Kyphosis
abnormal posterior convexity
Normal kyphosis = 20-40d
May occur d/t trauma, congenital, scheuermann’s
May occur secondary to rx of spinal tumor rx with laminectomy
Common in pt’s with: OI, neurofibromatosis, myelomeningocele, spondyloeiphyseal dysplasia, rickets, osteochondrodystrophies
Not the same as postural round back
Congenital Kyphosis
Anterior part of vertebrae is aplastic or hypoplastic and posterior elements are normal
Anterior unsegmented failure of formation or unsegmented bar leads to progressive kyphosis
M/c cause of spinal cord compression, may lead to paraplegia
Paraplegia often noted with progressive congenital kyphosis
Rx = surgery
Features: progression, cosmetic deformity, back pn, neuro deficit
Scheuermann’s Disease
Rigid form of postural kyphosis
Develops during childhood and adolescence
M/c form of kyphosis in adolescence
Onset occurs just before puberty
Dx made via xray: irregular vertebral end plates, narrowing of disc space, anterior wedging of 5d or more for 3 continuous vertebrae, kyphosis greater than 40d that is uncorrected on active hyperextension
Schmorl’s nodes- disc protrusions inro spongiosa– may cause end plate irregularity
Occurs in thoracic spine
Intervention Scheuermann’s Disease
Exercise:
- active trunk extensor strengthening, general postural exercise, hamstring stretches
- Recommend activities with trunk extensor component: volleyball, swimming, aerobic exercise
Orthotic Mgmt:
- Kyphosis greater than 45-65d
- Modified Milwaukee brace is used- worn for 22 hours for 12-18 mos, once skeletally mature used at night for maintenance
- high success rate in skeletally immature pt’s
- Milwaukee brace- 3 point dynamic system that promotes thoracic extension
- determined a successful rx when vertebral bodies appear less wedge shaped
Surgical Mgmt:
- Indicated when curve continues to progress despite use of orthotic, when curves > 65d, pnful degenerative changes
- posterior fusion
Postural Roudback
May be confused for Scheumermann’s
Roundback is not fixed
No end plate irregularity
Exercise = best intervention
Kyphosis greater than 60d patient may be rx with Milwaukee brace to prevent permanent structural changes
PT Goals for Scheuermann’s
Improve postural alignment
Increase flexibility
Increase extensor strength
Clinical Findings of Scheuermann’s
tight pects and hamstrings
increased thoracic kyphosis with a compensatory increased lumbar lordosis
forward head posture
Sometimes have associated scoliosis
Congenital kyphoscoliosis or lordoscoliosis
result of combo of defective segmentation that occurs in more than one location
