Kyphoscoliosis Disorders - Causes and Treatment

Introduction

Spinal curvature or twisting occurring sideways is termed scoliosis, and the curvature of the spine occurring in the forward or backward direction giving a rounded appearance, is called kyphosis. Deviation, the curvature of the spine in two planes and includes rotation of the spinal axis, is called kyphoscoliosis. Most of the conditions can be caused due to unknown reasons. Symptoms can range from abnormal hunched back to serious implications of the muscles affecting daily activities. Treatment can be done in a diversified approach explained in this article.

What Is Kyphoscoliosis?

Kyphoscoliosis is a condition in which the spine deviates from the normal curvature and rotational deviations. Lateral deviation occurs, which determines the severity of the condition. Kyphoscoliosis can be mild, moderate, or severe depending on the deviation in the angle. The number of vertebrae involved in deviation, along with the degree of rotation, also affects the severity of the disorder.

What Are the Causes of Kyphoscoliosis Disorders?

Causes of the disorder include:

• Idiopathic Causes - Most of the causes are unknown. Kyphoscoliosis occurring due to unknown reasons is called the idiopathic cause.

• Disease-Related Causes - These causes can include senile or degenerative changes, post-surgical changes, disc degenerative changes, and infectious causes such as polio, ataxia, spinal, muscular, and syndromes affecting the connective tissue.

• Congenital Causes - Segmentation and abnormal formation of the spine during the embryo's development that can also be associated with spinal cord abnormalities, absent vertebrae, and rib abnormalities.

• Functional Causes - These reversible causes can be attributed to muscle spasms, and other structural causes can be reversible.

What Are the Symptoms of Kyphoscoliosis?

The following are the symptoms of kyphoscoliosis:

• Hunched back.

• Uneven or unbalanced shoulder.

• Legs or arms are longer on one side of the body.

In cases where the lungs, nerves, and other organs are affected, the following are the symptoms that can occur.

• Breathing difficulty.

• Paralysis or weakness.

• Back pain.

• Disfigurement.

• Decreased appetite

• Heart issues.

• Neurological problems.

How Is the Kyphoscoliosis Evaluated?

Proper history and clinical examination form the basis for evaluating any disorder.

• Radiographic Imaging - This evaluation method helps determine the extent of curvature in the spine.

• Bone Mineral Density Scan - A bone mineral density scan can detect levels of calcium and other minerals present in the bone.

• Magnetic Resonance Imaging Scan (MRI) - Magnetic resonance imaging gives the visual display of the internal structures digitally and helps in assessing the abnormalities of the spine.

What Is the Treatment for Kyphoscoliosis?

Treatment for Kyphoscoliosis depends on the disorder severity and the presence and absence of any neurologic defects, and the underline cause. It is initiated very conservatively and can also progress, meaning a surgical intervention. When there is pain cosmesis progression of the disorder, pain neurologic changes, further testing, and a specialist referral is recommended.

Non-Operative Management

• Observation: Observation in minimally effective patients and symptomatic patients is the first line of treatment. The doctor simply monitors the patient closely over time and along with several investigations, including imaging studies and functional assessments, to track the progression of the disease or disorder.

• Pain Management: Management of pain use of nonsteroidal anti-inflammatory drugs is included in conservative pain management as there are compromising respiratory functions. Stronger painkillers such as narcotics should be used only when describing the physician. Muscle relaxants can also be prescribed, but it needs that the patients should be monitored closely.

• Respiratory Management: Restricted thoracic chest wall and reduced lung volume decrease compliance resulting in deaths should be assessed. Women can show lung disease, which leads to respiratory failure and hypoventilation. The decrease in oxygen caused due to these changes leading to pulmonary hypertension should be considered, and treatment should be started. The healthcare physician must be cognizant of this risk. Symptoms such as daytime fatigue, sleeping earlier, and snoring should be assessed in patients. Respiratory failure occurring due to kyphoscoliosis should be treated with noninvasive intermittent positive pressure ventilation. Bronchodilators, diuretics, and chest physiotherapy is also considered as treatment.

• Cardiac Management: Echocardiography is done to eliminate any cause related to the heart, and an evaluation of the heart overload is done. Elevation in the systolic pressure is observed and treated.

• Bracing: Skeletally immature patients are advised bracing to prevent the abnormalities that can occur. Bracing can be soft or rigid. Not all patients are given the same type of bracing. Rigidity and duration of use usually are dependent on the needs of the spine.

• Physical Therapy and Exercise: Strengthening and stretching exercises are significantly advised that prove a greater improvement in the condition. In older patients suffering from hyper kyphosis, targeted exercise programs are effective.

• Spinal Cord Stimulation (SCS) can be considered in patients with long-term back pain. The success rate of this procedure and the complications arising from this are still uncertain.

• Lifestyle Changes: Changes in habits and quitting smoking, and balancing the body weight can help improve the quality of life.

• Emotional Support: Monitoring the patient's emotional well-being and screening for mental health issues is advised. As the treatment involves regaining the body's posture, the person already has a distracted and depressed mindset which the physician should consider.

How Is the Prognosis of Kyphoscoliosis Disorders?

The prognosis of kyphoscoliosis disorders can change depending on the etiology of the disease. In cases with severe intensity, there are chances of occurrence of complications such as pulmonary hypertension that can lead to an increased death rate.

What Are the Complications of Kyphoscoliosis?

Complications can involve the following:

• Vertebral fractures.

• Gait changes.

• Risk of loss in the balance.

• Pulmonary abnormalities.

• Hypoxemia (low level of oxygen in the blood).

Conclusion:

Kyphoscoliosis is a condition that causes abnormal posturing of the body and is associated with many side effects. Treatment can be surgical or non-surgical. Many advancements have been implemented in recent ages to ensure a better outcome of the treatment. Though managing this condition is complex and challenging, the healthcare team works together to provide a quality outcome. The primary healthcare provider principally manages the condition by nonsurgical techniques. In cases where there are severe symptoms, an interprofessional team, including a surgeon, orthotics, pulmonologists, along with neurologists, are included in managing the condition.