Kyphosis

Question 1

Kyphosis

Answer 1

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

Question 2

Congenital Kyphosis

Answer 2

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

Question 3

Scheuermann’s Disease

Answer 3

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

Question 4

Intervention Scheuermann’s Disease

Answer 4

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

Question 5

Postural Roudback

Answer 5

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

Question 6

PT Goals for Scheuermann’s

Answer 6

Improve postural alignment
Increase flexibility
Increase extensor strength

Question 7

Clinical Findings of Scheuermann’s

Answer 7

tight pects and hamstrings
increased thoracic kyphosis with a compensatory increased lumbar lordosis
forward head posture

Sometimes have associated scoliosis

Question 8

Congenital kyphoscoliosis or lordoscoliosis

Answer 8

result of combo of defective segmentation that occurs in more than one location