Generality
Kyphosis is a pathological accentuation of the curvature that characterizes the vertebral column in its thoracic section.
In reality, the term kyphosis has a different meaning; it would in fact indicate the physiological curve formed by the thoracic vertebrae. However, its use with a pathological meaning is so widespread that it has now replaced more precise terminologies, such as "pathological kyphosis" or "hypercyphosis".
If present, the classic symptoms of dorsal hyperciphosis consist of: back pain, back stiffness, spinal cord soreness and tendency to easy fatigue.
For an accurate diagnosis, physical examination and imaging are essential.
The therapy depends on the severity of the kyphosis.
What is kyphosis?
Cifosi is the term that, in common jargon, indicates an accentuation of the characteristic curvature, with anterior concavity, that the vertebral column forms in its thoracic tract.
In reality, it would be more correct to define "phyphosis" the physiological anterior concavity of the vertebral thoracic tract and " pathological kyphosis " or " hypercifosis " the excessive accentuation of this curvature.
However, the use of the word "kyphosis" with a pathological meaning is now so widespread that it does not raise particular criticisms even from the medical community.
In specialized jargon
The specialists speak of pathological kyphosis when the so-called angle of kyphosis exceeds 45 °.
In normal conditions, the angle of kyphosis is between 20 ° and 45 °.
ANATOMICAL BRIEF REVIEW OF THE VERTEBRAL COLUMN
Supporting axis of the human body, the spine or spine is a bone structure that measures about 70 centimeters in the adult.
Consisting of 33-34 vertebrae stacked on top of each other, according to the most classic of anatomical subdivisions, the spine has 5 sections:
- The cervical section, which includes 7 vertebrae, called cervical vertebrae .
- The thoracic section, which includes 12 vertebrae, called thoracic vertebrae .
- The lumbar section, which includes 5 vertebrae, called lumbar vertebrae .
- The sacral section, which includes 5 vertebrae, called sacral vertebrae .
- The coccygeal section, which includes 4 vertebrae, called coccygeal vertebrae .
The vertebral holes of each vertebra coincide and this determines the formation of a long canal, which serves to house the spinal cord .
The spinal cord is, along with the brain, one of the two elements that make up the central nervous system .
Causes
Pathological kyphosis can arise for several reasons, including:
- Bad posture (postural kyphosis)
- The presence of morphological anomalies at vertebrae level (Scheuermann's kyphosis)
- An abnormal development of the spine during intrauterine life (congenital kyphosis)
- Advanced age
- A spine injury
POSTURAL KEYS
Postural kyphosis is the result of attitudes of poor posture, which produce an inappropriate lengthening of the ligaments and muscles, which support the thoracic vertebrae. This lengthening changes the normal structure of the thoracic vertebrae and permanently accentuates the anterior concavity formed by the thoracic section of the spine.
Kyphosis from poor posture is more common among young people, as these subjects have a vertebral column that is easier to shape than an adult.
Classic attitudes of bad posture are:
- Stand with your arms dangling. This posture is also known as a falling posture .
- Rest with the thoracic section of the spine on the back of the chair.
- If you regularly use a backpack, load it with excessive weight.
DIGITS OF SCHEUERMANN
Also known as juvenile kyphosis, Scheuermann's kyphosis is the most common form of pathological kyphosis among the young population.
Its onset is due to a wrong development of the vertebral bodies, which, instead of possessing the classical cylindrical-rectangular shape, take on a triangular-conical aspect.
This incorrect development of vertebral bodies generally occurs during childhood.
From a strictly medical point of view, Scheuermann's kyphosis is a form of osteochondrosis, involving the vertebrae.
The causes that determine the incorrect development of the vertebral bodies are unclear: according to experts, the Scheuermann kyphosis would have a multifactorial origin.
CONGENITAL KEYS
Those who suffer from congenital kyphosis are born with a spinal column with anomalous features.
Generally, these anomalous characteristics derive from a process of fusion of two or more vertebrae ; more rarely, they are the effect of a prenatal malformation of the vertebral bodies .
Currently, despite numerous researches, doctors and researchers are unaware of what exactly alters the spinal column's intrauterine development.
DIGITS DUE TO AGING
Following the natural aging process, the vertebral column undergoes various morphological changes, which, in some individuals, cause more or less severe pathological kyphosis.
The morphological changes of the spine are related to various factors, including:
- A change in the muscular structure of the back.
- Alterations of the ligaments that support the vertebrae of the column.
- Attitudes of bad posture.
OTHER CAUSES
Other possible causes of kyphosis are:
- Osteoporosis : in the presence of osteoporosis, the bones become weaker and susceptible to fractures.
- Spondylosis : is a special form of arthritis, which deforms the bodies and intervertebral discs.
- The spina bifida : is a morbid condition that involves an abnormal development of the spine.
- Paget's disease : its presence coincides with an alteration in bone remodeling and a weakening of the bones.
- Neurofibromatosis : it is a genetic disease that affects the nervous system.
- Muscular dystrophy : it is a genetic disease that affects the health of the muscles.
- Tuberculosis : it is a bacterial infection that mainly affects the lungs.
- A tumor affecting the spine .
Symptoms and Complications
Mild pathological kyphosis can be both asymptomatic - that is, devoid of obvious signs and symptoms - and responsible for some characteristic clinical manifestations, such as:
- Back pain.
- Sense of stiffness in the back.
- Soreness in the spine.
- Tendency to easy fatigue. In those suffering from pathological kyphosis, the muscles and ligaments of the back are subjected to greater stress, compared to people with a normal spine. This increased stress causes fatigue and fatigue more easily.
In general, the more severe the kyphosis is, the more likely it is that the affected subject will complain about the aforementioned symptomatology.
AESTHETIC DISEASE
Especially in young subjects, the kyphosis can induce a certain aesthetic discomfort, due to the anomalous shape that imprints on the back.
Even if it is not a symptom of kyphosis, this discomfort can affect, and not a little, the life of those who feel it.
COMPLICATIONS
Usually, the complications of kyphosis arise when the accentuation of the anterior concavity of the spine is considerable.
In other words, those with severe pathological kyphosis are more at risk of complications.
Possible complications of kyphosis are:
- Presence of persistent pain, which does not respond to treatment with pain medication.
- Presence of breathing difficulties . These difficulties appear due to the compression exerted by the spine to the damage of the lungs and the airways.
- Presence of nervous system disorders . These disorders arise due to the crushing of the spinal column due to nerve damage that occurs nearby.
Some classic symptoms of this complication are: numbness or weakness in the arms or legs, balance problems, loss of control of bladder function and loss of control of bowel function.
The complications of kyphosis require the attention of the doctor and, very often, make surgery necessary.
Diagnosis
For the diagnosis of kyphosis, it is essential to perform an accurate physical examination and some instrumental diagnostic imaging tests, such as: X-rays, CT and / or nuclear magnetic resonance .
The use of other methods of investigation takes place in particular cases of kyphosis: for example, if the patient shows signs of suspected tuberculosis, the doctor may prescribe blood tests; if instead the patient is an elderly person with probable osteoporosis, the attending physician could prescribe a measure of bone mass (bone densitometry).
EXAMINATION OBJECTIVE
During a classic physical examination for the evaluation of a kyphosis, the doctor carefully observes the vertebral column of the patient, asking in the meantime the latter to perform some particular movements with his back.
Based on how the patient performs the aforementioned movements, the doctor is very often able to identify the presence or absence of kyphosis.
DIAGNOSTICS FOR IMAGES
X-rays, CT (or Computerized Axial Tomography) and nuclear magnetic resonance (NMR) provide useful information on the precise characteristics of kyphosis (gravity, involvement of neighboring nerve structures, contact of the spine with other organs, etc.).
Treatment
In the case of kyphosis, the treatment depends on the degree of accentuation of the curvature at the thoracic level and on the causes that led to this curvature.
There are:
- kyphosis so mild and from causes not particularly worrying, that they do not need any treatment;
- kyphosis of mild to moderate severity and of correctable causes, which require the administration of painkillers and the performance of some exercises for postural improvement and muscle strengthening (physiotherapy);
- severe kyphosis with pathologically important causes, which make even surgical intervention indispensable.
EFFECTS OF ANTIDOLORIFIC AND PHYSIOTHERAPY
Painkillers and physiotherapy exercises for improving posture and strengthening the back have the primary purpose of reducing pain.
In some cases, physiotherapy may also be useful in improving the outward appearance of the thoracic spine section.
SURGERY
The surgery for kyphosis - known as spinal fusion for kyphosis - allows correcting too accentuated curvatures of the thoracic section of the spine and reducing the risk of complications (obviously in those cases where the risk of complications is high).
To be precise, doctors recommend the use of surgery in the presence of severe kyphosis and for which the benefits obtainable through the surgery are greater than the dangers of the latter. It is in fact important to remind readers that spinal fusion for kyphosis is a very delicate operation with complex implementation (it can take from 4 to 8 hours).
Briefly, from an operational point of view, spinal fusion for kyphosis consists in melting together two or more vertebrae, through the use of bone grafts, metal plates and screws.
The fusion of the vertebrae has the purpose of re-establishing, at least in part, the normal thoracic curvature of the spine.
Performed under general anesthesia, the spinal fusion operation involves a stay of about a week and the use of a brace (commonly called "shoulder straightener ") for at least 9 months.
Examples of classical circumstances in which kyphosis requires surgical intervention:
- When the curvature of the thoracic section of the spine is very pronounced.
- When the curvature causes severe pain and painkillers are completely ineffective.
- When bending hampers some important vital functions, such as breathing adequately.
- When, in the absence of surgery, doctors predict a further worsening of kyphosis.
CAN I USE A TUTOR?
Sometimes, for young patients with moderate kyphosis, doctors recommend the use of a brace or a straightener .
In these situations, the purpose of the shoulder straightener is to avoid a worsening of the curvature.
Initially, the use of brace for kyphosis can be uncomfortable, but then, very often, the patient gets used to it.
Prevention
The only type of kyphosis for which there are certain preventive measures is postural kyphosis.
These preventive measures consist of:
- Avoid taking the so-called falling posture
- Sit correctly
- If you use a backpack every day, avoid loading it with too much weight
- Practice physical activities regularly, involving a lengthening of the back muscles. Swimming, running, long walks, yoga and pilates are among the most recommended motor activities for the prevention of postural pathological kyphosis.
