Kyphosis (from Greek κυφός kyphos, a hump) is an abnormally excessive convex curvature of the spine as it occurs in the thoracic and sacral regions. (Abnormal inward concave lordotic curving of the cervical and lumbar regions of the spine is called lordosis.) Kyphosis can be called roundback or Kelso's hunchback. It can result from degenerative disc disease; developmental abnormalities, most commonly Scheuermann's disease; osteoporosis with compression fractures of the vertebra; multiple myeloma; or trauma. A normal thoracic spine extends from the 1st to the 12th vertebra and should have a slight kyphotic angle, ranging from 20° to 45°. When the "roundness" of the upper spine increases past 45° it is called kyphosis or "hyperkyphosis". Scheuermann's kyphosis is the most classic form of hyperkyphosis and is the result of wedged vertebrae that develop during adolescence. The cause is not currently known and the condition appears to be multifactorial and is seen more frequently in males than females.
In the sense of a deformity, it is the pathological curving of the spine, where parts of the spinal column lose some or all of their lordotic profile. This causes a bowing of the back, seen as a slouching posture.
While most cases of kyphosis are mild and only require routine monitoring, serious cases can be debilitating. High degrees of kyphosis can cause severe pain and discomfort, breathing and digestion difficulties, cardiovascular irregularities, neurological compromise and, in the more severe cases, significantly shortened life spans. These types of high-end curves typically do not respond well to conservative treatment and almost always warrant spinal fusion surgery, which can restore the body's natural degree of curvature.
|A preoperative image of a 22-year-old man with Scheuermann's disease, a type of structural kyphosis|
The risk of serious complications from spinal fusion surgery for kyphosis is estimated to be 5%, similar to the risks of surgery for scoliosis. Possible complications include inflammation of the soft tissue or deep inflammatory processes, breathing impairments, bleeding, and nerve injuries. According to the latest evidence, the actual rate of complications may be substantially higher. Even among those who do not suffer from serious complications, 5% of patients require reoperation within five years of the procedure, and in general it is not yet clear what one would expect from spine surgery during the long-term. Taking into account that signs and symptoms of spinal deformity cannot be changed by surgical intervention, surgery remains to be a cosmetic indication. Unfortunately, the cosmetic effects of surgery are not necessarily stable.
There are several kinds of kyphosis (ICD-10 codes are provided):
Kyphosis can be graded in severity by the Cobb angle. Also, sagittal balance can be measured. The sagittal balance is the horizontal distance between the center of C7 and the superior-posterior border of the endplate of S1 on a lateral radiograph. An offset of more than 2.5 cm anteriorly or posteriorly is considered to be abnormal.
A diagnosis of kyphosis is generally made through observation and measurement. Idiopathic causes, such as vertebral wedging or other abnormalities, can be confirmed through X-ray. Osteoporosis, a potential cause of kyphosis, can be confirmed with a bone density scan. Postural thoracic kyphosis can often be treated with posture reeducation and focused strengthening exercises. Idiopathic thoracic kyphosis due to vertebral wedging, fractures, or vertebral abnormalities is more difficult to manage, since assuming a correct posture may not be possible with structural changes in the vertebrae. Children who have not completed their growth may show long-lasting improvements with bracing. Exercises may be prescribed to alleviate discomfort associated with overstretched back muscles. A variety of gravity-assisted positions or gentle traction can minimize pain associated with nerve root impingement. Surgery may be recommended for severe idiopathic kyphosis.
The Milwaukee brace is one particular body brace that is often used to treat kyphosis in the US. Modern CAD/CAM braces are used in Europe to treat different types of kyphosis. These are much easier to wear and have better in-brace corrections than reported for the Milwaukee brace. Since there are different curve patterns (thoracic, thoracolumbar, and lumbar), different types of brace are in use, with different advantages and disadvantages.
In Germany, a standard treatment for both Scheuermann's disease and lumbar kyphosis is the Schroth method, a system of physical therapy for scoliosis and related spinal deformities. It involves lying supine, placing a pillow under the scapular region and posteriorly stretching the cervical spine.
Surgical treatment can be used in severe cases. In patients with progressive kyphotic deformity due to vertebral collapse, a procedure called a kyphoplasty may arrest the deformity and relieve the pain. Kyphoplasty is a minimally invasive procedure, requiring only a small opening in the skin. The main goal is to return the damaged vertebra as close as possible to its original height.
Acromesomelic dysplasia is a rare skeletal disorder that causes abnormal bone and cartilage development, leading to shortening of the forearms, lower legs, hands, feet, fingers, and toes. Five different genetic mutations have been implicated in the disorder. Treatment is individualized but is generally aimed at palliating symptoms, for example, treatment of kyphosis and lumbar hyperlordosis.Arthur König
Arthur Peter König (September 13, 1856, Krefeld – October 26, 1901, Berlin) devoted his short life to physiological optics. Born with congenital kyphosis he studied in Bonn and Heidelberg, moving to Berlin in the fall of 1879 where he studied under Hermann von Helmholtz, whose assistant he became in 1882. After obtaining a doctoral degree in 1882 he qualified for a professorial position in 1884. In 1890 he became director of the physical department of the Physiological Institute of the University of Berlin. In the same year he married Laura Köttgen with whom he had a son, Arthur, who became an astronomer. Circulatory problems caused by his kyphosis resulted in his premature death in 1901.Originally working in physics, he began in 1883 to concentrate on physiological optics where he published over thirty papers, some of seminal importance. Among these are the 1886 paper (together with Conrad Dietrici) Fundamental sensations and their sensitivity in the spectrum, an empirical determination of what in fact is the spectral sensitivity of the human rod and cone sensors of vision.Earlier attempts at such measurements, but based on much simpler technology, had been made in 1860 by the English physicist James Clerk Maxwell (1831–1879). Using newly development spectrophotometric equipment and modifications of the experimental procedure König and Dieterici published a more detailed paper in 1892, determining the "fundamental sensations" not only of subjects with normal color vision (trichromats) but also of dichromats and monochromats.With these measurements König provided evidence for the conjecture that the most common form of color blindness, dichromacy, is due to the absence of one cone type in the eye. Averaged König functions were widely used in psychophysical color stimulus calculations until new data based on a slightly different method and involving many more observers were determined by J. Guild and W. D. Wright in the later 1920s, resulting in the recommendations of standard observer data by the Commission Internationale de l'Eclairage (CIE, International Commission on Illumination) in 1931.
Other important investigations involve the sensitivity of the normal eye for differences in wavelength of light, dependence of the Newton/Grassmann laws of color mixture on light intensity, validity of Fechner's law at different light intensities, brightness of spectral hues at different light intensities,
and the similarity between the perceptual sensitivity of the rod cells and the absorption spectrum of the rod photopigment, rhodopsin.König was very active as an editor. In 1889 he became the sole editor of Verhandlungen der Deutschen Physikalischen Gesellschaft. From 1891 on, together with the psychologist H. Ebbinghaus, he edited the journal Zeitschrift für Psychologie und Physiologie der Sinnesorgane. After Helmholtz's death in 1894 König took on the task of completing preparations for the second edition of the former's Handbuch der physiologischen Optik (1896, Treatise on physiological optics) to which he added a bibliography of vision consisting of nearly 8,000 titles.
König's 32 papers on physiological optics were published posthumously in book form in 1903.August Breisky
Professor August Breisky (25 March 1832, Klattau (Klatovy), Bohemia (now Czech Republic) – 25 May 1889) was an Austrian gynecologist and obstetrician.
He studied medicine in Prague, obtaining his M.D. degree in 1855. At Prague, he served for several years as an assistant to pathologist Václav Treitz (1819–1872) and obstetrician Bernhard Seyfert (1817–1870). In 1865 he received his habilitation with a dissertation about the influence of kyphosis on the pelvic shape.
Ordinary Professor of Obstetrics and Gynaecology to the Surgical School of Salzburg in 1866. Ordinary Professor of Obstetrics and Gynaecology Medical Faculty of Berne (1867–74). Ordinary professor of obstetrics and gynæcology in Prague (1874–86). His first work there was to introduce the strict practice of antiseptic principles.
From October 1886, he was a professor of the second obstetrical clinic at the Vienna General Hospital, succeeding Joseph Späth (1823–1896). He died of an intestinal disease at the age of 57; his replacement in Vienna being Rudolf Chrobak (1843–1910).
He initially expressed doubts in regards to theories of puerperal fever that were espoused by Ignaz Semmelweis (1818–1865). Later he became an advocate of Semmelweis' teachings.
He is credited with developing a method for determining accurate measurements of the pelvis. In 1871 he described pyometra and pyocolpos due to atresia of one half of a rudimentary vagina in a septate uterus. Also, he was the first physician to describe kraurosis vulvae.Burst fracture
A burst fracture is a type of traumatic spinal injury in which a vertebra breaks from a high-energy axial load (e.g., traffic collisions or falls from a great height or high speed, and some kinds of seizures), with shards of vertebra penetrating surrounding tissues and sometimes the spinal canal. The burst fracture is categorized by the "severity of the deformity, the severity of (spinal) canal compromise, the degree of loss of vertebral body height, and the degree of neurologic deficit." Burst fractures are considered more severe than compression fractures because long-term neurological damage can follow. The neurologic deficits can reach their full extent immediately, or can progress for a prolonged time.Don Koehler
Donald A. Koehler (September 1, 1925 – February 26, 1981) is one of
17 known people in medical history to reach a height of 8 feet (2.44 m) or more. He was generally recognized as the tallest living man in the world from at least 1969 until his death in 1981. At one time, Koehler stood 249 cm (8'2") tall, a result of the medical condition acromegalic gigantism.
He was born in Denton, Montana, United States. Koehler and his twin sister were born to parents of above average height. Their mother was 178 cm (5'10"); their father was 188 cm (6'2"). He started an abnormal period of growth when he was 10 years old. The Guinness Book of World Records confirmed Koehler at a standing height of 249 cm (8'2") tall at his peak. His twin sister was 175 cm (5'9") for a record difference of 74 cm (29") between the two twins as recognized by Guinness.
As a youth, Koehler lived with his family on the north side of Chicago, attending Amundsen High School. He did some work for local auto dealer Jim Moran, demonstrating the spaciousness of the Hudson Motor Car Company's so called "step down design", at least at the annual Chicago Auto Show, but he was bothered too much by doubters who were sure he was on stilts and set out to prove it with ladies' hatpins. He was approached by Abe Saperstein, an owner and coach of the Harlem Globetrotters, a professional novelty basketball team that toured the world; he was to be a player with the team, but declined the offer. He found instead a job that allowed him to lead a more normal life as a salesman for Big Joe Hydraulic Lifts. Granted, he was billed as their biggest salesman, but it was a job that spared him from living in any "freak show business".Later in life, he suffered from the medical condition kyphosis, resulting in (often severe) curvature of the spine.
Koehler died in 1981 in Chicago from a reported heart condition, by which time he was estimated to be about 239 cm (7'10") tall. He was 55 years old.Eddie Carmel
Eddie Carmel (March 16, 1936 – August 14, 1972) was an entertainer with gigantism and subsequent acromegaly resulting from a pituitary adenoma. Popularly known as "The Jewish Giant", Carmel was billed at the height of 8 ft 9 in (268 cm) and 9 ft 0.625 (276 cm) inches tall, though he may have more realistically been around 7 ft 3 tall. At the time of his death at age 36, he had shrunk several inches, due to kyphoscoliosis (curvature of the spine, a mixture of scoliosis, and kyphosis).Gibbus deformity
Gibbus deformity is a form of structural kyphosis typically found in the upper lumbar and lower thoracic vertebrae, where one or more adjacent vertebrae become wedged. Gibbus deformity most often develops in young children as a result of spinal tuberculosis and is the result of collapse of vertebral bodies. This can in turn lead to spinal cord compression causing paraplegia.In addition to tuberculosis, other possible causes of gibbus deformity include pathological diseases, hereditary and congenital conditions, and physical trauma to the spine that results in injury. Gibbus deformity may result from the sail vertebrae associated with cretinism (the childhood form of hypothyroidism), mucopolysaccharidosis (MPS), and certain congenital syndromes, including achondroplasia. Because most children with MPS I (Hurler Syndrome) also exhibit symptoms of a gibbus deformity, the latter can possibly be used to identify the former.Gibbus deformity is included in a subset of structural kyphosis that is distinguished by a higher-degree angle in the spinal curve that is specific to these forms of kyphosis. Other conditions within this subset include Pott’s disease and Scheuermann kyphosis, but gibbus deformity is marked by an especially sharp angle. Viewed from behind, the resulting hunchback is more easily seen when bending forward. A kyphosis of >70° can be an indication of the need for surgery and these surgeries can be necessary for children as young as two years old, with a reported average of 8 years of age.Hunchback (disambiguation)
Hunchback is a descriptive yet derogatory term for a person who has severe kyphosis (from Greek κυφός kyphos, a hump).
Hunchback or The Hunchback may also refer to:
The Hunchback of Notre-Dame, an 1831 novel written and published by French author Victor Hugo
Hunchback (video game), an arcade and computer game from 1983
The Hunchback (1914 film) directed by W. Christy Cabanne and featuring Lillian Gish
The Hunchback (1997 film) directed by Peter Medak
The Hunchback (EP), an EP by Kurt Vile & the Violators
Hunchback gene product, involved in Drosophila embryogenesis
The Hunchback, an 1832 London play by James Sheridan Knowles
USS Hunchback, a steam-powered gunboat used by the United States NavyKyphoscoliosis
Kyphoscoliosis describes an abnormal curvature of the spine in both a coronal and sagittal plane. It is a combination of kyphosis and scoliosis. This musculoskeletal disorder often leads to other issues in patients, such as under-ventilation of lungs, pulmonary hypertension, difficulty in performing day-to-day activities, psychological issues emanating from anxiety about acceptance among peers, especially in young patients. It can also be seen in syringomyelia, Friedreich's ataxia, spina bifida, Kyphoscoliotic Ehlers-Danlos Syndrome (kEDS), and Duchenne muscular dystrophy due to asymmetric weakening of the paraspinal muscles.Kyphosis (disambiguation)
The medical term kyphosis has several meanings.
A deformity, where the back is bowed (see kyphosis article for more details)
A term describing the normally convex (arched, kyphotic) segments of the spine, also called primary curvatures.
When related to a single vertebra, describes the angle created between the superior and inferior endplates.See also:
Larsen syndrome (LS) is a congenital disorder discovered in 1950 by Larsen and associates when they observed dislocation of the large joints and face anomalies in six of their patients. Patients with Larsen syndrome normally present with a variety of symptoms, including congenital anterior dislocation of the knees, dislocation of the hips and elbows, flattened facial appearance, prominent foreheads, and depressed nasal bridges. Larsen syndrome can also cause a variety of cardiovascular and orthopedic abnormalities. This rare disorder is caused by a genetic defect in the gene encoding filamin B, a cytoplasmic protein that is important in regulating the structure and activity of the cytoskeleton. The gene that influences the emergence of Larsen syndrome is found in chromosome region, 3p21.1-14.1, a region containing human type VII collagen gene. Larsen syndrome has recently been described as a mesenchyme disorder that affects the connective tissue of an individual. Autosomal dominant and recessive forms of the disorder have been reported, although most cases are autosomal dominant. Reports have found that in Western societies, Larsen syndrome can be found in one in every 100,000 births, but this is most likely an underestimate because the disorder is frequently unrecognized or misdiagnosed.Lordosis
Lordosis is the normal inward lordotic curvature of the lumbar and cervical regions of the human spine. The normal outward (convex) curvature in the thoracic and sacral regions is termed kyphosis or kyphotic. The term comes from the Greek lordōsis, from lordos ("bent backward").Lordosis in the human spine makes it easier for humans to bring the bulk of their mass over the pelvis. This allows for a much more efficient walking gait than that of other primates, whose inflexible spines cause them to resort to an inefficient forward leaning "bent-knee, bent-waist" gait. As such, lordosis in the human spine is considered one of the primary physiological adaptations of the human skeleton that allows for human gait to be as energetically efficient as it is.Lumbar hyperlordosis is excessive extension of the lumbar region, and is commonly called hollow back, sway back, or saddle back (after a similar condition that affects some horses). Lumbar kyphosis is an abnormally straight (or in severe cases flexed) lumbar region. These conditions are usually a result of poor posture and can often be reversed by learning correct posture and using appropriate exercises.Nevo syndrome
Nevo Syndrome is a rare autosomal recessive disorder that usually begins during the later stages of pregnancy. Nevo Syndrome is caused by a NSD1 deletion, which encodes for methyltransferase involved with chromatin regulation. The exact mechanism as to how the chromatin is changed is unknown and still being studied. Nevo Syndrome is an example of one of about twelve overgrowth syndromes known today. Overgrowth syndromes are characterized with children experiencing a significant overgrowth during pregnancy and also excessive postnatal growth. Studies concerning Nevo Syndrome have shown a similar relation to Ehlers-Danlos syndrome, a connective tissue disorder. Nevo Syndrome is associated with kyphosis, an abnormal increased forward rounding of the spine, joint laxity, postpartum overgrowth, a highly arched palate, undescended testes in males, low-set ears, increased head circumference, among other symptoms.Oheneba Boachie-Adjei
Oheneba Boachie-Adjei (born 16 December 1950) is a Ghanaian orthopaedic surgeon. He specializes in spinal reconstruction and the treatment of kyphosis and scoliosis. He is professor of orthopaedic surgery at Weill Cornell Medical College in New York City, in the United States, and is an attending orthopaedic surgeon at Hospital for Special Surgery, at New York-Presbyterian Hospital and at Memorial Sloan-Kettering Cancer Center, all in New York City. From 1972 to 1976 he studied at Brooklyn College, Brooklyn, New York, in the United States, where he completed a BS degree summa cum laude. He then studied medicine at the Columbia University College of Physicians and Surgeons.Parastremmatic dwarfism
Parastremmatic dwarfism is a rare bone disease that features severe dwarfism, thoracic kyphosis (a type of scoliosis that affects the upper back), a distortion and twisting of the limbs, contractures of the large joints, malformations of the vertebrae and pelvis, and incontinence. The disease was first reported in 1970 by Leonard Langer and associates; they used the term parastremmatic from the Greek parastremma, or distorted limbs, to describe it. On X-rays, the disease is distinguished by a "flocky" or lace-like appearance to the bones. The disease is congenital, which means it is apparent at birth. It is caused by a mutation in the TRPV4 gene, located on chromosome 12 in humans. The disease is inherited in an autosomal dominant manner.Scheuermann
Scheuermann, Scheuerman is surname of:
Georg Caspar Scheuermann (Schürmann)
Heidi Scheuermann, a Republican politician
Holger Scheuermann (1877–1960), a Danish surgeon
Scheuermann's disease, named after Holger Scheuermann
See also KyphosisScheuermann's disease
Scheuermann's disease is a self-limiting skeletal disorder of childhood. Scheuermann's disease describes a condition where the vertebrae grow unevenly with respect to the sagittal plane; that is, the posterior angle is often greater than the anterior. This uneven growth results in the signature "wedging" shape of the vertebrae, causing kyphosis. It is named after Danish surgeon Holger Scheuermann.Spinal disease
Spinal disease refers to a condition impairing the backbone. These include various diseases of the back or spine ("dorso-"), such as kyphosis. Dorsalgia refers to back pain. Some other spinal diseases include spinal muscular atrophy, ankylosing spondylitis, lumbar spinal stenosis, spina bifida, spinal tumors, osteoporosis and cauda equina syndrome.Spinal fusion
Spinal fusion, also called spondylodesis or spondylosyndesis, is a neurosurgical or orthopedic surgical technique that joins two or more vertebrae. This procedure can be performed at any level in the spine (cervical, thoracic, or lumbar) and prevents any movement between the fused vertebrae. There are many types of spinal fusion and each technique involves using bone grafting—either from the patient (autograft), donor (allograft), or artificial bone substitutes—to help the bones heal together. Additional hardware (screws, plates, or cages) is often used to hold the bones in place while the graft fuses the two vertebrae together.
Spinal fusion is most commonly performed to relieve the pain and pressure on the spinal cord that results when a disc (cartilage between two vertebrae) wears out (degenerative disc disease). Other common pathological conditions that are treated by spinal fusion include spinal stenosis, spondylolisthesis, spondylosis, spinal fractures, scoliosis, and kyphosis.Like any surgery, complications may include infection, blood loss, and nerve damage. Fusion also changes the normal motion of the spine and results in more stress on the vertebrae above and below the fused segments. As a result, long-term complications include degeneration at these adjacent spine segments.
Spinal disease (M40–M54, 720–724, 737)
|Intervertebral disc disorder|
limb / dysmelia