What is thoracic kyphosis?
From the side the human spine is wavy, unlike the view from the front in
which it should be straight. The only part of the spine with kyphosis is the
thoracic spine, the cervical and lumbar spine are in lordosis.
How much thoracic
kyphosis is normal? In general normal kyphosis is in the 20-50 degree
range. A higher degree of kyphosis is called hyper-kyphosis
What are the
different types of hyper-kyphosis? There are broad, and sometimes
overlapping, sub-groups in hyper-kyphosis:
1. 1. Congenital: parts of the spine never developed
or separated or both
2. 2. Postural: this type of increased kyphosis is
flexible, some is of thought of “slouching”.
When they lay down the kyphosis improves
3. 3. Syndromic/Neuromuscular
4. 4. Post-traumatic: after a spine fracture
5 5. Scheuermann’s
What is Thoracic
Scheuermann’s Kyphosis?
Angular wedging >5 degrees per level over 3 consecutive
levels, called Sorensen’s criteria.
Instead of the vertebra being the normal rectangular shape, they become
trapezoidal, shorter in the front than in the back.
Over the area of Scheuermann’s it looks
like the St. Louis Arch on its side.
How does is develop? No
one is exactly certain, but we do know it is due to asymmetric growth of the
vertebra which occurs during the pubertal growth spurt, the second fastest time
of spine growth. So the individuals are
normal alignment when they are 9-10 years of age and then develop more and more
kyphosis as they go through puberty.
Is it due to sports
or wearing a heavy backpack? No
Can it be prevented?
If it is identified very early bracing may be an option to prevent worsening.
What are the main
symptoms of Scheuermann’s?
1. The
obvious physical changes of the body, the pronounced angular deformity of the
back.
2. Back
pain. Pain develops over the angular
area of the back and also the low back, which needs to hyperextend to
compensate for the increased thoracic kyphosis.
Can physical therapy
help? Physical therapy can help the back pain related to
Scheuermann’s. Working on aerobic
conditioning and strengthening the back and core musculature can decrease
pain. However, it will not change the
Scheuermann’s deformity.
When is surgery an
option? In general surgery is an options for deformities greater than 75
degrees and the patient is having significant back pain which is not responsive
to nonsurgical management (physical therapy, over-the-counter medications,
weight loss, aerobic conditioning).
Does surgery have to
be done for deformities >75 degrees? No.
If the person doesn’t have significant pain then surgery is not needed.
What is the long-term
implications of Thoracic Scheuermann’s Kyphosis? Mainly pain. All the other quality of life measures, such
as function, job, etc… is the same with and without Scheuermann’s kyphosis.
The next blog post will be on the surgery for Thoracic
Scheuermann’s Kyphosis……