis (the upper quartile of the Cobb angle) had no evidence of thoracic vertebral fractures or osteoporosis. Degenerative disc disease, not vertebral fractures, was the most common finding associated with radiographically defined angle of kyphosis in men and women. Thus kyphosis per se should not be considered diagnostic of osteoporosis. Nevertheless, patients with exaggerated kyphosis should be evaluated for underlying osteoporotic fracture.

Aged↗
PubMed2004

[Combined thoracoscopic anterior spinal release and posterior correction for Scheuermann's kyphosis].

OBJECTIVE: To evaluate the effectiveness of combined thoracoscopic anterior spinal release and posterior correction for Scheuermann's kyphosis. METHODS: Sixteen patients with a diagnosis of Scheuermann's kyphosis were selected to undergo thoracoscopic anterior spinal release, disc excision, and fusion in conjunction with instrumented posterior correction and spine fusion. Cobb angle of the kyphosis were measured before the operation and during the follow-up period to evaluate the correction. Pre- and post-operative Oswestry disability Index (ODI) were collected to evaluate the pain relief. RESULTS: All 16 patients underwent successfully corrections. The mean preoperative kyphosis (Cobb) was 78.8 degrees (70 degrees-92 degrees), the mean postoperative kyphosis (Cobb) was 40.5 degrees (36 degrees-47 degrees), and the last follow-up evaluation of the kyphosis was 41.7 degrees (36 degrees-50 degrees ). All patients obtained satisfied pain relief. The mean preoperative ODI was 37.3 (0-72), and the mean postoperative ODI was 6.4 (0-30). CONCLUSION: Combined thoracoscopic anterior spinal release and posterior correction is a good method for the treatment of Scheuermann's kyphosis.

Adolescent↗
PubMed2006

The clinical utility of measured kyphosis as a predictor of the presence of vertebral deformities.

UNLABELLED: Meaured spinal kyphosis, as a predictor of prevalent and incident vertebral deformity, was examined in older women (>70 years) and found to not have sufficient sensitivity or specificity to justify its use as a predictor of present or future vertebral deformity risk. INTRODUCTION: Kyphosis may be attributable to vertebral deformity and was investigated as a clinical tool for predicting the presence and future risk of vertebral deformity. METHODS: Kyphosis was measured in 434 women aged 70 years or older and the kyphosis index (KI) calculated. Prevalent and incident vertebral deformities were assessed by morphometric X-ray absorptiometry (MXA). The predictive value of KI was examined. RESULTS: Severity of kyphosis was categorised by tertile of KI; 65% of anterior thoracic deformities occurred in the 33% of subjects in the highest (most kyphotic) tertile. Using this tertile as a predictor of anterior thoracic deformity, the probability for a positive test rose from 14% for the whole population to 28% and for a negative test the probability fell to 8%. For any spinal deformity the highest tertile of KI increased the probability of a positive test from 34% to 42% and reduced the probability for a negative test to 30%. The incidence of new deformities was 6% over 4 years; a high KI tertile did not increase the probability of any vertebral deformity. CONCLUSIONS: Severe kyphosis does not increase the probability of detection of a prevalent or incident spinal deformity sufficiently to make it a useful method of selecting patients for further evaluation of spinal deformity.

Absorptiometry, Photon↗
PubMed1996

Thoracic kyphosis and the prevalence of advanced uterine prolapse.

OBJECTIVE: To determine if there is an association between the degree of thoracic kyphosis and the prevalence of advanced uterine prolapse in women. METHODS: A retrospective case-control study compared the degree of thoracic kyphosis among white women with advanced uterine prolapse with that of matched controls. Medical records were reviewed for 412 consecutive women who underwent either abdominal or vaginal hysterectomy. The cases were those with uterine prolapse to or beyond the level of the introitus, and women with no evidence of prolapse served as controls. Spinal curvature was measured preoperatively for each patient using a lateral chest x-ray and the Ferguson method. Forty-eight cases were matched to 48 controls for age, weight, menopausal status, and hormonal status. Results were stratified to analyze the effect of parity on the relationship between uterine prolapse and thoracic kyphosis. RESULTS: The degree of thoracic kyphosis was higher in patients with uterine prolapse than in controls (mean paired difference = 4.9 degrees, 95% confidence interval [CI] 3.1-6.7; P < .001). Patients with uterine prolapse had a mean spinal curvature of 13.0 degrees (95% CI 11.5-14.5), whereas controls had one of 8.1 degrees (95% CI 6.9-9.4). A higher degree of thoracic kyphosis was associated with an incremental higher occurrence of uterine prolapse (odds ratio 1.35, 95% CI 1.11-1.65; P < .01). CONCLUSION: Thoracic kyphosis appears to be associated with uterine prolapse.

Case-Control Studies↗
PubMed2005

[Radiological index as a predictive factor of kyphosis in spina bifida].

PURPOSE OF THE STUDY: The aim of this work was to validate the pertinence of a radiological index (P/A) used as a predictive factor for risk of kyphosis in children with spina bifida. P/A is defined as the ratio between P, the distance between the posterior vertebral wall and the remnant of the posterior arch, over A, the distance between the anterior wall and the posterior vertebral wall, measured on the lateral view of the spine in the most dysplastic vertebra before one year of age. MATERIAL AND METHODS: The files of 163 children were reviewed. The value of the P/A ratio was measured on lateral views of the spine obtained before the age of one year. The bone level on the anteroposterior film was also noted. The presence or absence of kyphosis was determined from the lateral views obtained at ten years of age. Paired variable analysis was used to compare the mean differences in P/A at one year and at ten years in 31 patients with a bone level of L1 or higher. The exact Fisher test was used to determine the difference in the kyphosis distributions in patients with a bone level of L1 or higher between those with P/A < or = 1/2 and the others. In addition, the specificity, sensitivity, and positive predictive value of a positive test (bone level L1 or higher and P/A < or = 1/2) for development of kyphosis were calculated. Results There was no statistically significant difference in the P/A mean value before the age of one year and after ten years. The distribution of patients with kyphosis was different between patients with a bone level of L1 or higher and P/A < /2 and the other patients (p < 0.01). Considering having a bone level of L1 or higher and a P/A < or = 1/2 as a prognostic test, the specificity was 100%, the sensitivity 87.56%, and the positive predictive value 100%. Many patients with spina bifida will develop kyphosis in the course of life. This spinal deformation raises many specific problems for patient management. Use of a radiological index as presented here allows early detection of patients at risk and can also predict which patients will remain free of deformation. This allows a selection of patients who can benefit most from more regular surveillance of the spinal static and avoid unnecessary radiographic examinations in others.

Adolescent↗
PubMed2000

A comparison of three methods for measuring thoracic kyphosis: implications for clinical studies.

OBJECTIVES: To compare the Cobb technique for measuring kyphosis with an alternative Cobb method and a computer-assisted curve assessment technique, and to examine the influence of vertebral body and disc shape on kyphosis. METHODS: Kyphosis measurements were derived from 93 lateral spinal radiographs or sagittal computed tomography images of cadaveric spines, using: (i) a computer-assisted method for estimating radius of curvature; (ii) the traditional Cobb method; and (iii) an alternative Cobb method. Regression models were applied for agreement analyses, and to examine the relative contribution of vertebral body and disc shape on the extent of curvature. Results and conclusions. Strong associations existed between curvature and angle data derived from the three methods, confirming the clinical utility of these techniques for the quantification of thoracic kyphosis. However, the traditional Cobb method tended to overestimate kyphosis in the presence of vertebral body end-plate deformation. The degree of kyphosis was strongly reflective of the extent of deformity of the vertebral bodies, and to a lesser extent the shape of the thoracic discs.

Cadaver↗
PubMed1994

Thoracic kyphosis, rib mobility, and lung volumes in normal women and women with osteoporosis.

STUDY DESIGN: Lung volumes and rib mobility were measured in 15 women with kyphosis resulting from spinal osteoporosis and in 15 healthy women. OBJECTIVES: The study first sought to determine the relationship between thoracic kyphosis and rib mobility and then sought to determine the effect of kyphosis and associated changes in rib mobility on respiratory function. SUMMARY OF BACKGROUND DATA: Spinal deformity in ankylosing spondylitis and scoliosis is associated with alterations in respiratory function. The effect of thoracic kyphosis on respiratory mechanics has not been investigated in an osteoporotic population. METHODS: Lung volumes were measured using a spirometer, and rib mobility, during maximal inspiratory and expiratory maneuvers, was monitored with four motion sensors placed anteriorly, posteriorly, and laterally on the thorax. RESULTS: Vital capacity, inspiratory capacity, total lung capacity, and lateral expansion of the thorax were lower in the osteoporotic group (P < 0.05). There was a significant negative correlation between kyphosis angle and inspiratory capacity, vital capacity, and lateral expansion of the thorax. CONCLUSIONS: Lung volumes and rib mobility were significantly impaired in women with thoracic kyphosis.

Aged↗
PubMed1996

Spinal stenosis above a healed tuberculous kyphosis. A case report.

STUDY DESIGN: This case report illustrates two patients with paraplegia of late onset resulting from cord compression in the hyperlordotic thoracic or thoracolumbar spine proximal to a healed tuberculous kyphosis. OBJECTIVES: The objective of this paper is to highlight that degenerative stenosis of the thoracic spine proximal to a healed stable kyphosis can be a cause of paraplegia of healed disease. SUMMARY OF BACKGROUND DATA: Paraplegia resulting from tuberculosis of the spine can be of early or late onset. Early onset paraplegia is usually a result of cord compression by active disease. Late onset paraplegia can be due to disease reactivation, bony ridge compression, or unstable kyphosis. To our knowledge, compression of the cord proximal to a healed, stable kyphosis giving rise to paraplegia has never been reported. METHODS: Patient 1 presented with symptoms of spinal claudication and progressive paraparesis. He was found to have spinal stenosis in the hyperlordotic thoracolumbar spine proximal to a healed lumbosacral tuberculous kyphosis. Patient 2 presented with a 2-year history of progressive paraplegia. Imaging revealed cord compression at the hyperlordotic T10-11 segment by disc protrusion, and facet hypertrophy. RESULTS: Laminectomy successfully relieved the first patient of all symptoms but the second patient had significant deterioration of the neurologic status after surgery. CONCLUSION: Compensatory hyperlordosis of the thoracic or thoracolumbar spine commonly occurs in patients with severe tuberculous thoracolumbar or lumbosacral kyphosis. Degenerative spinal stenosis and cord compression at such hyperlordotic segment can cause late onset paraplegia. The blood supply of these chronically compressed cords is precarious and the risk of surgery is high.

Adult↗