Kyphosis is an outward curvature (convex) of areas of the spine. In this case, there is a natural kyphosis in each of its thoracic and terminal regions. The convex curvature of the spine becomes pathological only when it occurs in an atypical location or when the Cobb angle is no longer within the normal range.
What is kyphosis?
A convex (outward curvature) of the spine is called kyphosis. In this case, the natural kyphosis of the thoracic and terminal spine and the natural lordosis (curved inward) of the lumbar spine are necessary for stability of the entire spine. Kyphosis becomes pathological only when it occurs in an atypical location or significantly exceeds the natural curvature. If the kyphosis of the thoracic spine is pathologically increased, it is referred to as hyperkyphosis or colloquially as a hump. In Latin it is called gibbus. The so-called Cobb angle serves as a measure for the assessment of a kyphosis. The normal range is between 30 and 50 degrees. The lumbar spine can also be uncharacteristically affected by kyphosis. Normally, it is concave (curved inward). In pathological changes, a flat back or, in extreme cases, even a kyphosis of the lumbar spine may be possible.
Causes
The causes of pathological kyphosis are usually postural deformities. During evolution, the human spine has had to adapt to an upright gait over the past 5 million years. This process is apparently not yet fully completed. The spine is not yet so stable that extreme curvatures during development can be ruled out. This is why kyphosis beyond measure is occurring more frequently among today’s population. Especially in industrialized countries, kyphosis is aggravated by frequently sedentary activities. Thus, postural kyphosis, which is often caused by postural defects in youth, is the most common form of kyphosis. In old age, it is called widow’s hump, and here it is the result of vertebral fractures or loss of musculoskeletal integrity. Scheuermann’s disease is another possible cause. Scheuermann’s disease is a maldevelopment of the adaptation during puberty. A growth spurt occurs during puberty. If the dorsal vertebrae are incorrectly loaded with weakly developed muscles, uneven growth of the vertebral bodies occurs. The outer part of the vertebral bodies grows faster than the inner part, so that they become wedge-shaped. As a result, an extreme curvature of the spine develops in the thoracic region. Furthermore, there are also congenital forms of kyphosis. In this case, the vertebral bodies may be malformed or fused together. Sometimes congenital kyphosis does not appear until the teenage years. Nutritional kyphosis is also possible with vitamin D deficiency. Kyphosis also occurs as a result of tuberculosis or unhealed vertebral fractures after accidents.
Symptoms, complaints, and signs
Kyphosis is manifested by an excessive convex curvature of certain areas of the spine. In many cases, the curvatures do not cause symptoms. However, they must be monitored and treated conservatively. However, sometimes there is severe pain, breathing problems, problems with digestion, cardiovascular disorders, neurological problems or even neurological deficits in the form of paralysis. Overall, life expectancy is reduced in the extreme forms of kyphosis. Possible long-term consequences include chronic pain with sleep disturbances, destruction of the vertebral bodies, impairment of the internal organs, sensory disturbances, damage to the spinal cord up to paralysis, reduced mobility or psychological stress due to the disfigurements.
Diagnosis and course of the disease
Imaging techniques such as spinal radiographs, CT or MRI are available to diagnose the causes of kyphosis. Cobb angle can be determined on lateral radiographs. These procedures make it possible to identify signs of old fractures. However, a medical history plays an important role in diagnosis to differentiate between postural deformities and organic causes of kyphosis.
Complications
Kyphosis can lead to a number of health problems. Spinal imbalance is usually accompanied by chronic pain, which can result in sleep disturbances and mental illness.The psychological burden is often increased by the cosmetic disfigurement and sometimes triggers depression and anxiety disorders in those affected. In the long term, deformities and subsequent fractures can occur, which can also put strain on the internal organs (especially the lungs and heart). The spinal cord can also be damaged, sometimes causing paralysis and dysfunction. In general, mobility is limited in kyphosis. This can lead to problems in everyday life and at work. The sensory disturbances that often accompany the condition further exacerbate these complications. In addition, complications can also arise during surgery for kyphosis. There may be inflammation of the soft tissues, impaired breathing, secondary bleeding and nerve damage. Prescribed pain medications can cause side effects. Temporary digestive problems, high blood pressure, or infections are common. Some people react to the drugs that are supposed to relieve discomfort with side effects such as headache, nausea, vomiting, intestinal bleeding, or clouding of consciousness. When multiple medicines are taken at the same time, interactions can occur.
When should you see a doctor?
Kyphosis does not always cause symptoms. However, monitoring by a doctor is still necessary. If symptoms such as pain, difficulty breathing or digestive problems are noticed, there may be underlying kyphosis that needs to be clarified. Neurological problems and cardiovascular disorders are also among the warning signs that should be investigated by a physician. Chronic pain, sensory disturbances and signs of paralysis indicate that the curvature of the spine is already advanced and must therefore be clarified. If further complications such as high blood pressure or infections are noticed, it is best to speak with a medical professional immediately. The same applies to chronic headaches, nausea, clouding of consciousness and other complaints that cannot be clearly attributed to a disease. Individuals who suffer from postural deformities or who have been diagnosed with a condition such as Scheuermann’s disease often develop kyphosis as well. Vitamin D deficiency, tuberculosis and poorly healed vertebral fractures also promote spinal curvature and require medical evaluation. Affected individuals are best advised to consult their family doctor or an orthopedist. Individual symptoms must be treated by the appropriate medical specialists.
Treatment and therapy
Treatment methods for kyphosis depend on its causes. In most cases, conservative treatment is sufficient. This involves regular physiotherapy exercises. During these exercises, the back and chest muscles are trained simultaneously. Only with a strong musculature a constant straightening of the spine is possible. The exercises also include regular stretching of the spine to prevent the deterioration of postural deformities. The standard therapy for Scheuermann’s disease and lumbar kyphosis in Germany is the use of the Schroth method. This involves three-dimensional exercise techniques to straighten the spine, breathing exercises to increase breathing volume, and movement strategies for everyday life. Wearing corsets has also proven effective for adolescents with severe kyphosis. However, since the corset must be worn for 3/4 of the day, the adolescent’s cooperation is required, which is not always so easy. In extreme cases of kyphosis often only surgical treatment helps. However, this can only be carried out on adults, because in adolescents the growth process is not yet complete. In the surgical treatment method, a fusion of two to three vertebrae is performed in order to restore the full load-bearing capacity of the spine. This method is also known as spondylodesis. Furthermore, of course, any underlying conditions of kyphosis must be treated.
Outlook and prognosis
The prognosis varies depending on the age of the patient, the severity and extent of symptoms, and the deformity of the spine. The underlying disease, concomitant diseases, and obesity are other factors in a prognosis. It is not uncommon for patients with kyphosis to live without major impairments in their daily lives. Postural kyphosis can go unnoticed for a long time, as symptoms often only become apparent when the patient has adopted an incorrect posture for a long time.If left untreated, it can lead to back pain, restricted mobility, or even breathing difficulties. With timely and consistent treatment, the prognosis is usually favorable. Kyphosis caused by Scheuermann’s disease is self-limiting with completion of the growth phase, but is not curable. The prognosis is often favorable, and early diagnosis can prevent severe deformities. Today, kyphoses caused by ankylosing spondylitis are rarely severe. Timely initiation of therapy and addition of appropriate medication prevent disability. If the patient suffers from kyphosis caused by bone loss, regular monitoring is important. Vertebral fractures caused by osteoporosis require urgent treatment, as there is a high risk of further vertebral fractures. Prognosis is unfavorable for kyphosis above 60%. Severe degeneration of the spine impairs the quality of life. This can be significantly improved again by surgical therapy.
Prevention
To prevent kyphosis, care should be taken to maintain proper posture. Strengthening the back muscles through appropriate exercises can also prevent the development of a crooked back. During sedentary work, the back and neck muscles should be regularly relaxed by stretching and standing up. Ergonomic office furniture should be provided at the workplace.
Aftercare
Kyphosis, as a physiological phenomenon in itself, only requires therapy and subsequent aftercare if it is too severe and causes discomfort. Aftercare is designed in collaboration with the orthopedist or physiotherapist, but requires the patient’s cooperation for success in many cases. This primarily concerns exercises learned during physiotherapy that are consistently continued at home. These are usually exercises that serve two main purposes. First, the shortened muscles in the chest area are gently stretched to counteract the unhealthy forward bent posture in the long term. Secondly, the muscles in the upper back area are strengthened, which promotes a physiological straightening of the spine if the exercises are performed regularly. In the gym or rehabilitation sports, training can be done on equipment that precisely guides the exercises required for targeted strengthening. This increases efficiency and noticeably reduces the risk of injury. In addition, it is important in the aftercare of kyphosis to also pay attention to an upright posture. This also includes the ergonomic design of the workplace. Especially the bending forward of the upper body at the desk should not be too strong and should be interrupted again and again by active breaks. Yoga can help to sensitize for a straight back.
This is what you can do yourself
As an alternative to medical measures, kyphosis can be treated by yourself with various back exercises. Methods of physiotherapy or yoga specifically build back and chest muscles and reduce the hunchback. An exemplary exercise is stretching the chest muscles. This involves leaning a forearm against a wall and turning the upper body and head to the side until a stretch is felt in the chest. Backbends while standing and on the stomach are similarly effective. Special breathing techniques support these exercises by relaxing and relieving the muscles. To remedy kyphosis in the long term, the above measures must be performed regularly. Especially in old age, targeted and consistent training is essential for the success of treatment. In daily life, conscious attention must be paid to a straight posture. In the case of a pronounced hunchback, it is sometimes necessary to wear a corset. The garment supports the entire holding apparatus and compensates for the bad posture. If pain or other discomfort occurs, the doctor must examine the kyphosis and, if necessary, prescribe an appropriate medication. In case of major complications, surgery may be required.
