The term kyphosis is used to describe the spinal curve that results in an abnormally rounded back. Kyphosis can occur at any age.
Kyphosis is a deformity that can appear in early childhood, where it can then increase with growth and development. The primary curve of the spine, the so-called the thoracic angle consists of 12 vertebrae. As children grow, the angle of the thoracic spine increases with age and is significantly more pronounced in girls than in boys.
Hyperkyphosis or an increase in the thoracic curvature larger than the normal range is one of the most common disorders of the spine. Biomechanical data suggest that an increase in kyphosis could be associated with significantly higher spinal loads and torso muscle strength in an upright position, which could accelerate the degenerative process which in turn leads to further dysfunction and pain in the spine in children. An increase in kyphosis is also associated with decreased physical function, impaired respiratory function, increased cervical pain, headaches and shoulder problems such as subacromial syndrome. It is an obvious fact that physical activity has a positive impact on the psychophysical development of children, especially if it is implemented in an early period of childhood, with an adequately trained person. Critical periods taken in the development of deformities, related to the growth and development of active and passive forces in the body are: the period of the first year of life, period of starting school; period of puberty, a period of pronounced neuro-hormonal influence, with adolescent growth momentum.
It is of two types; round or angular. Round kyphosis means a gentle backward curvature of the spinal column. It is caused by diseases affecting a number of vertebrae (e.g., senile kyphosis). Such a kyphosis may be localised to a segment of the spine, or it may be diffuse.
Angular kyphosis means a sharp backward prominence of the spinal column. It may be prominence of only one spinous process because of the collapse of only one vertebral body: as may occur in a compression fracture of a vertebra. This is called as knuckle. There may be a kyphosis localised to a few vertebrae, and is called as gibbus. It is seen commonly in tuberculosis where usually two oe more vertebrae are affected.
Kyphosis can be congenital or postural, or result from trauma or degenerative disease. Additionally, spondylolisthesis, neurofibromatosis, Paget’s disease, and tumors have been shown to cause kyphosis. Scheuermann’s disease is a thoracic kyphosis of greater than 45 degrees associated with three sequential vertebrae anteriorly wedged at 5 degrees or more. Although kyphosis is idiopathic, there is evidence to suggest that Scheuermann’s disease may be inherited through autosomal dominance or caused by juvenile osteoporosis.
The following are the common causes of diffuse kyphosis: Postural: This is the commonest type, seen in tall individuals, especially in some tall women, because of their tendency to stand with a forward stoop. It occurs in the upper dorsal spine, and can be corrected by postural training and physiotherapy.
Compensatory: If there is an exaggerated lumbar lordosis due to some disease, the thoracic spine develops compensatory kyphosis.
Scheurmann's disease: It is a common type. There is a gentle round kyphosis in the lower thoracic spine. It is due to osteochondritis affecting the ring-epiphyses of the vertebral bodies. On X-rays, the vertebral bodies appear wedge-shaped, narrower in front. There may be a dull constant pain during early stages of the disease, but later, only kyphosis remains. Conservative treatment is adequate for most patients with pain as the complaint. If the deformity is severe, especially if it is compromising the activities in any way, surgical intervention may be required.
Ankylosing spondylitis: The disease produces a stiff and kyphotic spine. It begins in young men as low backache, which gradually spreads to affect the whole spine. Chest expansion is reduced because of the limitation of movements at the costo-vertebral joints. In a few cases, hips and shoulders are also affected.