Curvatures in the anterior-posterior axis of the spine are called kyphosis (colloquially known as hunchback). This situation disrupts the sagittal balance, the importance of which has become more apparent lately. Sagittal balance is the harmony of cervical lordosis, thoracic kyphosis and lumbar lordosis, which constitute the normal spinal alignment in a person. If it is in harmony, the vertical line drawn from the middle of the 7th cervical vertebra is expected to end in the sacral promotorium. It is essential to maintain this balance in the treatment.
This curvature in the spine can cause various complaints such as difficulty breathing, fatigue, back pain, hump appearance, sensitivity and stiffness. Due to the curvature, lung capacity decreases, which can cause severe pain, decrease in muscle strength, and even serious neurological symptoms, including paralysis. But the most well-known among them is the humpback deformity.
We can evaluate kyphosis in 3 main types.
Postural Kyphosis
It is the most common type of kyphosis. It is more common in girls and adolescence. It is characterized by poor posture and muscle and ligament weaknesses. It gets progressively worse. Muscle aches and fatigue may be observed.
Scheuermann Kyphosis
It is a rigid type of kyphosis characterized by wedges in the vertebral body of late childhood. Flexibility-lateral extension radiography is valuable in its diagnosis. End-plate irregularities, Schmorl's nodules, and narrowing of the disc space may be seen on radiography. 3 consecutive vertebrae wedged at least 5 degrees (Sorenson); Kyphosis above 45 degrees (Bradford), where at least one vertebra is wedged more than 5 degrees, or in immature children, the diagnosis is made in line with the common opinion of physicians in measuring the wedging. It can also be seen in adolescents with normal kyphosis angle.
Congenital Kyphosis
It is the least common type of abnormal kyphosis. Formation defect type 1 develops due to congenital abnormal development of the vertebra such as hemivertebra, butterfly vertebra, wedge vertebra, segmentation defect type 2, mixed type 3.
These 3 main types are external endocrine disorders, ankylosing spondylitis, trauma, ligament. due to various reasons such as tissue disorders, infection (tuberculosis, Pott's disease), muscular dystrophy, polymyelitis, spina bifida, tumor. Kyphosis may also develop.
Diagnosis
AP lateral direct radiography (occiput-femoral head standing); dynamic radiography flexion-extension neutral lateral radiography; BT-3D reformat; Various radiological imaging techniques such as MRI (tension cord, cavity, disc compression) can be used. These images are interpreted with various techniques such as the pelvic radius technique, Duval-Beaupere method, Roussouly tangential circle method.
Treatment
Exercise (especially swimming is recommended), Conservative treatments such as corset treatment and intercostal block injection for pain can be mentioned. However, as a result of progressive neurological damage, progressive deformity, pain that does not go away with conservative techniques, thoracic curvatures over 40 degrees, thoracolumbar curvatures over 65 degrees and cardiopulmonary problems, surgical treatment, which is the only way to correct this deformity, may be required.
Surgery
It has been reported that following a posterior approach in surgery shortens surgical time, reduces blood loss, accelerates wound healing, and neurological recovery is relatively higher. In surgery, the most suitable one for the deformity should be chosen from various techniques such as rod reduction and fixation (degenerative kyphosis and Scheuermann kyphosis), Smith-Petersen osteotomy (ankylosing spondylitis kyphosis) and Ponte osteotomy (Scheuermann kyphosis). With correct surgery, a decrease in pain, neurological recovery and a decrease in deformity are expected. In addition to all these treatments, it should not be forgotten that preventing the occurrence of kyphosis is easier than treating it. In this regard, it is of great importance to inform families raising children.
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