The thoracic spine has a curve viewed on the side called a kyphosis. The vertebral bodies are wedged shaped and are the reason the curve is shaped like a kyphosis. The normal curve measures from 20-40 degrees.
This curve is essential for postural balance. There are two mirror image curves above and below (the cervical and lumbar curves). When added together with the sacral curve (the base bone of the spine is normally angulated 40 degrees to the front) the spine is in perfect balance. This means the head is positioned directly over the pelvis and no energy in the form of muscle contraction is necessary to stay upright.
This balance can be distorted by increasing the thoracic kyphosis as is seen in degenerative hyperkyphosis syndrome, Scheuermann’s Disease and Postural round-back deformity. In all of these disorders, the thoracic curve is increased and the balance of the spine is put off.
Compensation needs to come from the lumbar spine and cervical spine in the form of increased lordotic curves (the opposite curves to the thoracic curve to balance the spine). Without increased curves in these areas, the patient will either be thrown forward (if the lumbar curve does not increase) or have the head looking down instead of forward (if the cervical curve does not increase).
Symptoms
The increased cervical and lumbar curves create amplified wear on the facets as the neck and lower back have to hyperextend (bend further backwards) to accommodate the thoracic imbalance. The increased curves have to be “held in place” by increased muscle contraction which causes muscle fatigue and pain from prolonged muscle contraction. Neck and or lower back pain will result.
The thoracic spine can generate local pain from overload of the vertebral bodies and discs. In addition, with aging and osteoporosis, the increased loading of the vertebra can cause fractures even by simply stepping off a curb too hastily. Increased local pain will be the result.
Fatigue can be a common complaint with hyperkyphosis / Scheuermann's Disease as muscle overload uses too much energy. Prolonged walking or activities that require being upright can cause exhaustion.
Treatment
Non-surgical
Like with most other spinal disorders, physical therapy, chiropractic treatment, medications and injections can be very helpful to manage the pain associated with hyperkyphosis / Scheuermann's Disease.
Surgical
Surgery for this disorder should be considered if the curve exceeds 65 degrees or the pain cannot be treated adequately. Surgery is no small undertaking as the curve has to be straightened and there are significant risks to surgery
 |
| This is a picture of the normal alignment of the spine when viewed from the side (sagittal alignment). The curves of the neck and lower back are in the same direction (lordosis) and the mid-back curve (kyphosis) is reversed. All curves add up to make the spine align with the head directly over the pelvis. |
 |
| This is a side view diagram of a patient with Scheuermann’s hyperkyphosis disease. The mid back (thoracic spine) has a much bigger curve than normal. Note the thick black arrow pointing to the increased curve. This causes the patient to be tilted forward (see the thin gravity line in front of the pelvis which should be pointed into the pelvis). To compensate, the patient must increase the size of the lumbar curve which can prematurely wear it out. |
 |
| This is an illustration of a patient with Scheuermann’s disease. Note the prominent curve or “hump’ in his mid-back. |
 |
| This is an x-ray of the side view of the thoracic spine of a patient with Scheuermann’s disease. Note that the curve looks like a letter “C” but should be almost straight. |
No comments:
Post a Comment