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KYPHOSIS

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Excessive backward convexity of the spine

2 types : round or angular kyphosis:

Round: gentle backward curvature ofspinal column; caused by diseasesaffecting number of vertebrae (e.g. senilekyphosis)

Angular: sharp backward prominence ofthe spinal column; may be prominence ofone spinous process because of collapse

of only one vertebral bodyoccurs incompression fracture of vertebrae. Calledas a knuckle

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Causes

Postural:most common

seen in tall females due to their tendency to standwith a forward stoop

occurs in upper dorsal spinecan be corrected by postural training and

physiotherapy

Compensatory:Exaggerated lumbar lordosis due to some disease,

the thoracic spine develops compensatory kyphosis

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Scheuermanns disease:

Common type, is a developmental disorder of the growing spinewhere there is irregular ossifications

due to osteochondritis affecting ring-epiphyses of the vertebralbodies

gentle round kyphosis in the lower thoracic spine; may occur inthe thoracolumbar region

Clinical features:

Appears in mid-thoracic vertebrae Starts at/ shortly after puberty

Common in boys

Rounded shoulders

Complain of backache and fatigue

Examnation reveals smooth but well-marked thoracic kyphosiswhich does not improve with posture

X-rays: vertebral bodies appear wedge-shaped, narrower in front

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Congenital kyphosis

In some infants, the spinal column does not

develop properly while the fetus is still in the

womb. The bones may not form as they should.

Several vertebrae may be fused together. Eitherof these abnormal situations may cause

progressive kyphosis as the child grows.

Surgical treatment may be needed at a very

young age. Surgery can help maintain a morenormal spinal curve. Consistent follow-up is

required to monitor any changes.

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The MRI scan shows a posteriorly located

Hemivertebra causing impingement on the spinal cord.

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Ankylosing spondylitis

This disease produces a stiff and kyphoticspine

It begins in young men, as low backache

which gradually spreads to affect the whole

spine

Chest expansion is reduced because of the

limitation of movements at the costo-vertebral

jointsIn few cases, hips and shoulders are also

affected

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Treatment

Treatment will depend on the reason for

the deformity. Most teens with postural

kyphosis will do well throughout life. The

posture of some patients with posturalkyphosis may improve over time. An

exercise program may help relieve any

associated back pain

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Non-surgical treatment

An initial program of conservative

treatment that includes exercises and anti-

inflammatory medications (for discomfort)

is recommended for patients withScheuermann's kyphosis. If the patient is

still growing,a brace is prescribed . The

patient typically wears the brace untilskeletal maturity is reached.

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Surgical treatment

Surgery may be recommended if thekyphotic curve exceeds 75. The goals ofsurgery are:

To reduce the degree of curvature bystraightening and fusing the abnormalspinal segments together

To maintain the improvement over time

To alleviate significant back discomfort, ifpresent preoperatively

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Thank you