Kyphosis

Key Features

• When looking at the sagittal view of a spine, there are two normal curves to be noticed

• In the lumbar region, the normal curve with an anterior convexity is known as lumbar lordosis

• In the thoracic region, a normal curve with a posterior convexity is called kyphosis; excessive kyphosis is pathologic and known as hyperkyphosis

Clinical Findings

• A visible deformity may be visible on the back, exacerbated by the forward bend test

• Can often accompany scoliosis, in which case the two conditions may share a common etiology

• Excessive kyphosis can be caused by trauma and degenerative and inflammatory conditions

• Congenital abnormalities are the most common cause of severe kyphosis; in Scheuermann disease, for example, abnormal vertebrae arise from either a failure of segmentation or formation and commonly result in wedge-shaped vertebrae that cause severe kyphosis

Diagnosis

• Standing radiographs taken in the lateral plane are necessary to measure the angle of the curve of the spine and quantify the severity of the curve

  • The curve is typically measured across the thoracic region from T1–T12

  • Normal values for this measurement fall in the 20–45 degree range

  • Anything in excess of 45 degrees is considered pathologic

Treatment

• Mild forms of the deformity may undergo treatment with bracing

• More severe deformities require surgical intervention with spinal instrumentation and fusion

• In patients who have congenital, wedge-shaped abnormal vertebrae, vertebral column resection may be indicated