Spinal kyphosis: causes, types and treatment

29.01.2021

Kyphosis is an acquired or congenital deformity of the spine that forms a bulge. Curvature of the thoracic region within normal limits is called physiological and does not require special treatment. Kyphosis acquires its pathological form against the background of lung diseases (rickets, tuberculosis). Significant curvature is characterized by pain in the back and has neurological disorders.

Kyphosis is manifested by stooping or hunchback (in especially severe cases). The patient's shoulders protrude forward and down, causing the chest to narrow. The diaphragm changes its position, moving down, and the upper part of the body moves forward. The longer the pathology develops, the higher the risk of vertebral deformation and destruction of intervertebral cartilage. Over time, the back muscles become stretched and the muscles in the front of the abdominal cavity become deformed. As a result, the mobility of the ribs and intercostal muscles decreases, and the lungs cannot function fully. Therefore, severe forms of kyphosis are accompanied by cardiac and pulmonary pathologies.

The nature of the curvature determines its shape and has its own characteristics. Angular kyphosis is characterized by a hump-shaped formation, which causes the chest to protrude forward and the torso to become shorter. Arc-shaped kyphosis deforms the entire thoracic region in the shape of the letter C.

Causes of kyphosis

As a pathology, kyphosis develops for reasons such as:

disturbances in the process of fetal development;
genetic predisposition;
spinal injuries of various etiologies;
underdeveloped back muscles;
compression fractures of the vertebrae due to the loss of bone tissue density;
diseases of the spine of various nature;
neoplasms in the spinal column.

In very rare cases, pathological kyphosis can occur after radiation therapy, which is used to treat malignant neoplasms in children.

Prevention of poor posture

The best prevention is an age-appropriate sleeping place with an orthopedic mattress and pillow, clothes and shoes with stable soles, wearing a backpack instead of a briefcase, and sufficient lighting of the study area.
The child must be consulted by an ophthalmologist and an ENT doctor, and the identified violations must be corrected.

Children with incorrect posture should be observed by a pediatric orthopedist, whose recommendations should be strictly followed. Sufficient physical activity, sports, and games with physical activity are required.

Specialists at the SM-Doctor clinic will conduct a preventive examination of a child of any age and advise on all the necessary measures to correct posture. The center uses innovative diagnostic and treatment methods. Contact the best specialists who know how to make your child’s posture perfectly straight!

Forecast

A large curvature of the thoracic spine affects both the health and anatomy of the spine and the organs located nearby. Due to the reduction in the size of the chest, the volume of the lungs decreases, and accordingly, the functioning of the circulatory system and its dependent systems is disrupted, since an insufficient amount of oxygen is supplied.

Pressure from the diaphragm disrupts the functioning of the abdominal organs, causing constipation. The load on the spine is redistributed, subjecting the intervertebral discs to deformation and provoking the development of osteochondrosis. Severe kyphosis can lead to compression of the spinal roots, as evidenced by symptoms such as partial or complete loss of sensation, impaired functioning of the pelvic organs and muscle weakness.

Complaints about poor posture

At the first stage, children practically do not complain about anything.
In more severe stages, headaches, back pain, fatigue, and decreased vision may occur. Long-term deformities change the functioning of the heart, lungs, and digestive system. If the chest is flat, then the respiratory capacity of the lungs decreases, which causes oxygen deficiency and changes in metabolism. Children look more lethargic compared to their peers, often suffer from respiratory infections, bronchitis, pneumonia, and are predisposed to tuberculosis.

Due to abnormal lumbar curve, the abdominal muscles weaken, the stomach and intestines sink, and constipation occurs.

Types of disease

Pathological kyphosis is varied. Its type depends on the causes of the disease:

functional kyphosis or incorrect posture: the cause of the appearance is a weak muscle corset or an unnatural position of the back during prolonged sitting. In some cases, this type of kyphosis is associated with psychology: for example, very tall teenagers try to hide their height and slouch, just as insecure people raise their shoulders to appear more inconspicuous. Trying to compensate for the excessive backward curvature of the spine, the body begins to protrude the lumbar region inward, forward, which causes a concomitant disease - lumbar hyperlordosis.
dorsal juvenile kyphosis (Scheuermann-Mau disease): presumably, Scheuermann-Mau disease appears as a consequence of necrosis of cartilage tissue (avascular necrosis), excessive growth of bone tissue in the vertebral bodies and multiple vertebral fractures due to osteoporosis. The causes of this type of kyphosis have been little studied, but one thing is certain - genetic predisposition plays a special role here. Scheuermann-Mau disease distorts the shape of the vertebrae, complicating the form of kyphosis. The bending angle can reach up to 75 degrees.
congenital kyphosis: a disorder appears at the stage of development of the vertebrae in the embryo. The deformation appears as irregularly shaped segments. The curvature can develop in any direction with the apex located in any part of the spine. A disease of this form often progresses, combined with other pathologies and neurotic disorders.
paralytic kyphosis: appears against the background of diseases associated with weakened or paralyzed back muscles. For example, with cerebral palsy, thoracic kyphosis progresses and increases its length to the lower back, acquiring scoliosis as a concomitant disease.
post-traumatic kyphosis: fractures of the thoracic or lumbar vertebrae often cause the development of post-traumatic kyphosis. The appearance of the disease is associated with the severity of the injury, the accuracy of following the instructions of the attending physician for the rehabilitation period, and the presence of other diseases associated with disorders of bone or muscle tissue.
degenerative kyphosis: such kyphosis is a consequence of degenerative changes in the spinal column. Degenerative changes can be either a natural process of aging of the body or a consequence of a slowly developing pathology. Therefore, older people are more likely to be affected by this type of kyphosis.

Development of the musculoskeletal system in children

All parents want to see their child healthy and strong. Therefore, their concern about whether it is developing correctly is understandable.

Of course, it would be wrong to consider a child as a smaller copy of an adult. The newborn is helpless, cannot hold his head in an upright position, and cannot independently change the position of his body; the movements of his arms and legs are erratic. The body of a newborn, as it were, strives to maintain the intrauterine position with arms and legs bent and brought to the body due to the increased tone of the flexor muscles, which gradually disappears with age. The bone tissue of a breastfed baby contains less dense substances and more water. The bones of the skull are not fused to each other, which allows them to “pass over each other” when passing through the mother’s birth canal: the size of the child’s head decreases, which facilitates the birth process. This deformation of the skull may persist for some time after birth and then disappear on its own. Gradually, the sutures between the bones of the skull ossify, the fontanelles decrease and completely close by 9-11 months. However, by the time of birth, final ossification has not yet occurred, and the baby’s skeleton remains weak and pliable for quite a long time. Therefore, if the child is carried incorrectly (always on the same arm), the rules of swaddling are violated, or the prevention of rickets is not carried out effectively, the bones of young children are easily bent, and preconditions arise for the occurrence of postural disorders. The child should also not constantly lie on the same side - in this case, flattening of the skull bones on one side may occur.

When the baby's crib is against the wall, he turns his head in the opposite direction, reacting to sounds and movement around him. If the baby’s position is not changed, he develops a persistent habit of keeping his head on one side and develops so-called positional torticollis. If noticed in time, it can be easily corrected by alternating the position of the child in the crib and massage.

True congenital muscular torticollis is much less common. The basis of this disease is the underdevelopment of the sternocleidomastoid muscle, which leads to compaction and thickening, and then its shortening. Already in the third week of life, it becomes noticeable that the chin turns in the healthy direction, the shoulder girdle on the affected side becomes higher than the other, the muscle is thickened and tense, and the range of head movements is limited. If noticed in time, this pathology is successfully treated by orthopedists, which avoids the development of facial asymmetry and complications such as scoliosis in the future.

The spine in newborns in the first months of life is almost straight; its physiological bends, which are normally characteristic of older children and adults, are formed gradually as the child grows: when he begins to hold his head up, lordosis (forward bend) occurs in the cervical spine; when sitting down, kyphosis (backward bend) appears in the thoracic region; when learning to stand and walk - lordosis in the lumbar region. At first, these bends are smoothed out in a lying position, and later they acquire a stable shape.

The more a child moves, the more actively his musculoskeletal system develops. In addition, an active, strong, physically developed child gets sick less often, and when he gets sick, he recovers faster. Physical activity stimulates the development of the cerebral cortex, which controls all vital functions of the body. Therefore, from a very early age it is necessary to do gymnastics with your baby. Under the influence of exercise, the baby's muscles develop well and become stronger. Moreover, the greatest benefit comes from active movements that stimulate the development of motor skills: you need to teach the child to reach out and take an object; not sit, but sit down; not stand, but stand up, holding onto a support, etc.

When the child grows up, teach him to swim, dance, ride a bike. In addition, do not lead him by the same hand to avoid distortion of the torso; make sure that he sits straight and correctly at the table, without placing his legs under him; Do not allow drawing while sitting on the sofa or lying on the floor, but choose furniture appropriate for your child’s height. This will prevent the development of postural disorders and scoliosis. By the way, parents who believe that posture is given to a child from birth think wrongly. Posture, or the habitual posture acquired throughout the entire period of growth, depends not only on the correct relative position of individual parts of the body, but also on the tone of the muscles that hold the spine. With good posture, a person holds himself straight, his shoulders are at the same level, slightly turned, his chest is slightly pushed forward, his stomach is tucked. Due to insufficient muscle development in preschoolers, the physiological curves of the spine are still poorly expressed, and the head and shoulder girdle may be slightly shifted forward, the shoulder blades may protrude slightly, and the line of the chest may smoothly transition into the line of the abdomen, which protrudes by 1-2 cm. All this is not a deviation from the norm for children 3-5 years old.

Also, the legs of a small child differ from the legs of an adult. A person is born with a flat foot, and only by the age of 6-7 years should the bones of the foot form a structure similar to an arch. In children 1-2 years of age, subcutaneous fatty tissue in the area of the plantar surface of the foot is often well developed, but this is not flat feet. But the deviation of the foot outward, when the load when walking falls more on its internal parts (valgus position of the foot), is a reason to consult a doctor who will prescribe special corrective exercises and, if necessary, insoles. In any case, in order for the arches of the feet to form correctly, the child must walk in shoes with hard but elastic soles; arch support; wide heels and a tight, fairly high heel that holds the foot in the correct position.

When a child begins to walk, he may develop an O- or X-shaped deformity of the lower extremities. This usually happens due to weakness of the muscles and ligaments due to a lack of calcium in the bones. The load when walking and excess weight provoke the development of curvature. However, as the child grows, the bones align and in 95% of children this leg deformity disappears completely by the age of three. This is facilitated by normalizing the child’s body weight, gymnastics and massage, taking calcium, and choosing the right shoes.

Raising children is a true art that requires constant improvement. You literally need to mold the child’s health. The most important condition for the development and preservation of health is movement, which brings not only benefits, but also joy to the baby. Attentive, loving and patient parents will help their child grow healthy and strong and develop his talents and capabilities.

Physiotherapy doctor of the medical rehabilitation department Irina Petrovna Malinovskaya

Diagnosis of kyphosis

Kyphosis is diagnosed and treated by a traumatologist or orthopedist. An initial consultation allows you to collect a clinical picture from the patient’s words and a visual examination by a doctor. The doctor is interested in the nature of the pain and whether there are neurological disorders. To do this, palpation of the affected part of the spine is used, muscle strength is measured, deep reflexes are examined to determine the sensitivity of the nerves, and the heart and lungs are listened to.

For kyphosis, radiography is included in the list of mandatory studies. Pictures of the spine are taken in different projections.

An additional study in all cases of kyphosis is MRI. It is needed to examine soft tissues at the time of their damage. CT scan is prescribed if pathological changes in bone tissue are suspected.

Tips for Maintaining Good Posture

Use your eyes. When working with electronic devices, practice looking at the device with your eyes only, instead of bending your neck, lifting the device.
Straighten up and stand up! You can experiment with the stand. You certainly don't need to stand all day, but it's likely that the more you stand up straight, the better your posture will be. If you can't work while standing, try to take breaks from sitting more often throughout the day. When answering the phone, get up and walk around. This will help you feel better, have more energy, and be more creative.
Walk more. Wear a fitness tracker and set a goal to walk 7,000 to 10,000 steps every day, which is more than eight kilometers. While you could probably walk this distance all at once, it's best to spread it out evenly throughout the day as your schedule allows. Make it a habit to use the stairs and park away from entrances.
Take 30-60 second breaks from the exercise: Every 30 minutes, gently stretch in the opposite direction of where you were. If you've been sitting, this may mean stretching on the back of a chair or standing leaned back. Try to hold the stretch for at least 10 seconds and do 5 exercises at a time.
Anti-Gravity Strength Training: Strengthen the muscles that move your body in the opposite direction of the positions and movements you normally perform. This will help relieve stress on body tissues and structures, restore joint mobility, correct muscle imbalances, and increase strength and endurance so you can stay upright.
Posture Training: The only way to achieve permanent results is to permanently correct your posture and movement habits. This requires intense training that includes releasing locked joints and supporting and strengthening weak muscles. Poor postures and movement patterns can be achieved using kinesio tapes or braces. Research shows that it takes about 300-500 repetitions to develop a habit, but it takes about 3000-5000 repetitions or about 4-6 weeks of training to correct a bad habit. If correct postures and movements are achieved, you will experience a lifetime of reduced mechanical pain and problems.

However, the opposite is also true. If children start out with poor posture and movement patterns, they are more likely to suffer from physical, psychological, cardiovascular, respiratory and digestive problems for the rest of their lives. This is why it is so important to show children correct posture and movement and teach them about the detrimental effects of poor posture. Correcting your child's posture and movement early will change his life forever. If you notice your child is slouching or have any concerns about their posture, get it checked. It might just save them from a life of pain and suffering.

Treatment of kyphosis

The treatment method is prescribed according to the type of disease.

Functional kyphosis is treated with exercise therapy and conservative therapy. With the help of exercises, the patient strengthens the muscle corset and learns to maintain correct posture. An orthopedic corset is not needed in such cases. A similar method is used for degenerative kyphosis.

Juvenile kyphosis usually does not bother patients until the angle of curvature increases enough to cause pain. The chest is deformed, interruptions in the heart function and difficulty breathing appear. The main treatment is conservative. It includes massage, physical and manual therapy, exercise therapy, and in special cases it is recommended to wear an orthopedic corset. If the bend is 75 degrees, surgery is prescribed.

Congenital kyphosis in 13% of cases is combined with other pathologies of the spine, accompanied by impaired development of organs, systems and neurological disorders. Conservative treatment for this disease is ineffective, so surgery is performed in childhood so that the spine can be stabilized by growing bone tissue, thereby preventing deformation in the future.

With paralytic kyphosis, the disease tends to develop, which is why conservative therapy is delayed for a long time. If there is no positive result and the patient’s condition worsens, surgery is prescribed.

Post-traumatic kyphosis is a type of kyphosis that is treated primarily surgically because the disease affects the nerve endings. If the patient has contraindications for surgery, then an intensive course of conservative therapy using an orthopedic corset is prescribed.

IV degree

It is characterized by a curvature of the spine that is 71 degrees or more. Patients suffering from the most severe form of kyphosis should completely exclude independent movement, unless this has already happened due to progressive disease. Such a serious curvature of the spine poses the highest threat to all vital systems of the body: circulatory, respiratory, musculoskeletal and nervous. The only treatment option in this case is surgery. However, there are also cases when it may be contraindicated.

What is dangerous about pathological kyphosis of the spine?

Kyphosis itself is not a dangerous disease. Its progression can provoke osteochondrosis, the formation of protrusion of intervertebral discs and hernia. As a result of thickening of the ligaments around the spinal column, the back part of the spine grows and the growth of the front part of the spine slows down. This is already becoming an aesthetic problem.

Excessive curvature of the thoracic region leads to impaired blood circulation and changes in the normal functioning of internal organs. Severe pain develops as a result of compression of the spinal cord and nerve roots.