Normally, the spine (backbone) curves forward gently as it runs up our back. This helps the spine support our head and upper body. However, sometimes a person’s spine is far too rounded. This condition is known as kyphosis. Kyphosis is a type of spinal deformity in which the spine is curved forward in the upper back area, giving an abnormally rounded or “hunched back” appearance. When a doctor measures it on an x-ray, the normal range for kyphosis is quite broad, between 20 and 50 degrees. However, when kyphosis is greater than 50 degrees, it becomes easy to see and is considered abnormal. Kyphosis is most commonly seen in older women, as a result of osteoporosis.
What causes kyphosis?
Kyphosis occurs when the vertebrae in the upper back become wedge-shaped. This deformity can be caused by a variety of conditions including
- Metabolic problems.
- Neuromuscular conditions.
- Spina bifida.
- Scheuermann’s disease is a condition that causes the vertebrae to curve forward in the upper back area. The cause of this disease is unknown and is commonly seen in teenage boys. The kyphosis tends to be rigid (not flexible) when examined. A mild degree of scoliosis is common in teenagers with Scheuermann's kyphosis.
- Postural kyphosis is the most common type of kyphosis. It generally becomes noticeable in adolescence and can be associated with slouching versus a spinal abnormality. Exercise is used to help correct posture. Postural kyphosis can cause mild discomfort but rarely leads to problems later in life.
- Congenital kyphosis is when the structure of the spine is abnormal right from birth. Several vertebrae can be fused together or the bones can form improperly. This type of kyphosis can get worse as a child grows. It is important to check a baby or child with congenital kyphosis for other health problems.
Kyphosis is more common in females than males.
Symptoms of kyphosis
Each individual may experience symptoms differently. However, the commonly noted symptoms of kyphosis include:
- Difference in shoulder height.
- The head bends forward compared to the rest of the body.
- Difference in shoulder blade height or position.
- When bending forward, the height of the upper back appears higher than normal.
- Tight hamstrings (back thigh) muscles.
A severe case of kyphosis can even affect your lungs, nerves, and other organs. Mild cases, however, may produce no noticeable signs or symptoms. The symptoms of kyphosis may resemble other spinal conditions or deformities, or may be a result of an injury or infection. It is advised that you consult your doctor for a diagnosis.
Diagnosis of kyphosis
To check you for kyphosis, a doctor will run a physical examination of your spine and might ask you to do a forward-bending test, which involves simply bending forward at the waist. This allows for a better observation of kyphosis. The doctor also might ask you to lie down, which can help in diagnosing postural kyphosis.
If it looks like someone has kyphosis, doctors will usually order X-rays of the spine. Looking at the X-rays can help determine the type of kyphosis. To check if kyphosis is affecting breathing, doctors may ask a person to breathe in so they can listen to the lungs. If more details are required, your doctor may order a CT scan as well. In some cases, your doctor may also request an MRI of your spine if he or she suspects an underlying cause such as a tumor or infection that could be causing the curvature.
Early detection of kyphosis is important for successful treatment.
Reasons for the procedure
There are several reasons to treat scoliosis:
- Appearance is a major concern.
- Kyphosis may cause back pain.
- If the curve is severe enough, kyphosis affects the patient’s breathing.
Treatment options for kyphosis
Treatment options for kyphosis are based upon the cause of the curvature, the degree of deformity, the risk of progression during and after growth (in children and adolescents), and the severity of symptoms associated with the kyphosis.
The goal of treatment is to stop the progression of the curve and minimize deformity. Treatment may include:
- Observation and repeated examinations – The child will need observation and repeated examinations. Progression of the curve depends on the amount of skeletal growth, or how skeletally mature, the child is. Curve progression slows down or stops after the child reaches puberty.
- Braces – If the child is still growing, the doctor may prescribe a brace. Some braces are designed to help correct posture. Others are stiffer body jackets designed to help straighten the spine as a person grows. The type of brace and the amount of time spent in the brace will be determined by your doctor.
- Surgery – Surgeries, such as spinal fusion, are usually reserved for curves greater than 75 degrees on X-ray and when bracing is not successful in slowing down the progression of the curve. Also if the kyphosis curve is pinching the spinal cord or nerve roots, your doctor might suggest surgery to reduce the degree of curvature. Surgical treatment consists of both a correction of the deformity using spinal instrumentation and fusion of the involved portion of the spine to prevent progression later in life.
Risks of the procedure (surgery)
As with any surgical procedure, complications can occur. Some complications may include, but are not limited to, the following:
- Nerve damage.
- Failure to heal.
There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.
Before the procedure
- Your doctor will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the surgery.
- You may be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.
- In addition to a complete medical history, your doctor may perform a complete physical examination to ensure you are in good health before undergoing the procedure. You may undergo blood tests or other diagnostic tests.
- Notify your doctor if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general).
- Notify your doctor of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.
- Notify your doctor if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.
- You will be taught how to do special breathing exercises to help the lungs recover after surgery.
- You will be taught special ways to do everyday things after surgery to protect the spine. This includes learning how to move properly, changing from one position to another, and sitting, standing, and walking.
- Your doctor will suggest pre-donation of blood, i.e. store some of your blood about a month before the surgery. This is so that your own blood can be used if a transfusion is needed during surgery.
- If you smoke, you will be asked to stop it. People who have spine fusion and keep smoking do not heal as well. Ask the doctor for help.
- Let the doctor know right away if you have any cold, flu, fever, herpes breakout, or other illness before the surgery.
- On the day of the surgery, you will likely be asked not to eat or drink 6 – 12 hours before the procedure.
- Take any medicines the doctor told you with a small sip of water.
During the procedure
Kyphosis surgery requires a stay in the hospital. Procedures may vary depending on your condition and your doctor’s practices.
Generally, the surgery follows this process:
- You will be asked to remove clothing and given a gown to wear.
- An intravenous (IV) line will be started in your arm or hand. Additional catheters may be inserted to monitor the status of your heart and blood pressure, as well as for obtaining blood samples.
- If there is excessive hair at the surgical site, it may be clipped off.
- A catheter will be inserted into your bladder.
- The surgery will be performed while you are asleep under general anesthesia. The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
- The skin over the surgical site will be cleansed with an antiseptic solution.
- There are two types of spinal fusion surgeries, depending on your condition and your doctor’s choice. The surgeon may also do the procedure using a special video camera.
- If a surgical cut is made in the back, it is called the posterior approach. This surgery usually takes several hours. In this procedure, a metal rod is attached to each side of the patient’s spine by using hooks or screws attached to the vertebral bodies. Then, the surgeon fuses the spine with a piece of bone from the patient’s hip (a bone graft). The bone grows in between the vertebrae and holds them together and straight. This process is called spinal fusion. The metal rods attached to the spine ensure that the backbone remains straight while the spinal fusion takes place.
- If a cut is made through the chest wall, it is called a thoracotomy. The patient lies on his or her side during the surgery. During this procedure, the surgeon makes incisions in the patient’s side, deflates the lung, and removes a rib in order to reach the spine.
- During surgery, the nerves that come from the spine are watched using special equipment to make sure no damage is done to any of the nerve roots.
- The surgery usually takes 4 – 6 hours. It may take longer or shorter for some children.
- The incision will be closed with stitches or surgical staples.
- A sterile bandage or dressing will be applied.
After the procedure
After the surgery you will be taken to the recovery room for observation. Once your blood pressure, pulse, and breathing are stable and you are alert, you may be taken to the intensive care unit (ICU) or your hospital room. You will need to stay in the hospital for about 5 -7 days after surgery. The repaired spine should be kept in its proper position to keep it aligned. If the surgery involved a surgical cut in the chest, you may have a tube in the chest to drain fluid build-up. This tube is often removed after 24 – 72 hours. A catheter may be placed in the bladder the first few days to help your child urinate.The patient’s stomach and bowels may not work for a few days after surgery. He or she may need to receive fluids and nutrition through an IV line. You will receive medicine to relieve pain in the hospital. At first, the medicine may be delivered through a special catheter inserted into your back. After that, a pump may be used to control how much pain medicine you should get. You may also get shots or take pain pills. In most cases, your surgeon will want you to get out of bed on the first or second day after your surgery. Nurses and physiotherapists will assist you with this activity until you feel comfortable enough to get up and move around on your own. You may have a body cast or a body brace.
Follow any instructions you are given on how to care for your spine at home.
Aftercare at home
Before you are discharged from the hospital, your doctor and other members of the hospital staff will give you additional self-care instructions for you to follow at home – a list of “dos and don’ts,” which you will be asked to follow for the first 6 to 8 weeks of your home recovery.
Some restrictions are as follows:
- No lifting weights heavier than 2.5 kg.
- No bending above the waist. It is important to bend from the hips and keep the back straight.
- No bicycling for 1 month after surgery.
- The patient may shower seven days after surgery.
- No sports, running, or jumping for 3 months after surgery.
- There are no permanent restrictions after 6 months of the date of surgery.
Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.
Remember that it is important to follow up in clinic six weeks after the date of discharge from the hospital.
Your spine should look much straighter after surgery. There will still be some curve. It takes at least 3 months for the spinal bones to fuse together well. It will take 1 – 2 years for them to fuse completely. Most patients are able to return to school or work in 2 to 4 weeks after the surgery.
Fusion stops growth in the spine. This is not usually a concern because most growth occurs in the long bones of the body, such as the leg bones. Children who have this surgery will probably gain height from both growth in the legs and from having a straighter spine.