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PubMed1977

Post-laminectomy kyphosis.

Post-laminectomy spinal deformity occurs in 50% of children undergoing laminectomies for cord tumors. Kyphosis is the most frequent deformity found. The integrity of the facet joints appears to be one of the most important factors in the development of this kyphosis. More children are surviving after treatment of these tumors and a pessimistic attitude is not warranted. Observation of a progressing deformity is not acceptable treatment. When kyphosis develops, early prompt bracing must be started. For a progressive or severe kyphosis, an anterior spine fusion is indicated. This is reinforced by a posterior fusion with Harrington instrumentation. Surgical reconstruction is indicated in children recovering from extensive laminectomies but with a good prognosis.

Adolescent↗
PubMed1983

Age changes in kyphosis and lordosis of Jat-Sikh and Bania females of Punjab (India) from 20 to 80 years.

The age changes in spinal curvature of the trunk region in females of the two important communities of Punjab Jat-Sikh and Bania have been studied in the present paper. These two communities are traditionally engaged in different types of occupations, the former being agriculturist and the latter being the trading community. The results are based on a cross-sectional data collected on 502 Jat-Sikh and 510 Bania females ranging in age from 20 to 80 years. A flexicurve has been used to measure kyphosis and lordosis. The kyphosis has been observed to be influenced by weight and spinal length. Therefore, various indices were examined to test their suitability as estimates of measuring kyphosis due to age only. Linear regression of B/H index on age showed an increase in kyphosis with age from age-group 45-49 to 70+. Lordosis has been found to decrease after age-group 45-49.

Adult↗
PubMed1994

[Postlaminectomy kyphosis of the cervical spine complicating spinal cord tumor in the foramen magnum].

Postlaminectomy kyphosis is rarely encountered as a sequela of decompression of the upper cervical spine, especially in adults. We present a case of disabling cervical kyphosis which developed after laminectomy for excision of a foramen magnum tumor and was treated successfully by occipito-vertebral fusion. A sixty-one-year old female was treated by laminectomy of the first through to the third cervical spine for a foramen magnum meningioma. One year later, the laminectomy was extended downward to include the fourth through to the seventh cervical spine because of neurological deterioration. Seven years after the first laminectomy, she was referred to our spinal service because of severe neck pain, numbness and muscle weakness of both upper extremities. Lateral X-ray of her cervical spine presented a severe kyphosis. Roentgenogram two months after the first laminectomy already showed slight deformity and, timewise, it corresponded with the time when the patient experienced neurological deterioration. Subsequent X-rays showed progression of kyphosis. After we confirmed a lessening of the pain and improvement of the neurological symptoms during an axial traction using a halo-vest, posterior occipito-cervico-thoracic fusion was performed using Luque segmental spinal instrumentation and autogenous bone graft. After surgery the pain decreased and neurological symptoms improved. It is important to be aware of the complication of kyphotic deformity after laminectomy and once it has developed, it is recommended to stabilize the progression by early spinal fusion.

Cervical Vertebrae↗
PubMed1997

The progression of untreated lumbar kyphosis and the compensatory thoracic lordosis in myelomeningocele.

Radiographs of 37 patients with untreated lumbar kyphosis without congenital vertebral anomalies associated with myelomeningocele were analyzed. With an average interval between radiographs of 6.2 years, the kyphosis was noted to increase at a mean rate of 4.3 degrees per year without correlation to its initial magnitude. The compensatory lordosis was more variable and progressed at a mean of 2.5 degrees per year. Children under the age of 2 years were more likely to increase the Cobb angle and the height of their kyphosis. There was an inverse relationship between the height of the kyphus and the lumbar spine height and the resultant growth of each. A modified kyphotic index less than 4 correlated with an increase in the curve and height of the kyphosis and the subsequent desire for surgery. Wide variability in radiographic parameters make predictions for an individual patient difficult.

Adaptation, Physiological↗
PubMed2003

The use of Irradiated Allografts in Posterior Spinal Fusion for Healed Tubercular Kyphosis in Children.

Post-tubercular spinal kyphosis in children is not only cosmetically unacceptable but functionally disabling as well, as with the progression of the deformity there is a very significant risk of late onset paraplegia. We present our preliminary results in a prospective study of 12 cases of healed post-tubercular kyphosis in children treated with isolated posterior spinal fusion using irradiated allografts and autogenous cancellous grafts.The study included 12 patients of healed post-tubercular kyphosis documented by clinical, radiological and haematological criteria, with >2 spine at risk signs radiologically. The mean age was 7 years. In situ posterior spinal fusion with irradiated allografts and autogenous cancellous bone graft without any instrumentation was done for all the patients. The total follow-up is 5 years (mean 2.8 years).Eight patients (66%) showed a correction of the kyphosis, 3 patients (25%) were static and only 1 patient showed worsening of the deformity. Eleven patients had sound fusion and 1 patient had good fusion but a pseudoarthrosis at the lower vertebral level.Good posterior fusion was achieved because of the judicious use of morcellised, irradiated cancellous allografts with autogenous cancellous grafts. The proposed mechanism of correction is selective anterior column growth vis-à-vis posterior fused mass leading to gradual self-correction and remodelling.Conclusion. In situ posterior spinal fusion with irradiated allografts is a simple, safe, easily reproducible, less morbid surgical procedure with good results which may alter the long term disability of the patients.

Journal Article↗
PubMed1994

[The place of traction and the anterior approach in the surgical treatment of kyphosis and kyphoscoliosis in children using C.D. instrumentation].

The surgical treatment of kyphosis and kyphoscoliosis in children or adolescents using the Cotrel-Dubousset (C. D.) instrument through a posterior approach may often need a further anterior procedure either before or after. We have reviewed 20 adolescents who were operated on at l'Hôpital Saint Vincent de Paul since 1983. Our choice of management was determined by consideration of the aetiology, the age, the degree of angulation and the suppleness of the kyphotic spine in hyperextension on the operating table. The use of preoperative traction for a mean of 25 days gained an improvement of 14% of the final correction. It was used in the curves which were most pronounced, usually high thoracic curves which lacked suppleness in the lumbar spine and which were stiff on the table. The anterior approach was not indicated in long double dorso-lumbar curves, usually of idiopathic origin, which had already reached an advanced stage of development. It was necessary in severe angular kyphoses which were unstable or had marked anterior stiffness. It was sometimes used in younger patients with kyphoscoliosis in which it was difficult to assess the state of maturity. After operation the kyphosis was corrected by up to 73% in simply kyphoses, 66% in kyphoscoliosis and 59% in scolio-kyphosis. After operation we were usually able to mobilise patients without a corset.

Adolescent↗
PubMed1995

Severe mid-cervical kyphosis with cord compression in Larsen's syndrome and diastrophic dysplasia: unrelated syndromes with similar radiologic findings and neurosurgical implications.

Mid-cervical kyphosis in diastrophic dysplasia (DD) with cord compression and weakness has been recognized for the last three decades. A strikingly similar situation exists in Larsen's syndrome (LS), an otherwise unrelated problem of weakness with lay joints and dislocations with typical facies. Forty patients with DD were studied of whom seven had cervical spine kyphosis: one patient had spontaneous correction over the ensuing two decades. Seven patients with LS were studied of whom four had cervical spine changes with cord compression. There was one sudden death among the patients with LS and no cases of spontaneous correction. Muscle weakness in DD and LS should lead to evaluation of cervical spine kyphosis with cord compression. Plain films, CT and recently MRI are useful.

Cervical Vertebrae↗
PubMed1994

Kyphosis in older women and its relation to back pain, disability and osteopenia: the study of osteoporotic fractures.

To test the hypothesis that thoracic kyphosis is associated with substantial pain, disability, and height loss, we measured thoracic curvature, using an architect's flexicurve, of 610 women aged 65-91 years who were recruited from population-based listings. We assessed study subjects for back pain, back-related disability, height loss since age 25 years, perceived state of health, and bone mineral density (BMD) at the spine, calcaneus, proximal radius, and distal radius. Compared with the rest of the cohort, the 10% of women with the most severe kyphosis had 7%-17% lower BMD (p < 0.001) and had lost an additional 2.4 cm height (p < 0.001). However, kyphotic women had no greater back pain, disability caused by back problems, or poorer health. This cross-sectional study suggests that kyphosis is associated with decreased BMD and loss of height but does not cause substantial chronic back pain, disability, or poor health in older women.

Aged↗
PubMed2006

Primary and secondary tissue expansion gives high quality skin and subcutaneous coverage in children with a large myelomeningocele and kyphosis.

When operating on a child with a large myelomeningocele and kyphosis, coverage with skin of high quality and a supporting layer of subcutaneous tissue can be difficult. The dermal circulation in the newborn is finite and an extensive mobilisation of the skin is a risky venture. Between 1988 and 2003 five children with large thoraco-lumbal myelomeningocele and kyphosis underwent subcutaneous insertion of silicon tissue expanders due to skin cover difficulties. In three children the skin surface was allowed to granulate over the myelomeningocele. In the other two children closure of the myelomeningocele was attempted but failed leading to secondary epithelialisation. Four of the children had two tissue expanders inserted at the age of 8-12 months; two of them before delayed operation for the myelomeningocele and two before elective spinal column surgery. The fifth child was nine years old when two tissue expanders were inserted before delayed myelomeningocele repair. Saline was injected into the expanders every 3-7 days during six to eight weeks. The expansion treatment was well tolerated. The result was an excellent skin and subcutaneous coverage in four of the children. For the fifth child who was the oldest and obese, one filling port was damaged during one of the injections, leading to insufficient tissue expansion. An extensive skin mobilisation was required and the result was not optimal. Tissue expansion is a simple, but a less known technique for acquiring good skin and subcutaneous coverage in children with large myelomeningocele and kyphosis. The expansion can be done either before delayed myelomeningocele repair or after failed primary operation thus eliminating the need for extensive musculo-cutaneous flaps.

Age Factors↗
PubMed1982

Acute respiratory failure in scoliosis or kyphosis: prolonged survival and treatment.

Acute respiratory failure (ARF) in adults with severe thoracic spinal deformity is said to be a preterminal event with a median survival of one year. Twenty patients with ARF (mean +/- S.D., arterial oxygen tension [PaO2] 35 +/- 7 mm Hg, arterial carbon dioxide tension [PaCO2] 63 +/- 9 mm Hg, pH 7.34 +/- 0.08) due to severe scoliosis or kyphosis (spinal curve 113 +/- 28 degrees ) were seen between 1965 and 1980. All 20 survived the initial episode of ARF and during the follow-up period (median, six years) experienced 2.4 additional episodes of ARF. The age at presentation was 52 years (mean, range 13 to 78), and the cause of spinal deformity was idiopathic (seven patients), poliomyelitis (seven), tuberculosis (five), and arthrogryposis multiplex congenita (one). ARF was treated with controlled low dose oxygen by Venturi mask and intensive general measures in 13 patients and by mechanical ventilation in seven. Of the latter seven patients, ventilatory failure was treated in two with a tank respirator and a cuirass, avoiding endotracheal intubation. Outpatient management was similar to conventional therapy for chronic obstructive pulmonary disease (COPD). Severe restrictive ventilatory impairment characterized the group after recovery from the first episode of ARF: vital capacity (VC) 906 +/- 362 ml (31 percent predicted) and FEV1 589 +/- 197 ml (23 percent). During follow-up, the VC decreased by 1.5 ml/year and the FEV1 by 13.9 ml/year. The PaO2 increased by 2.6 mm Hg/year and the PaCO2 increased by 1.7 mm Hg/year. Successful management of ARF due to severe scoliosis or kyphosis is possible in the great majority of patients, and long-term survival may be expected. Unlike COPD, pulmonary function following ARF in kyphosis or scoliosis deteriorates at a slower than expected rate and, in fact, may improve with treatment over many years.

Acute Disease↗
PubMed1990

Wrist fracture, heel bone density and thoracic kyphosis: a case control study.

The heel bone density measured by Broadband Ultrasound Attenuation (BUA), the thoracic kyphosis measured by a Kyphometer, height, and weight were compared between 294 women over 49 years of age who sustained a wrist fracture and 294 age-matched women who had not previous wrist, hip or spine fracture. The BUA was significantly less in the women who had wrist fracture (p less than 0.0005), though there was a considerable overlap between the two populations. The women with wrist fracture had significantly greater thoracic kyphosis (p less than 0.0005) and smaller stature (p less than 0.0005). There was no significant difference in weight. There was a significant tendency (p less than 0.0005) for women in the fracture patient group to have both poor BUA and greater kyphosis.

Aged↗
PubMed2004

Cervical kyphosis is a possible link to attention-deficit/hyperactivity disorder.

OBJECTIVE: To discuss the case of a patient who was diagnosed with attention-deficit/hyperactivity disorder (ADHD) by a general practitioner and was treated with chiropractic care. CLINICAL FEATURES: A 5-year-old patient was diagnosed with ADHD and treated by a pediatrician unsuccessfully with methylphenidate (Ritalin), Adderall, and Haldol for 3 years. The patient received 35 chiropractic treatments during the course of 8 weeks. A change from a 12 degrees C2-7 kyphosis to a 32 degrees C2-7 lordosis was observed after treatment. During chiropractic care, the child's facial tics resolved and his behavior vastly improved. After 27 chiropractic visits, the child's pediatrician stated that the child no longer exhibited symptoms of ADHD. The changes in structure and function may be related to the correction of cervical kyphosis. CONCLUSION: The patient experienced significant reduction in symptoms. Additionally, the medical doctor concluded that the reduction in symptoms was significant enough to discontinue the medication. There may be a possible connection that correction of cervical kyphosis in patients with ADHD may produce a desirable clinical outcome.

Attention Deficit Disorder with Hyperactivity↗
PubMed1994

Kyphosis and fractures in children and young adults with cystic fibrosis.

The purpose of this study was to examine children and adolescents with cystic fibrosis for an increased frequency of fracture and excessive thoracic kyphosis, which may result from inadequate skeletal mineralization. In a survey of 143 patients (ages 4.7 to 21.9 years; mean, 11.3 years), the fracture rate for male patients from birth to 5 years of age was higher than for female patients and both rates were comparable with those for normal children. In contrast, female patients 6 to 16 years of age with cystic fibrosis had a higher-than-normal fracture rate and a higher rate than their male counterparts. Review of the chest radiographs showed that thoracic kyphosis correlated with age and with disease severity as judged by Brasfield scoring. In the > 15-year-old age group, kyphosis exceeding 40 degrees, the upper limit of normal, was found in 77% of the female patients and 36% of the male patients. The cause of these findings is uncertain and perhaps multifactorial, but osteopenia is likely a contributing factor. As the life expectancy of patients with cystic fibrosis continues to increase, the skeletal consequences, particularly in female patients, may become increasingly significant.

Adolescent↗
PubMedDate not supplied

[Surgical therapy of hemivertebrae scoliosis and kyphosis--a retrospective analysis of 53 cases].

AIM OF THE STUDY: We performed a retrospective analysis of the results of operative treatment of 53 patients with congenital scoliosis (n = 47) or kyphosis (n = 6) due to hemivertebrae. PATIENTS AND METHODS: The mean age of the patients (31 girls and 22 boys) at the time of the initial examination was 6 +/- 4 years. Surgical treatment was carried out on average at the age of 9 +/- 5 years. Follow-up examinations were carried out up to a mean age of 16 +/- 6 years. RESULTS: The results of operative treatment depended on the localization of the hemivertebrae and the surgical technique. Progression of scoliosis due to a thoracic hemivertebra was halted, but the scoliosis could not be corrected (Cobb angle at initial examination 37 +/- 17 degrees at follow-up 34 +/- 23 degrees). Scoliosis due to lumbar hemivertebrae was reduced by surgery (Cobb angle at initial examination 36 +/- 14 degrees, at follow-up 21 +/- 15 degrees). Surgery without instrumentation led to worse results than did surgery with instrumentation with thoracic as well as lumbar scoliosis. Combined dorsoventral procedures with resection of the hemivertebra seemed to be superior to spondylodesis without resection of the hemivertebra. Surgical correction of kyphosis associated with dorsal hemivertebrae was performed by means of dorsal or dorsoventral spondylodesis with hemivertebra resection (preoperative kyphosis 70 +/- 34 degrees, at follow-up 44 +/- 25 degrees). CONCLUSION: Spondylodesis without instrumentation is associated with an unsure prognosis with respect to effects on the progression of the scoliosis, even if it is performed on very young patients. In contrast, spondylodesis with instrumentation can achieve better and longer-lasting corrections of scoliosis even with larger initial curvatures. Scoliosis due to lumbar hemivertebrae is more amenable to surgical correction than thoracic scoliosis due to hemivertebrae.

Adolescent↗
PubMedDate not supplied

[Ultrasound topometric measurements of thoracic kyphosis and lumbar lordosis in school children with normal and insufficient posture].

AIM: The posture of school children was examined in order to establish whether possible differences in clinically normal and insufficient posture can be detected by means of ultrasound topometry. METHOD: 105 healthy school children (56 female, 49 male) with an average age of 8 years (+/- 0.9) were examined. To classify the children as having sufficient or insufficient posture the Matthiass posture test was used. While the child stood in a relaxed position, the profile of the spine was measured with a topometric digitiser, recording each spinal processus from C7 to L5. RESULTS: 42 children (22 female, 20 male) showed an insufficient posture during the Matthiass test. The topometrically measured angles of kyphosis and lordosis were significantly smaller in these children, corresponding to a clinically greater thoracic kyphosis and lumbar lordosis. No significant differences in the lateral and anterior-posterior trunk deviation, nor in the range of trunk sway in the relaxed standing position could be observed. CONCLUSION: Using ultrasound topometry, the posture of children with sufficient and insufficient posture can be differentiated by measuring, the angles of kyphosis and lordosis. This quantification could be used for objective monitoring of the posture.

Anthropometry↗
PubMed1999

[Sports and physical load bearing capacity after spondylodesis in patients with Scheuermann kyphosis].

In this investigation it was examined which is the effect of an extensive spondylodesis by patients with Scheuermann's kyphosis on their sport activity and their physical load capacity. Between 1983 and 1990, 10 patients with severe kyphosis secondary to Scheuermann's disease underwent surgical correction and spinal fusion. In 1997 all 10 patients were clinically and radiologically examined and interviewed at an average follow-up of 9.6 years. At the time of follow-up one patient was active in top sports, seven patients in normal sport, two patients were members in a sports-club and one patient was not interested in sport. Eight patients went in for sports regulary. Mostly the patients were active in gymnastics, cycling and swimming. At follow-up almost all patients found that their physical load capacity and the behaviour in relation to back pain were better than before operation. Half of the patients were exposed to a middle physical load in the daily life. The presented study shows that patients after extensive spondylodesis for Scheuermann's kyphosis and clear reduction of pain are not automatically limited in the daily life, both for sport and professional activity. However, generalized recommendations for the physical load capacity of the operated patient cannot be given, and an individualized decision must be taken for each case.

Adolescent↗
PubMedDate not supplied

[Comparison of the effects of lordosis on the thoracic spine using the Milwaukee and Gschwend brace in scoliosis and kyphosis].

64 patients in Milwaukee-Brace and 32 patients in Gschwend-Brace have been assessed for creating lordosis of the thoracic spine. In both types of braces induction of lordosis can be observed although there did not seem to exist a directly proportionate relationship towards the period of treatment. The degree of correction in the thoracic spine depends on the kyphosis at the onset of treatment. In marked kyphosis exceeding 60 degrees or corresponding kyphotic components in scoliosis the Milwaukee-Brace is preferred over against the Gschwend-Brace. In a pure kyphosis with minimal scoliotic curve the Gschwend-Brace remains the treatment of choice.

Adolescent↗
PubMedDate not supplied

[Study of dorsal erection osteotomy in kyphosis].

Presented is a procedure for the correction of the juvenile kyphosis and the kyphotic false posture upon spondylitis ankylopoietica. Upon spine dissects the extraction and outbreak force of screws and screw pairs dorsally brought into the vertebral body were measured. It has been showed that the pedicle screws tolerate very high extraction forces upon sagittal and right-angle stress as well. The correction of the juvenile kyphosis upon rigid kyphosis and the correction by lordosing the thoraco-lumbar transition upon patients with a spondylitis ankylopoietica is clinically possible with good results.

Adolescent↗