CHILDREN KYPHOSIS

CHILDREN KYPHOSIS

Kyphosis in children is a relatively common phenomenon that concern parents and pediatricians. The configuration of the spine in the sagittal plane (profile) significantly affects the appearance, cardiopulmonary function and the likelihood of spondyloarthritis in life. The spine has three curvatures: cervical lordosis, thoracic kyphosis and lumbar lordosis. The upright position requires a balance between them because they are interrelated.

The leg alignment also affects the spine. For example excessive lumbar lordosis typically compensates by contracture of the hip.

The kyphosis is usually painless. The painful kyphosis need direct control with additional imaging tests such as MRI or CT scans.


Boy 12 years old with thoracic kyphosis

KYPHOSIS
Kyphosis is a spinal deformity characterized by an increase in the posterior convex angulation in the sagittal plane.  The normal posterior convex angulation of the thoracic spine is 20-40 degree measured by the Cobb method (X-ray)


X-ray of the thoracic spine  52 degree of kyphosis (Cobb method). Boy 12 years old  

ROUND SHOULDER

Usually in everyday clinical practice meet children with so-called round shoulder which is a natural variant of the spine, particularly the problem is a cosmetic.

The back is flexible and can be enhanced by requiring the child to straight the spine without causing permanent deformation. Usually we see one of the two parents of the child (inherited body composition).


Round shoulder


Functional correction of the shoulders with back extension exercise


The boy has no disturbance of the spine in the frontal plane


Boy 9 years old with rounded shoulders. We see in the photo except the thoracic kyphosis (high red arrow) and increased lumbar lordosis (low red arrow)


Panoramic view of the child's shoulder. Observe the forwardly inclined shoulder. (The child's father has exactly the same clinical picture on the shoulders)


Girl 12 years with functional kyphosis (rounded back - round shoulder red line) and a compensatory lumbar lordosis. There insolence and belly (orange arrow)


Many times during the clinical examination is observed that the shoulders are not at the same height. This may indicate a problem in the spine which need control by special orthopedic

SCHEUERMANN KYPHOSIS

Scheuermann's kyphosis is a disorder of endochondral ossification that affects the vertebral endplates and ring apophyses, resulting in intravertebral disc herniation, anterior wedging of consecutive vertebrae (>5 degree in three adjancent thoracic vertebrae), and fixed thoracolumbar kyphosis. 

The exact etiology is unknown.  A familian predilection has been theorized.  Increased height and repetitive loading may be inciting factors

Scheuermann's disease in overweight teenager



Wedge deformation of thoracic vertebrae suggesting kyphosis due to Scheuermann disease

 

CONSERVATIVE TREATMENT
THERAPY: 

The treatment of Scheuermann disease depends on the rate of kyphosis showing the child during the first examination, age (skeletal skeletal growth potential), and gender. The decision of the brace use is a serious matter that concerns the whole family. .  Usually the child should wear the brace 23 hours in 24 hours and stop to wear during sports activities and the physical care of hygiene.

Monitoring the development of kyphosis done with clinical and radiological control and that determined by the special orthopaedist. The development of kyphosis usually stops with the skeletal maturation (about 2.5 years after the onset of menstruation in girls and about 19 years of life in boys).

The use of thoracolumbar brace to the child or not is determined by many factors such as:

  •      measuring the kyphotic angle on radiographs (Cobb method)
  •      the age of the child (remaining capacity of skeletal development)
  •      the child's sex
  •      evolution rate of Kyphosis relative to the time

A child - teenager with kyphosis angle in radiography 60 degrees or more, the application of brace - splint is immediate

Where however, that in a 10 year old boy and thoracic kyphosis 50 degrees with skeletal growth potential as the 19 years of believe that the application of the splint should start immediately.

Proper spine tips:

  •      Using the correct office chair during study
  •      avoidance study on the floor, on the bed or couch
  •      systematic and under proper guidance physical exercise (swimming, basketball)
  •      weight maintenance in adequate levels
  •      avoid weight lifting in childhood (heavy school bag hung on shoulders)


Wrong way


Right way