Increased Thoracic Kyphosis
The most common deformity is the exaggerated thoracic kyphosis [Figure 66]. This can take on worrying forms in the pubertal growth spurt. A distinction has to be made between a supple exaggerated kyphosis and the rigid variety.
Figure 66
A = Ideal posture
B = Kypholordosis position
C = Flat back
D = ‘Sway-back’ position
The distinction can be made in a straightforward manner, using the following 2 methods:
- In standing position:
The patient often stands with increased lordosis and an overly tilted pelvis. By asking the patient to tilt the pelvis backwards, the lumbar lordosis will reduce. When the patient actively moves the shoulders backwards, stretching the cervical vertebral column, the thoracic kyphosis is reduced and an impression can be gained of the degree of flexibility of the kyphosis. - In prone position:
The spinous processes of the thoracic spine are palpated and an impression is gained of the degree of kyphosis. With a supple exaggerated kyphosis, it is usually already completely disappeared. By asking the patient to lift the shoulders, arms and the head, the kyphosis – if rigid – will not or will hardly reduce, whilst this is the case with a supple kyphosis.
The exaggerated kyphosis can be observed well from the side with the patient stooped forward, during which the shoulder blades slide forward and no longer obstruct the view onto the spine. In standing position, the lordosis depth (distance between the plumb line past the top of the kyphosis and the lowest point of the lordosis) and the sway-back distance (distance between the plumb line past the top of the kyphosis and the upper side of the sacrum at the level of the start of the natal cleft) can be measured. These measurements are conducted by an orthopaedist to estimate the severity of the kyphosis and, during follow-up of the patient, to assess the effect of therapeutic interventions.
If the kyphosis clearly shows rigid characteristics, osteochondrosis defects should be looked for on an x-ray image of an upright lateral total spine, which fits Scheuermann’s disease or, more rarely, fusion of the front of the vertebrae (congenital kyphosis). Scheuermann’s disease can often not be sufficiently corrected with posture therapy only and requires brace treatment in a growing child.
With supple posture kyphosis, exercise therapy or ‘watchful waiting’ will suffice. In adult patients, only extensive operations can alter the rigid form of hyperkyphosis.