Thoracic Kyphosis - Types, Symptoms, and Treatment

What Is Kyphosis?

The human spine has 7 cervical, 12 thoracic, 5 lumbar, 5 fused sacral, and 3 to 5 fused coccyx vertebrae. There is a normal amount of curvature in the thoracic region of the spine, which, if present excessively, is called kyphosis. Kyphosis is a curvature of the spine in which the upper back appears more rounded than normal. This curvature makes the person look like they are slouching. Normally, the spine has natural curves. The middle portion of the spine is called the thoracic vertebrae. The thoracic spine region has some normal curvature, giving space for the heart, lungs, and other organs. Excessive curvature of the thoracic part of the spine is called thoracic kyphosis and may cause posture problems, pain, and other symptoms.

What Are the Causes of Thoracic Kyphosis?

Kyphosis can be congenital or acquired later in life.

• Poor posture during childhood.

• As individuals age, they may develop this condition.

• Congenital causes in which the development of the spine is disrupted before birth.

• Some neuromuscular and metabolic disorders may cause kyphosis.

Some conditions can cause kyphosis-

• Spina bifida.

• Osteoporosis.

• Muscular dystrophy.

• Osteogenesis imperfecta.

• Cancer that develops in the spine.

• Paget's disease of bones.

• Cervical spondylosis.

• Infections in the spine.

• Slipped discs.

What Are the Types of Kyphosis?

1. Postural Kyphosis:

It is the most common type. It occurs mainly during adolescence and is more common in girls. It is due to poor posture or slouching, which stretches the muscles and ligaments supporting the spine. The stretched muscles and ligaments pull the spine from its normal position, leading to a rounded back.

2. Congenital Kyphosis:

Congenital kyphosis occurs due to any fault in the development of the spine before birth. It progresses rapidly with age. It usually occurs along with other congenital abnormalities.

3. Scheuermann’s Kyphosis:

It is also called juvenile kyphosis. It is a structural deformity in which the vertebrae are wedge-shaped rather than rectangular. The cause of Scheuermann’s disease is unknown. It occurs during adolescence and is more common in males. It is more severe than postural kyphosis.

What Are the Symptoms of Thoracic Kyphosis?

The symptoms of kyphosis vary depending on the severity and cause of the condition.

• Rounded shoulders and back.

• Differences in shoulder height.

• Visible hump in the back.

• Tight hamstrings.

• The head is more forwardly bent than the rest of the body.

• Stiffness.

• Mild back pain.

Rare symptoms which may occur in more severe cases include

• Numbness, weakness, or tingling in the legs.

• Fatigue.

• Breathing problems like shortness of breath.

• Bladder and bowel habits change.

• Balance issues.

How Is Thoracic Kyphosis Diagnosed?

Kyphosis is diagnosed with a combination of physical examinations and diagnostic tests.

1. Physical Examination:

The doctor does a thorough physical examination. The medical and family history of the patient is recorded to rule out congenital or inherited kyphosis. In most cases, the patient is asked to lie down. In cases of postural kyphosis, the spine straightens when lying down. A curved spine, even after lying down, denotes a structural defect of the spine.

2. Adam’s Forward Bend Test - The patient is asked to bend forward. The feet are placed together, the knees are straight, and the arms are free. This position allows the doctor to examine the spine easily and detect deformities.

3. X-Rays and Scans:

An X-ray of the spine is taken to measure the curvature of the spine. The natural curvature of the spine is about 20 to 45 degrees. A curvature above 50 degrees is considered abnormal. X-rays also confirm the diagnosis and detect structural defects in the spine. Further scans and imaging tests, like MRIs (magnetic resonance imaging), are required if surgery is needed.

4. Additional Tests:

Additional tests are done to determine the underlying cause of kyphosis in adults.

• Pulmonary function tests are used to check for restricted breathing.

• Blood tests to check for infections.

• A bone density scan may be done to assess the bone condition in case of osteoporosis.

• Neurologic tests to see if there are any signs of spinal compression.

How Is Thoracic Kyphosis Treated?

The treatment of kyphosis is initially conservative and aims to prevent it from worsening. Surgical intervention is done in more severe cases.

The treatment of kyphosis differs for each individual and depends on the following factors.

• Age of the patient.

• Severity and flexibility of the spinal curvature.

• Type of kyphosis.

• Symptoms in a patient.

• Gender of the patient.

• Medical history of the patient.

Conservative Treatment: Conservative management of kyphosis is done in patients with a spinal curvature of less than 60 degrees. Conservative treatment procedures include patient observation, physiotherapy, and NSAIDs (non-steroidal anti-inflammatory drugs).

1. Observation: Patients should have regular checkups where the doctor analyses the progress of the curve. X-rays may be taken to keep track of the progress. If the patient does not have other symptoms or has no curvature progress, no treatment is required.

2. Physiotherapy: Physiotherapy is done to strengthen the back and abdominal muscles while giving better support to the spine. Other physiotherapy treatments for kyphosis include,

• Exercises to improve flexibility and posture.

• Electrotherapy.

• Biomechanical correction.

• Postural education and retraining.

• Soft tissue massage.

• Joint mobilization and activity modification.

3. NSAIDs: NSAIDs (non-steroidal anti-inflammatory drugs) are utilized to relieve pain.

4. Underlying Illnesses: Treat underlying conditions like osteoporosis to prevent the progression of kyphosis.

Bracing: Bracing is considered for adolescent patients with kyphosis greater than 50 degrees. Bracing helps guide the spine's growth before skeletal maturity to straighten it out. The Milwaukee brace is the most commonly used one. It is worn for about 16 to 24 hours per day. Braces should be worn until there is growth in the bones. In adult patients, braces support the spine and reduce discomfort but do not help correct the spine.

Surgical Treatment: Surgical treatment of kyphosis is considered in the following conditions.

• Pain that is not improving with conservative treatments.

• Very pronounced curvature of the spine, which keeps progressing.

• Neurologic problems are caused by kyphosis.

• Scheuermann’s kyphosis with a curve of more than 70 degrees.

• Cardiovascular compromise.

• Congenital kyphosis.

• Breathing is affected due to kyphosis.

The surgery used to correct kyphosis is called spinal fusion. In this procedure, the vertebrae are lined up straighter and fused using small pieces of bone to fill up the spaces between the vertebrae. Both the pain and the spine's posture are corrected by surgery. Surgical treatment usually has a high risk of complications. Complications after surgery include infection, excessive bleeding, and accidental nerve damage, which could result in paralysis.

Can Kyphosis Be Prevented?

Postural kyphosis can be prevented. Some things to be followed to prevent postural kyphosis include

• Avoiding slouching.

• Avoid carrying heavy backpacks or school bags.

• Sitting straight and back should be supported.

• Regular exercises like swimming, running, walking, etc., should be done to strengthen back muscles.

Conclusion

Thoracic kyphosis is when the upper spine curves too much outward. It can pose challenges to posture, mobility, and spinal health. Management strategies include different methods like exercises, postural awareness, and making changes to the workspace to prevent problems. If the condition is diagnosed early, the patient can be treated with conservative treatments and will not need surgery. Regular follow-ups should be done to monitor the progression of kyphosis, even if surgery is not done.