Kyphosis is fundamentally curvature of spine that results into bowing of the back & ultimately leads to slouching or hunchback posture. Pervasiveness of Kyphosis is predicted to affect 5 – 8 percent of the general world-wide population. While prevalence of this condition is generally acknowledged to be necessarily equal in men & women, this finding is still uncertain. There are mainly three types of kyphosis; congenital, postural & Scheuermann’s kyphosis. Most cases of kyphosis do not need any dedicated treatment. Specific exercises & physical therapy are often adequate in treating postural & Scheuermann’s kyphosis. Surgery is usually suggested for patients suffering from congenital kyphosis & more serious cases of Scheuermann’s kyphosis.
What is Kyphosis?
Normal spine has a series of curves when viewed from the side angle. These curves help to absorb stack of loads applied to spine from weight of the body. Upper back portion of spine has a regular outward curvature that is known as kyphosis by which spine can bend in the forward direction. Normal spine, when inspected from behind seems straight. Spine affected by kyphosis shows evidence of a forward curvature of vertebrae in the upper back area & which gives an impression of a humpback. Clinical research states kyphosis as a curving of spine which is 45 degrees or more on an x-ray examination.
Kyphosis is a deformity of spine that can result from developmental problems, trauma or degenerative diseases. Kyphosis may be present at birth, or due to conditions that may include the following.
- Neuromuscular conditions
- Metabolic problems
- Spina bifida
- Osteogenesis Imperfects (Brittle Bone Disease) – This unwanted condition causes easy fracture of bones with minimal force.
- Scheuermann’s Disease – This condition causes vertebrae to curve forward in the upper back area. It is most commonly seen in males & its cause is yet unknown.
Kyphosis is a type of spinal abnormality & should not be confused merely with poor posture. Some of the most commonly found signs & symptoms of Kyphosis include the following.
- Persistent mild pain in back
- Tenderness & stiffness of spine
- Difference in shoulder’s height
- Difficulty in breathing
- Slouching posture
Kyphosis Surgery is generally the last treatment option which should be taken into consideration. Non-surgical treatments, such as, physical therapy, should be attempted first. If symptoms & pain do not lessen after all these treatments then orthopedic surgeons may advise Kyphosis Surgery. Other criteria taken into consideration for Kyphosis Surgery include the following.
- Progression of Curvature – When the curve is increasing rapidly & getting worse, despite non-surgical procedures, surgeons may suggest Kyphosis Surgery to correct curvature & restrict it from getting worse.
- Balance of Body – Bending forward can affect the balance of patients, when the curve is making it tough to get through normal daily life, one may need Kyphosis Surgery to rebalance abnormal spine.
- Severity of Curve – Severity of curve is dependent upon the position of spine where it has hyper-kyphosis curve. In the mid-back area, curves measuring more than 80° are reviewed as severe; whereas, in the mid-back to low back area curves which are more than 60° – 70° are considered severe.
- Neurological Signs – Kyphosis can highly affect spinal nerves. Patients may suffer from weakness, tingling or numbness & in extreme cases, when Kyphosis Surgery is recommended patients may have bladder dysfunction as well.
There are three main types of kyphosis that most commonly affect adolescents & children.
- Postural Kyphosis
- Scheuermann’s Kyphosis
- Congenital Kyphosis
- Postural Kyphosis – Postural kyphosis is the most general type of kyphosis, which generally becomes observable during adolescence. It is perceived clinically as slouching or poor posture, but is not related with serious structural deformities of spine. Curve caused by postural kyphosis is usually smooth & round & can often be rectified by the patient when he/she is told to stand up straight. Postural kyphosis is more common in females than in males. It is barely painful & because the curvature does not advance, it normally does not lead to significant issues in adult life.
- Scheuermann’s Kyphosis – Similar to postural kyphosis, Scheuermann’s kyphosis generally becomes apparent during the growing teen years of patients. However, Scheuermann’s kyphosis can develop in a more harsh deformity than postural kyphosis, principally in thin patients. It is caused by a fundamental abnormality in spine & the curve is usually angular & sharp. It affects the thoracic spine of patients, but at random may also develop in the lumbar spine. This condition could be painful & is more commonly observed in boys than girls. Harsh pain in this condition is generally felt at the top portion or apex of the curve.
- Congenital Kyphosis – Congenital kyphosis can be present at the time of birth. It appears when the spinal column fails to grow normally while the child is in-utero. It worsens as the child ages. Surgical treatment is required to treat this condition & stop the curve from progression.
Mild kyphosis normally goes ignored until the patient notices changes & consults a doctor. Orthopedic surgeons will begin diagnosis by checking the medical history of patients & asking about the symptoms. Following imaging tests may be performed in order to check the condition of spine.
- X-Rays – This test provides pictures of dense structures, such as bone in patients. X-rays from various angles are taken to see if there are significant changes or any other abnormalities in the vertebrae of patients. X-rays also help to measure the degree of curvature & curvature which is greater than 50 degrees is treated as abnormal.
- Pulmonary Function Tests – When curvature of spine is serious, orthopedic surgeons may tell patients to undergo pulmonary function tests.
- Other Tests – Patients who are suffering from congenital kyphosis can have abnormal & progressive curves heading to symptoms of spine compression, including tingling, pain, weakness or numbness in lower body. In addition to this, surgeons may order MRI scans or neurologic tests to confirm diagnosis.
Aim of kyphosis treatment is to stop progression of irregular curvature & prevent deformity. Orthopedic surgeons consider the following points while deciding treatment for kyphosis.
- Patient’s health status & age
- Type of kyphosis
- Severity of curve
Non-surgical treatments are suggested for patients with postural kyphosis. It may also be recommended for patients with Scheuermann’s kyphosis who have curves of less than 70 degrees. Non-surgical treatments for kyphosis may include the following.
- Observation – Orthopedic surgeons may suggest simple monitoring of irregular curve to ensure it does not get worse. Unless spinal curve becomes painful & worse, no surgical treatment is needed.
- Physical Therapy – Some exercises may help alleviate back pain & improve back posture by strengthening muscles of patients in back & abdomen.
- Non-steroidal Anti-inflammatory Drugs – Medications including ibuprofen, aspirin & naproxen, can help relieve back pain.
- Bracing – Bracing may be suggested for patients suffering from Scheuermann’s kyphosis who are still in their growing phase. Surgeons will fix brace on a regular basis as curves improve.
- Donating Blood – Patients may lose considerable amount of blood during spine surgery & therefore quite often it is crucial to receive transfusions during or after kyphosis surgery.
- Medications – Aspirin & non-steroidal anti-inflammatory drugs (NSAIDS) such as Motrin, Advilor Naprosyn may result in excessive bleeding during the time of surgery. Such medications may need to be stopped two to three weeks prior to undergoing kyphosis surgery. Patients may also require to stop some non-steroidal anti-inflammatory medications such as Motrin or Advil for the first few months following spinal fusion surgery. However, several pain relieving medications can be taken with permission of orthopedic surgeons.
- Night before Surgery – Night before surgery, patients must remember not to drink or eat anything after midnight. This may include water, food or chewing gum. Patient’s stomach needs to be empty when they are administered anesthesia for surgery. This will help evade complications during or after general anesthesia. It will also keep patient’s stomach from getting upset & also prevent vomiting after completion of surgery.
Following list of questions may help patients to choose a better option for treating kyphosis. Patients may ask the enumerated questions to clear doubts during initial consultation with orthopedic surgeons.
- What is kyphosis?
- Have you dealt with kyphosis cases like mine before & can you explain long-term outcomes experienced by previous patients?
- Can you provide me a list of patients who would be willing to share their kyphosis treatment experiences with me?
- Can you tell me the degree of my spine’s curvature?
- How often will follow-up sessions be scheduled & what will they involve?
- Will non-surgical treatments get me outcomes that I am expecting?
- Do I need to undergo surgery for kyphosis treatment?
- What are the chances of success with this surgical procedure?
- What steps can I perform to enhance chances of success?
- What is the alternate plan if this kyphosis surgery does not work?
- What are the potential complications & side-effects of spine surgery?
- How will spine surgery affect my quality of life?
- How long will it take for completion of spine surgery & how soon will I recover?
- What percentage of your patients have kyphosis?
- Can you explain me the entire surgical method for treating kyphosis?
- What are my other options if I do not wish to undergo the recommended surgery?
- What is the best / worst case scenario?
- Are there any other kyphosis specialists that you would suggest me to take a second opinion?
Kyphosis Surgery has the following goals.
- Minimize deformity
- Reduce neurological symptoms & pain
- Restrict curvature from getting worse
Depending upon these goals, respective orthopedic surgeons will make recommendations for Kyphosis Surgery. Typical surgeries for kyphosis are listed below.
- Kyphoplasty – Kyphoplasty is a minimally invasive procedure for treating compression fractures of spine. Compression fractures generally occur when weak backbones collapse & appear wedge-shaped. Patients with multiple fractures might look hunched, with a rounded back. To perform this surgery, doctors insert & inflate a balloon into the fractured back to create a cavity inside the bone. Cavity is then packed with cement to strengthen the weak bone. Most patients report dramatic improvement in the quality of life after this procedure, alongside increased ability to participate in normal everyday activities.
- Spinal Fusion Surgery – It is a surgical procedure in which two or more vertebrae are fused together, to restrict any movement that occurs in vertebral levels. Concept of spinal fusion surgery is to permanently connect vertebrae to each other. This produces a solid bone, rather than a joint that permits movement.
After Kyphosis Surgery, patients may experience some pain & discomfort, especially if they underwent traditional spinal fusion surgery for Kyphosis. Within a few days after Kyphosis Surgery, orthopedic surgeons may refer patients to a physical therapist in order to take care of their customized daily schedule. This program’s aim is to steadily & carefully build flexibility & strength of patients. Recovery of patients will be much quicker if they strictly follow all guidelines provided by orthopedic surgeons.
Complications following surgery of kyphosis generally occur in serious cases. They may include the following.
- Uncontrollable & persistent pain which cannot be controlled even with pain medications.
- Difficulty in breathing caused by spine compressing airways & lungs of patients.
Occasionally, following symptoms may also be seen in patients due to disrupting of nerve signals.
- Weakness or numbness in legs & arms
- Loss of normal bowel or bladder control
- Issues with sense of balance
These severe complications need urgent medical attention & patients should immediately consult orthopedic surgeons to control them.
While results for correction of deformity following kyphosis surgery vary due to a variety of reasons, most patients observe the following outcomes.
- 5 to 6 out of 10 patients report excellent results
- 1 to 2 out of 10 reports no significant improvement
- 1 to 2 out of 10 report worsening of spine symptoms or having had a complication with kyphosis surgery
In case kyphosis condition is diagnosed earlier, patients can be successfully treated without surgery & go on to lead healthy & active lives. However, when kyphosis is left untreated, spine curve progression could possibly result in problems during adulthood. Even after surgery, regular follow-up sessions are required to monitor condition of patient’s spinal curve.
Medical Tourism for Best Treatment of Kyphosis
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Success of medical tourism industry across the world can be attributed to such vital factors.
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