Kyphosis

As a kyphosis (Greek κύφωσις, literally " Buckelung " of κύφος, kýphos, 'hump' ) is called in the jargon in humans according to the back (dorsal ) convex curvature of the spine. Naturally, kyphosis occurs in the chest area ( thoracic kyphosis ) and at the end of the spine even as a small kyphosis, the so-called Sakralkyphose. Only when a pathological gain of kyphosis, in this case those of the thoracic spine, is called a hunchback, a hyperkyphosis, a hump or a latin hump. The Cobb angle ( by John Robert Cobb) serves as a measure for the assessment of kyphosis. It also clearly defined and thus better reproduced Stagnara angle is often used between the base plate and cover plate TH12 TH4 .. The normal range is 30-50 °.

• 4.1 Consequences of kyphosis
• 4.2 surgical risk

Causes

To speak of a kyphosis, the curvature in the state in the thoracic spine should be available. The expression of kyphotic thoracic spine depends on personal anatomical peculiarities, but - generally well developed - at least in the population of industrialized countries. Man had ( evolutionary biology considered ) little time (about 5 million years) to adapt its locomotor system to upright walking. Whales, for example, had about 50 million years to adapt their skeletons to life in the water by, among other compact bone were replaced by cancellous bone. Due to lack of carefree walking, improper sitting and standing, the muscles of the musculoskeletal system are not able to keep the natural upright posture. Therefore, it usually comes to a collapsing of the vortex oscillations (lordosis - kyphosis ). This leads to a bending of the back, seen as a curved posture. If not this harmful posture is compensated by alternative activities, manifests the crooked posture and results in large losses.

In older people can lead to osteoporosis Sinterungsbrüchen of vertebral bodies, so that, thus together form a wedge vertebrae hyperkyphosis. This is popularly known in older women as " dowager's hump ". Kyphosis (Greek - kyphos, a hump ), also known as humpback or hunchback, is a common condition of a curvature of the upper back. It can be either the result of degenerative diseases (such as arthritis, ankylosing spondylitis ), developmental disorders ( the most common example of this is Scheuermann's disease ), his osteoporosis with compression fractures of the vertebral bodies and / or injury ( posttraumatic kyphosis ).

In terms of a deformity, it is the pathological curvature of the spine, where it may happen also that parts of the spine lose their lordotisches profile, and there is a flat back or even a kyphosis of the lumbar spine.

Classification

There are different types of kyphosis ( ICD-10 codes):

• Postural kyphosis ( M40.0 ), the most common form, usually to slouch, can be used both in age and in youth occur. In youth, it may be called slouch and is reversible by correcting muscular imbalances. At the age they may be called " hyperkyphosis " or " dowager's hump ". About one-third of the most severe cases of hyperkyphosis have vertebral fractures. Otherwise, the aging body tends to a loss of musculoskeletal integrity, and can be used alone due to the aging kyphosis develop ..
• Scheuermann's kyphosis ( M42.0 ) is significantly worse cosmetically, cause of pain can be of different thickness and can also have an impact on different areas of the spine (the most common of the middle thoracic region ). Scheuermann's disease is considered to be form of juvenile osteochondrosis of the spine. It is found mostly in teenagers and presents a significantly worse deformity than postural kyphosis. A patient suffering from Scheuermann's kyphosis can not consciously take a correct attitude. The apex of the curve, located in the thoracic spine is quite rigidly. Patients may feel at this vertex pain, which may be aggravated by physical activity and by long periods of standing or sitting. This can have a significantly negative effect on their lives, because the activity level decreases by; affected children may feel isolated or uneasy amongst peers, depending on the degree of deformity. While appear normal in postural vertebral bodies and intervertebral discs, they are irregular, often happened in Scheuermann 's kyphosis and wedge- shaped over at least three adjacent levels. Fatigue is a very common symptom, probably because of the intense muscle work that is required to stand and sit correctly. The assessment for this seems to lie in the families. Most patients who undergo surgery to correct their kyphosis, suffering from Scheuermann's disease.
• Congenital kyphosis ( Q76.4 ) can be the result of faulty development of the spine in the womb in infants. Vortices can be malformed or fused together, which can lead to the fact that in the child a progressive kyphosis developed .. At a very early stage, surgical treatment may be necessary and contributes to maintaining a normal curve in coordination with consistent follow-up for monitoring changes with. However, the decision on the implementation of the procedure because of the potential risks for the child prove to be very difficult. A congenital kyphosis can also suddenly appear in their teens, more common in children with cerebral palsy and other neurological disorders.
• Nutritionale kyphosis can result from nutritional deficiencies, especially during childhood, such as vitamin D deficiency ( producing rickets ), which leads to softening of the bones and as a result of bending of the spine and limbs under the body weight of the child.
• Gibbusbildende deformity is a form of structural kyphosis, often a sequela of tuberculosis.
• Posttraumatic kyphosis ( M84.0 ) to untreated or not treated effectively vertebral fractures.

Treatment methods

While many cases of kyphosis will require only a routine monitoring and conservative treatment, other cases severe pain and discomfort, difficulty in breathing and digestion, cardiovascular irregularities, neurological impairment and also to a considerably shortened life expectancy may result. These cases usually respond not respond well to conservative treatment, but justify almost always a spinal fusion in order to successfully restore the natural degree of curvature of the body can.

" Insufficient reposition or increasing or Rekyphosierungen are to not just muscular compensated in TLÜ bad and lead even at low Cobb angles ( < 15-20 ° ) to the static loads above and below the deformity located spinal segments. These post-traumatic deformities are therefore a indication for revision surgery is "

Orthosis ( corset )

Corsets showed benefit in a randomized control study.

The Milwaukee brace is a special corset that is used in the U.S. often to treat kyphosis. Modern CAD / CAM corsets are used in Europe to treat different types of kyphosis. These are much easier to carry and have better possibilities of correction than the Milwaukee brace. Since different curves ( thoracic, thoracic and lumbar spine ) are known, are different kinds of corsets in use. The advantages / disadvantages of different corsets are discussed in an overview.

Specialised Physiotherapy

Regular physiotherapy exercises ( Auftrainieren the autochthonous back muscles and chest muscles) contribute significantly to achieve a permanent establishment of the spine. In Germany, a standard treatment for both ( Scheuermann and lumbar kyphosis ) is the Schroth method, a system of physical therapy for scoliosis and related spinal deformities by Katharina Schroth. This includes three-dimensional exercise techniques to reposition the spine, breathing therapy to increase the tidal volume and movement strategies for everyday life.

Surgery

In patients with progressive kyphotic deformity due to vertebral collapse, a procedure called kyphoplasty may lead towards recovery, stabilization and pain relief. Fatal is the method of spinal fusion.

Complications

Follow the kyphosis

Possible consequences of kyphosis and the resulting static imbalance of the spine are ( depending on the cause):

• Chronic pain, sleep
• Structural changes in the vertebral body
• Disorders of internal organs (especially lung - reduction of tidal volume, heart)
• Risk of subsequent fractures (with kyphosis after induced osteoporosis WK- fracture)
• Limited mobility
• Sensory disturbances
• Increase of the curvature
• Spinal cord injury
• Cosmetic disfigurement with psychological distress
• Depression

Surgical risk

Possible complications of spinal fusion in kyphosis can be an inflammation of the soft tissue or deep inflammatory processes, breathing impairments, bleeding and nerve injuries. Recent findings suggest that the actual rate of complications may be much higher. Even among those who do not suffer from severe complications that require 5% of patients a reoperation within five years .. In the case of a decision to have surgery a specialized center should be preferred.