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KYPHOSIS

Kyphosis, a spinal disorder, causes an excessive forward curve of the spine — resulting in an abnormal rounding of the upper back.  While kyphosis can occur at any age, it occurs more in adolescents.

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Minor cases of Kyphosis can often get corrected with exercises, physical therapy, and proper posture.

 

Kyphosis

KyphosisKyphosis, a spinal disorder, causes an excessive forward curve of the spine — resulting in an abnormal rounding of the upper back. While kyphosis can occur at any age, it occurs more in adolescents. The term kyphosis refers to a severe front-to-back curve of the upper spine. This problem usually occurs at a young age with Scheuermann disease (also known as Scheuermann’s kyphosis). It can result in a rounded upper back (or a humpback) in healthy adolescents.

The normal thoracic spine can have a curvature between 20 and 40 degrees. When the curve is greater than this, then there is a spinal deformity. If the thoracic spine has a curvature of at least 45 degrees, then there is a severe thoracic kyphosis.

Multiple compression fractures can cause kyphosis, a spinal deformity of the upper back, that leads to a hunchback. If the compression fractures are mild, a child might not notice any signs and symptoms.

The physicians at Medical City Children’s Orthopedic and Spine Specialists have extensive experience treating kyphosis, scoliosis, and other complex spinal conditions. In most cases we can see your child right away, so you don’t have to wait long for an appointment. Also, we have four convenient locations in Arlington, Dallas, Frisco, and McKinney, so we remain close to wherever you live.

Common Types of Kyphosis in Children and Adolescents

In most cases, kyphosis does not cause serious problems requiring surgical treatment. Many patients improve their posture and strengthen their spine through the use of a back brace and/or by doing specific therapeutic exercises.

However, severe cases of kyphosis cause pain and significant spinal deformity, even leading to breathing problems if left untreated. Patients with this problem may require surgery to reduce their abnormally curved spinal cord and relieve their symptoms.

The types of kyphosis include:

  • Developmental (Postural and Structural/Scheuermann’s) kyphosis: The developmental of this disorder is usually classified as either postural or structural in origin. Both are most commonly seen in children and adolescents, but they may occur at any age. Scheuermann’s kyphosis often affects the thoracic spine, but in some cases, it develops in the lumbar spine. It is more common in boys than girls and the progression stops once growth is complete.
  • Congenital kyphosis: The disorder a curvature of the spine is present at birth and occurs when the spinal column fails to develop normally before the child is born.
  • Post-Traumatic kyphosis: Usually resulting from an accident or injury, post-traumatic kyphosis is commonly seen in the mid-to-lower back.

Postural Kyphosis

Postural kyphosis, the most common type of this disorder, usually becomes evident in childhood. It occurs more frequently in girls than in boys, rarely causes pain, and doesn’t normally lead to problems in adulthood. As the child grows, the curve does not get worse.

Structural Scheuermann’s Kyphosis

Structural kyphosis (also called Scheuermann’s kyphosis) occurs when the structure of the spine develops abnormally. Occurring most often with the front sections of the vertebrae growing slower than the back. Instead of normal, rectangular vertebrae with ideal alignment, structural kyphosis results in more triangular, wedge-shaped vertebrae that cause misalignment.

When viewed from the side, normal vertebrae appear like stacked rectangles. In a child with Scheuermann’s kyphosis, they appear as triangles or wedge shapes. As a result, the spine hunch forward. Kids with this condition are unable to straighten the curve in their spine by standing up straight.

Structural kyphosis usually develops during periods of rapid bone growth. Normally this occurs between the ages of 12 and 15 in males or a few years earlier in females. The curve caused by this abnormality usually appears sharp and angular, as well as stiff and rigid. Unlike the postural type, structural kyphosis cannot become corrected simply by standing up straight.

Congenital Kyphosis

While congenital kyphosis does not usually occur, it may involve the bones developing in an unusual shape (called the failure of formation). Or it can occur when several vertebrae become fused (called the failure of segmentation).

This is a birth defect that emanates from misshaped vertebrae. The deformity occurs when the spinal cord of a child does not develop very well in the womb. It usually causes compression of the spinal cord and worsens as the child grows.

Unfortunately, casting and/or bracing does not effectively treat patients with congenital kyphosis. This type of abnormality usually requires surgical treatment at a very young age to stop the progression of the curve.

Post-Traumatic Kyphosis

Post-traumatic kyphosis usually occurs from a fall, a motor vehicle accident, or a horseback riding accident. The impact of these kinds of injuries can lead to fractures and/or dislocation of the vertebrae. And these injuries can lead to a kyphotic curve of the spine — especially if treatment is not promptly addressed.

Symptoms of Kyphosis

The most common symptom of kyphosis is a rounding of the upper back, which can force the head forward and lead to pain in the back and neck. Other symptoms may include a difference in shoulder height and shoulder blade height, as well as tightness in the hamstring muscles in the back of the thighs.

Diagnosing Kyphosis in Children

During an exam, Dr. Kishan, Dr. Hostin, or Dr. Wiesman will ask your child to bend forward with both feet together, knees straight, and arms hanging free. This test, known as Adam’s forward bend test, allows the doctor to better observe the curve of the spine and spot any spinal deformity.

The doctor may also ask your child to lay down to see if this straightens the curve. If it does, this indicates that the curve remains flexible and may exist as a result of postural kyphosis. The doctors may also order X-rays to determine if changes exist in the vertebrae or any other bony abnormalities.

In patients with postural kyphosis who do not manifest any abnormalities in the vertebrae, the forward curve shows flexibility and is corrected simply by encouraging proper posture.

Non-Surgery Management

Observation and physical therapy are typically recommended for:

  • Postural kyphosis (the back can straighten with proper posture)
  • Curves less than 60° in patients who are growing
  • Curves 60° – 80° in patients who completed growing

X-Rays and Exercise

Full-spine X-rays are usually taken every 6 months as the child grows using our advanced imaging system that scans the entire spine in just seconds while delivering an extremely low dose of radiation.

Bracing

With a moderately severe curve (60° – 80°) and a patient who continues to grow, brace treatment in conjunction with a tailored exercise program can provide positive results.

Full-time use of a brace (20 hours/day) is usually required in the beginning until maximum correction has been achieved.

In the final year of treatment before skeletal maturity, your child’s physician may propose part-time bracing (12-14 hours/day). Your child must continue to wear the brace for a minimum of 18 months to significantly and permanently correct their kyphosis.

Surgery Treatment for Kyphosis

At Medical City Children’s Orthopedics and Spine Specialists, we consider surgery only when necessary. Our pediatric orthopedic surgeons use the most advanced treatment options to ensure that patients can return to normal daily activities as soon as possible.

Spinal Fusion

If kyphosis has become severe (greater than 80°) and causes frequent back pain, doctors may recommend surgical treatment. Surgery can significantly correct the deformity without the need for postoperative bracing. To keep the spine stable and ensure that it heals properly, the surgeon will implant screws, hooks, and or sublaminar cables.

Thanks to Medical City Children’s Orthopedics and Spine Specialists’ enhanced recovery after spine, pelvic and hip procedures, hospital stays for spinal fusions performed here become shorter than most.

While most surgeries occur from the back, your child’s pediatric orthopedic surgeon may recommend additional surgery on the front of the spine. Patients return to normal daily activities within 4 to 6 months following surgery.

Spine Osteotomy

Spine osteotomy occurs when a section of the spinal bone is cut and removed to allow for correction of the spinal alignment. The Smith-Peterson Osteotomy, one of the most common procedures, involves removing sections of bone from the back of the spine, as well as the posterior ligament and facet joints. This causes the spine to lean more toward the back, correcting the kyphotic curve.

Long-Term Prognosis

Should your child require surgery to correct kyphosis, the expert surgeons and caregivers at Medical City Children’s Orthopedics and Spine Specialists can provide the care and attention they deserve. In addition, Dr. Richard Hostin, Dr. Kathryn Wiesman, and Dr. Shyam Kishan have been treating children and adolescents for more than 10 years.

When kyphosis is diagnosed early, the majority of children can get treated successfully without surgery and go on to lead active healthy lives. If the problem is left untreated, however, the progression of the curve could potentially lead to problems in adulthood.

Exercises to Reduce Kyphosis

The spine needs a certain amount of curvature to keep it healthy. However, you can maintain a healthy amount of spinal curvature by engaging in stretching and stretching exercises. The following exercises strengthen and stretch the spinal muscles and also help to maintain an upright posture.

Horizontal posture check

This helps in finding a natural back position without an excessive curve of the upper back. Here are the steps that your child can follow for this exercise:

  • Lie flat on the ground and stretch the legs out flat. Place your hands on your stomach and ensure the shoulders relax towards the ground.
  • While bending your knees, slowly slide your heels up towards the body. Place your hands flat on the ground beside you. If you pay attention to your back, you will feel your entire back is in contact with the ground. If you have been experiencing kyphosis for some time, you will feel a gentle stretch in your back.

Arm raises

This exercise engages the muscles of the shoulders by strengthening and straightening them.

  • While standing, place your arms by your sides and ensure your palms face forward.
  • Raise your arms and bend them at the elbows to make the upper arms parallel to the ground and your palms face forward (just like a goalpost). Hold this position for about 5 to 10 seconds.
  • Raise your arms until they are fully extended upward, as high as possible, while your palms are still facing upward. Hold this position for about 5 to 10 seconds before lowering your arms.

Repeat this stretch ten times per set, about three times every day.

Shoulder blade squeeze

This exercise reduces tension and strengthens the muscles of the upper back.

  • While sitting or standing, maintain an upright posture and pull your shoulders back.
  • Squeeze the shoulder blades together as tightly as possible and hold this position for 5 to 10 seconds. Release and repeat this step.

Patients should repeat this exercise 3 to 5 times per set with 2 sets per day.

Standing cat-cow

Doing this stretch while you’re standing loosens up the tightness in the back, hips, and glutes.

  • Stand and spread your feet about hip-width apart while slightly bending your knees.
  • You can either stretch your hands in front of you or place them on your thighs.
  • Lengthen your neck, bring your chin close to your chest, and round your spine.
  • Look up, lift your chest, and move the spine in the other direction.
  • Hold this position for five breaths per set and continue the movement for some minutes.

When Should I Be Concerned?

If the spinal curve gets so severe that breathing and heart function are affected, the patient should be seen by us ASAP.  In some cases, even if these complications are not experienced, the curve can make it difficult to stand, walk, and sit. Children with kyphosis should be evaluated by a specialist that specializes in spine problems until they stop growing. Growth can worsen the curve but it can be maintained from severe conditions when it is followed by a spine specialist.

At Medical City Children’s Orthopedic and Spine Specialists, our doctors have successfully performed 5,900 surgeries, so you can rest assured your child is in good hands. In the case that your child requires surgery, our compassionate medical team will sit down and discuss with you all the options available so your family can make an informed decision.

Kyphosis is more common in kids and adolescents

“Postural Kyphosis is a benign condition, but one that needs attention before the curve progresses. Poor posture can lead to this and observed if a child sits slumped forward. A lot of children today who play video games or electronics often sit this way. Thankfully, we can correct this with exercises and by correcting the posture of the child.” Shyam Kishan, MD

At Medical City Children’s Orthopedic and Spine Specialists, our doctors have successfully performed 5,900 surgeries, so you can rest assured your child is in good hands. In the case that your child requires surgery, our compassionate medical team will sit down and discuss with you all the options available so your family can make an informed decision.

Call 214-556-0590 to make an appointment.

Comprehensive services for children from birth through adolescence at three convenient locations:
Arlington, Dallas, Frisco, and McKinney.