Kyphosis and lordosis are types of spinal deformities. While slight
curvature of the spine is normal and healthy, there are some cases where
it is over-pronounced and can cause both cosmetic deformity and health
risks. When the spine curves inward too much in the low back, it is called
lordosis. When the spine in the shoulder blade or mid-spine area has
too much forward curve, or too much of a hump, it is called kyphosis.
Kyphosis most often occurs in the thoracic area of the spine.
Some people are born with kyphosis when there is a naturally occurring
abnormality in the spine. Kyphosis can also be an acquired condition.
Teenagers in particular may develop kyphosis due to bad posture, especially
girls between the ages of 12 and 15. Adolescent kyphosis is called
Scheuermann's disease.
Compression fractures are often linked to the development
of many cases of adult kyphosis, because they cause vertebrae to become
wedged, reducing the amount of space between each vertebra. These fractures
can occur as the result of degenerating discs, arthritis, osteoporosis
and spondylolisthesis. Individuals with osteoporosis may develop kyphosis
due to a weakening and compression in the vertebrae. Kyphosis in these
individuals is treated with aggressive anti-osteoporosis action to prevent
further bone weakening.
The symptoms of kyphosis are similar to those of scoliosis. These include
uneven shoulders, chest, hips, shoulder blades, waist, or a tendency
to lean to one side. In other cases, there are no visible symptoms.
To diagnose a person with scoliosis, have them touch their toes.
If either one or both shoulder blades are prominent, the waist is shifted
or ribs are uneven, kyphosis may be present. Kyphosis is also called “hunchback” because
of the hunched over appearance often seen in patients. Other symptoms
include fatigue and difficulty breathing.
Outlined below are some of the diagnostic tools that your physician may
use to gain insight into your condition and determine
the best treatment plan for your condition.
Medical history: Conducting a detailed medical history
helps the doctor better understand the possible causes of your back
and neck pain which can help outline the most appropriate treatment.
Physical exam: During the physical exam, your physician
will try to pinpoint the source of pain. Simple tests for flexibility
and muscle strength may also be conducted.
X-rays are usually the first step in diagnostic testing
methods. X-rays show bones and the space between bones. They are of
limited value, however, since they do not show muscles and ligaments.
MRI (magnetic resonance imaging) uses a magnetic field
and radio waves to generate highly detailed pictures of the inside
of your body. Since X-rays only show bones, MRIs are needed to visualize
soft tissues like discs in the spine. This type of imaging is very
safe and usually pain-free.
CT scan/myelogram: A CT scan is similar to an MRI in
that it provides diagnostic information about the internal structures
of the spine. A myelogram is used to diagnose a bulging disc, tumor,
or changes in the bones surrounding the spinal cord or nerves. A local
anesthetic is injected into the low back to numb the area. A lumbar
puncture (spinal tap) is then performed. A dye is injected into the
spinal canal to reveal where problems lie.
Electrodiagnostics: Electrical testing of the nerves
and spinal cord may be performed as part of a diagnostic workup. These
tests, called electromyography (EMG) or somato sensory evoked potentials
(SSEP), assist your doctor in understanding how your nerves or spinal
cord are affected by your condition.
Bone scan: Bone imaging is used to detect infection,
malignancy, fractures and arthritis in any part of the skeleton. Bone
scans are also used for finding lesions for biopsy or excision.
Discography is used to determine the internal structure
of a disc. It is performed by using a local anesthetic and injecting
a dye into the disc under X-ray guidance. An X-ray and CT scan are
performed to view the disc composition to determine if its structure
is normal or abnormal. In addition to the disc appearance, your doctor
will note any pain associated with this injection. The benefit of a
discogram is that it enables the physician to confirm the disc level
that is causing your pain. This ensures that surgery will be more successful
and reduces the risk of operating on the wrong disc.
Injections: Pain-relieving injections can relieve back
pain and give the physician important information about your problem,
as well as provide a bridge therapy.
When treating kyphosis, the cause of the disease must first be considered.
Some cases require surgery early on, while other times, bracing and
physical therapy may be the best course of action. Although bracing
can help reduce pain symptoms, it is less successful at fixing the
underlying problem of a curved spine, especially in adults. Strengthening
and stretching programs can be successful at reducing symptoms. Swimming
and other low-impact forms of exercise are beneficial. In cases which
require surgical intervention, the goal is to reduce the curvature
and relieve pain and discomfort over a long period of time.
1. Kyphoplasty for Osteoporotic Fractures
Kyphoplasty is a surgical procedure offered at Dr. Regan's private practice that treats kyphosis caused by fractures of the vertebral body caused by osteoporosis or bone diseases such as multiple myelona. The surgery is minimally invasive, requiring only a very small incision in the back. A narrow tube is inserted through the incision using fluoroscopy to guide it into the correct position in the damaged vertebrae. Using the tube as a channel, the doctor then guides a special balloon into the vertebral body.
The balloon is then carefully inflated, restoring the vertebrae to a more normal shape. The balloon also creates a cavity in the vertebral body by compacting the soft inner bone material.
Next, the balloon is deflated and gently removed. Special instruments are then used to fill the cavity with a soft cement-like material which quickly hardens to stabilize the vertebrae. With the vertebrae shape and height restored, the pressure on the nerves is reduced, easing the pain.
Dr. Regan, Los Angeles spine surgeon, and his colleague analyze a patient's spine condition, studying a set of X-ray images that will help the doctors to formulate treatment options.
2. Fusion With Bone Graft
Spinal fusion is a "welding" process by which two or more of the vertebrae that make up the spinal column are fused together with bone grafts and internal devices such as metal rods. The surgery performed by Dr. Regan eliminates motion between vertebrae segments. Spinal fusion may be used to treat abnormal curvatures such as scoliosis or kyphosis.
Bone is the most commonly used material to help promote fusion. Generally, small pieces of bone are placed into the space between the vertebrae to be fused. Sometimes larger solid pieces of bone are used to provide immediate structural support. Bone may come from the patient (autogenous bone) or a bank of bone harvested from other individuals (allograft bone). After the fusion procedure has been performed, the adjacent spinal segments are held immobile to allow fusion to progress. Immobilization is achieved through internal fixation devices or external bracing or casting. Both forms of immobilization may be necessary at times.
3. Fusion With Instrumentation
Normally, each vertebrae moves with respect to the one above and below it, allowing the spine to bend and rotate. A fusion means to fuse the two vertebra so that they cannot move on one another.
Spinal instrumentation is often used to help provide stability for the spine after vertebrae have been fused together. Common types of instrumentation utilized at Dr. Regan's private practice include:
Anterior cervical plates, which can be applied to the front of the spine.
Posterior cervical plates, which can be placed on the side of the spine.
Posterior cervical wiring, which can be placed around the spinous processes or the facet joints in the posterior cervical spine.
Post-operative cervical braces. Because of their relatively small size, the cervical spine is well suited for postoperative braces.
Not all causes of kyphosis can be prevented, but certain actions may reduce the possibility of developing kyphosis. These actions include good posture, good nutrition, consistent and sensible exercise, avoiding smoking, proper lifting, and accident prevention.
FAQ
When is surgery necessary to treat kyphosis?
Surgery is always treated as a last resort, while more conservative methods
are tried first. In general, surgery is considered when the curve exceeds
75 degrees. Other cases in which surgery may be recommended are for those
suffering from chronic pain and/or a rapidly progressive curve.
How can I prevent kyphosis?
Strengthening the back muscles can help prevent poor posture, which can
lead to kyphosis. Osteoporosis, which can also cause kyphosis, can
be prevented by getting enough calcium and vitamin D, exercising and
strength training regularly.
Click here for narrated videos of spine surgeries, procedures and what causes various symptoms. Click here to see medical illustrations that help you understand back and neck problems. Click here to see an exercise library that has special stretches that can relieve pain symptoms.
John J. Regan, MD is the author of the First Chapter of Minimally Invasive Spine Surgery: Clinical Examples of Anatomy, Indications, and Surgical Techniques.
Our spine Internet site acts as on-line spine encyclopedia. In addition, as a free community service, Spine Group Beverly Hills mails out Home Remedy Books on a limited basis to residents in Southern California. Click here to learn more.
We understand that traveling with a back problem can be difficult and unsettling. That’s why we enable you to set up a telephone consultation with Spine Group Beverly HIlls in advance, to determine if a trip would be worthwhile. Because this involves significant time for our practice to receive your information and diagnostics, and for Dr. Regan to review your case in advance of your call, there is a fee for this consultation. Click here to learn more.
The vast majority of back problems improve on their own or with nonsurgical treatment. There are a few warning signs, however, that may indicate serious spinal problems. If you experience any of these symptoms, seek medical attention immediately. Click here to learn more.
Want to tackle back or neck pain? Dr. Regan has developed an educational journal to help patients get Back to Life. Click here to download our latest Back to Life Journal.
Welcome to Spine Group Beverly Hills Watch the video above to hear a message from Dr.
John Regan about finding freedom from back pain.
Recognize emergency symptoms
for back and neck pain Do you have weakness or numbness in a hand or foot?
Are you unable to raise your toe as you walk?
Do you have any loss of bowel or bladder control?
If you answered yes to any of these questions, click here.
