Kyphosis / Scoliosis / Lordosis

Scoliosis is an abnormal curving of the spine. Your spine is your backbone. It runs straight down your back. Everyone’s spine naturally curves a bit. But people with scoliosis have a spine that curves too much. The spine might look like the letter C or S.Most of the time, the cause of scoliosis is unknown. This is called idiopathic scoliosis. It is the most common type. It is grouped by age.

• In children age 3 and younger, it is called infantile scoliosis.
• In children age 4 through 10, it is called juvenile scoliosis.
• In children age 11 through 18, it is called adolescent scoliosis.

Scoliosis most often affects girls. Some people are more likely to have curving of the spine. Curving generally gets worse during a growth spurt.

Other types of scoliosis are:

• Congenital scoliosis: This type of scoliosis is present at birth. It occurs when the baby’s ribs or spine bones do not form properly.
• Neuromuscular scoliosis: This type is caused by a nervous system problem that affects the muscles. Problems can include cerebral palsy, muscular dystrophy, spina bifida, and polio.

Usually there are no symptoms. If there are symptoms, they may include:

• Backache or low-back pain
• Tired feeling in the spine after sitting or standing for a long time
• Uneven hips or shoulders (one shoulder may be higher than the other)
• Spine curves more to one side

EXAMS AND TESTS

The health care provider will perform a physical exam. You will be asked to bend forward. This makes your spine easier to see. It may be hard to see changes in the early stages of scoliosis.

The exam may show:

• One shoulder is higher than the other
• The pelvis is tilted

X-rays of the spine are done. X-rays are important because the actual curving of the spine may be worse than what your doctor can see during an exam.

Other tests may include:

• Spinal curve measurement (scoliometer screening)
• MRI of the spine

TREATMENT OPTION

As an adult, your spine is no longer growing, but it is important to stabilize your spine and lessen symptoms. Non-surgical treatments usually are recommended for any magnitude of curve. These include physical therapy, aerobic exercise, stretching and strengthening to improve flexibility. Braces should almost never be used in adults as they lead to loss of muscle tone and eventually will increase symptoms.

KYPHOSIS

Kyphosis (from Greek word means a hump), also called roundback or Kelso’s hunchback, is a condition of over-curvature of the thoracic vertebrae (upper back). It can be either the result of degenerative diseases (such as arthritis), developmental problems (the most common example being Scheuermann’s disease), osteoporosis with compression fractures of the vertebrae, or trauma. A normal thoracic spine extends from the 1st to the 12th vertebra and should have a slight kyphosis ranging from 20 degree to 45 degree . When the “roundness” of the upper spine increases past 45 degree it is called “hyperkyphosis”. Scheuermann’s kyphosis is the most classic form of hyperkyphosis and is the result of wedged vertebrae that develop during adolescence. The cause is not currently known and the condition appears to be multifactorial and is seen more frequently in males than females. In the sense of a deformity, it is the pathological curving of the spine, where parts of the spinal column lose some or all of their lordotic profile. This causes a bowing of the back, seen as a slouching posture.

While most cases of kyphosis are mild and only require routine monitoring, serious cases can be debilitating. High degrees of kyphosis can cause severe pain and discomfort, breathing and digestion difficulties, cardiovascular irregularities, neurological compromise and, in the more severe cases, significantly shortened life spans. These types of high-end curves typically do not respond well to conservative treatment and almost always warrant spinal fusion surgery, which can successfully restore the body’s natural degree of curvature.

LORDOSIS

The term lordosis refers to the normal inward curvature of the lumbar and cervical regions of the spine.Excessive or hyperlordosis can happen and this is commonly referred to as swayback or saddle back, a term that originates from the similar condition that arises in some horses. A major factor of lordosis is forward pelvic tilt, when the pelvis tips forward when resting on top of the thighs. Curvature in the opposite direction is termed kyphosis.

Normal lordotic curvatures, also known as secondary curvatures results in a difference in the thickness between the front and back parts of the intervertebral disc. Lordosis may also increase at puberty sometimes not becoming evident until the early or mid-20s. Imbalances in muscle strength and length are also a cause, such as weak hamstrings, or tighthip flexors (psoas).

Other health conditions and disorders can cause lordosis.

Spondylolisthesis (a condition in which vertebrae slip forward) and osteoporosis (the most common bone disease in which bone density is lost resulting in bone weakness and increased likelihood of fracture) are some of the most common causes of lordosis. Other causes include obesity, kyphosis (spine curvature disorder in which the thoracic curvature is abnormally rounded), discitits (an inflammation of the intervertebral disc space caused by infection) and benign juvenile lordosis. Excessive lordotic curvature is also called hyperlordosis, hollow back, saddle back, and swayback. Common causes of excessive lordosis include tight low back muscles, excessive visceral fat, and pregnancy. Although lordosis gives an impression of a stronger back, incongruently it can lead to moderate to severe lower back pain. Rickets, avitamin D deficiency in children, can cause lumbar lordosis.

Measurement and diagnosis of lumbar lordosis can be difficult. Obliteration of vertebral end-plate landmarks by interbody fusion may make the traditional measurement of segmental lumbar lordosis more difficult. Because the L4-L5 and L5-S1 levels are most commonly involved in fusion procedures, or arthrodesis, and contribute to normal lumbar lordosis, it is helpful to identify a reproducible and accurate means of measuring segmental lordosis at these levels.

A visible sign of lordosis is an abnormally large arch of the lower back and the person appears to be puffing out his or her stomach and buttocks. Precise diagnosis of lordosis is done by looking at a complete medical history, physical examination and other tests of the patient. X-rays are used to measure the lumbar curvature, bone scans are conducted in order to rule out possible fractures and infections, magnetic resonance imaging (MRI) is used to eliminate the possibility of spinal cord or nerve abnormalities, and computed tomography scans (CT scans) are used to get a more detailed image of the bones, muscles and organs of the lumbar region.

TREATMENT

Physical therapy effectively treats 70% of back pain cases due to scoliosis, kyphosis, lordosis, and bad posture.Hypo-lordosis is more common than hyper-lordosis.Hypo-lordosis can be corrected non-surgically through rehabilitation exercises. Many different techniques exist to accomplish this correction. These exercises, if done correctly, may reduce symptoms in those with the typical presentation in 3-6 months. This type of treatment is typically provided by a chiropractor, though some physical therapists offer it as well.

Controversy regarding the degree to which manipulative therapy can help a patient still exists.