The correct structure of the human spine
A correct human spine is straight only in the frontal plane, i.e. when viewed from the front or back. In the lateral projection, the curves are clearly outlined. A forward bend of the spine (the top of the arch pointing forward) is called lordosis, a back bend (top of the arch facing back) is kyphosis. There are cervical lordosis, thoracic kyphosis, lumbar lordosis and sacral kyphosis. Such a structure of the spine is an evolutionary adaptation to moving in an upright position on two legs. The spine thus acts as a shock absorber.
In the majority of the population, the angular values of lordosis or kyphosis fall within the so-called physiological ranges, with the most important thing being the balancing of individual curves, because it ensures the correct balance (maintaining the balance with the lowest possible expenditure of energy).
The most common disorder of the spine axis is, probably resulting from the lifestyle, shallowing of the cervical lordosis and, resulting from structural disorders of the spine, deepening of thoracic kyphosis.
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What is thoracic hyperkyphosis?
Physiologically, thoracic kyphosis is 20-40 degrees and it is a fairly stable value due to the significant stiffness of the thoracic spine, resulting from the presence of the ribs and the sternum (chest) and the shaping of the vertebrae and intervertebral joints themselves. Angular changes in thoracic kyphosis usually result from changes in the morphology (structure) of the vertebrae. Most often it is the deepening of kyphosis (increasing its angular value), because this is how force vectors act on individual thoracic vertebrae. Disturbance of the bone structure of the vertebrae is the main cause of changes in their shape - wedging. It can be the result of an injury (compression fracture), osteoporosis or osteochondrosis. The last two causes are generally metabolic disorders. Osteochondrosis of the spine is characteristic of developmental age and osteoporosis of old age, although it may also occur earlier.
Focusing on juvenile osteochondrosis of the spine (Scheurmann's disease), it can be described as an increasing backward bending of the spine during the growth period, resulting from a disturbance of the bone structure of the vertebrae with their subsequent wedging. Additionally, in the radiological image, apart from the increasing angle of kyphosis, the so-called Schmorl nodules, i.e. round or oval deformation of the vertebral laminae, which in turn is the result of soft bone modeling by flexible nuclei of the intervertebral discs. Spine pain complaints quite often occur during this period.
To some extent, the deepening of kyphosis does not pose a threat to the health and efficiency of the patient, it remains only a cosmetic defect. This is usually the case with kyphosis in the range of 40-60 degrees. Above 60 degrees, kyphosis can become a nuisance. Lumbar lordosis (balance) is intensely aggravated, overload pain ailments appear, and the shape of the chest changes. Disturbance of the axis of the spine and incorrect loads over time also lead to degenerative changes.
Diagnosis
Hyperkyphosis is diagnosed primarily on the basis of a physical examination and X-ray images. In X-ray, especially postural, so-called telemetry, i.e. covering the entire spine, we observe angular disturbances, as well as compensation in other sections. The progression of the curvature is also assessed in periodically taken control pictures.
Additionally, computed tomography can be performed - helpful in assessing the morphology of the vertebrae and pre-operative planning of screw placement and possible corrective osteotomies.
Magnetic resonance imaging is performed less frequently and is used to assess the structures inside the spinal canal.
How is hyperkyphosis treated?
The indications for surgical treatment of hyperkyphosis are 60-65 degrees Cobb angle and pain. And this could be the end of the discussion of indications for treatment, as there are no other common and effective methods of treatment. It should be noted here that the so-called postural defects, i.e. round back, shoulder protraction, etc., sometimes undergoing rehabilitation, are completely different from the rigid kyphotic deformity with vertebral deformation, which is the subject of these considerations.
Attempts at corset treatment are justified, but a rigid corset is required, made according to an orthotic design or the so-called Jewett's corset. However, treatment should be introduced at about 50 degrees of kyphosis, which is below the current indications for treatment in general, and maintained until around 17 years of age. Treatment decisions should be discussed with the patient and family.
Surgical treatment of hyperkyphosis is quite similar to that of scoliosis, however, it is mainly aimed at correcting backward curvature of the spine. It is a major surgery that requires control of the nervous system (neuromonitoring) and blood supply. The transpedicular screws are the base, the bars are embedded in them and the correction is made using the stiffness of the bars.
To improve the correctivity of the spine, the so-called osteotomies, i.e. partial excision of fragments of vertebral arches and intervertebral joints. In most cases, it is possible to achieve a good correction of the spine axis, a significant and permanent correction of the figure and reduction of pain. Post-operative healing is, similarly to scoliosis surgeries, standing up in the first two postoperative days, initial rehabilitation and discharge home after a week. Further rehabilitation treatment, more individual, return to activity, including sports activities, after 6-12 months, i.e. after the period needed to achieve bone union between the vertebrae, i.e. spondylodesis.
The limitation of the patients' efficiency after the surgical correction of kyphosis is relatively small, apart from, of course, the stiffening of the spine in the section of the correction.
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