Background

Definition

 

Abnormal posteriorly directed sagittal plane curve of spine

 

Scoliosis Research Society 

 

Thoracic

 

Normal range thoracic kyphosis is 20-40° 

- measured over T1 to T12 by Cobb method

- upper limit of normal thoracic kyphosis < 45°

 

Cervical & Lumbar

- lordosis is normal

- any kyphosis (>5°) considered abnormal

 

Classification Scoliosis Research Society

 

Postural

 

Scheuermann's Disease

 

Inflammatory / Ankylosing Spondylitis

 

Congenital

- failure of segmentation / formation / mixed

 

Iatrogenic

- post laminectomy / tumour excision in child / radiotherapy

 

Traumatic

- acute fracture / anterior wedging

- chonic - osteoporosis, OI

 

Infection

- TB

 

Metabolic

- Osteoporosis

- OI

- Mucopolysaccharidoses

 

Neuromuscular

- Polio

- Spinal muscular atrophy

- UMN Syrinx

- SB

 

Developmental

- Achondroplasia

- SED

- morquio's 

 

Postural Kyphosis

 

Often confused with Scheuermann's

 

Examination

 

Gradual, no angular curve

 

Patient can voluntary correct roundness on stance

 

Prone hyperextension test

- reversal of thoracic spine hyperkyphosis

 

X-ray

 

No structural vertebral changes

 

Corrects on supine xray on bolster

 

Management

 

No treatment necessary

 

Post - Laminectomy Kyphosis

 

Mechanism

 

Occur because posterior supporting structures removed

- normally resist gravity producing kyphosis

 

Adult

 

Following radical laminectomy

- facet joints removed bilaterally

 

Infection post surgery

 

Kyphotic deformity Post Fusion

 

Growing child

 

Usually after excision spinal cord tumour

- radical laminectomy removing facet joints bilaterally

 

Management

 

Laminectomy

- prevention is key

- must preserve at least 1/2 of each facet joint or one whole facet / level

- if not possible, fusion indicated

 

Child

- must recognise potential for deformity & closely observe child

- orthoses don't often work

- if deformity develops & progresses, fusion usually indicated

 

Post-Traumatic Kyphosis

 

Risk Factors

 

Wedge fracture with initial kyphosis of > 30o

 

Focal kyphosis may develop if there is damage to the anterior column

- worse if posterior column fracture as well

- Most common TL junction

 

Indication for surgical intervention

 

Neurological deficit due to kyphosis

Refractory pain

Progress of deformity

Poor cosmesis 

 

Management

 

If curve < 60°  

- posterior instrumentation & fusion 

 

If curve > 60° 

- anterior approach usually necessary to obtain releases