Congenital kyphosis

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1. Overview


The spine has a series of normal curves when viewed from the side. These curves help absorb pressure resulting from a person’s weight on the spine.

Cervical spine and lumbar spine has a normal curvature which is referred to in medical literature as lordosis (slight bend of the spine on the inside).

Thoracic spine has a normal passive curvature, which is called kyphosis. This is characterized by a slight outward curvature of the spine.

Spine should normally be straight, seen front. Normal curvature of the spine allows the head to have a balanced position towards the pelvis. A possible imbalance can lead to back pain, stiffness or wrong walking.


Contents

1. Overview
2. Symptoms of kyphosis
3. Congenital kyphosis
4. Nonsurgical treatment
5. Surgery


2. Symptoms of kyphosis

The most common symptoms of patients who have abnormal kyphosis are:
- Incorrect position of the spine; humpback look (rounded);
- Back pain;
- Muscle fatigue;
- Stiffness of the back.

Often these symptoms remain relatively constant and not worsen over time. In more serious situations, over time, the worsening of these symptoms can be observed. Kyphosis can progress, emphasizing abnormal curvature of the spine.

In rare cases, this can lead to compression of the spinal cord and can cause neurological symptoms, including weakness, loss of sensation or loss of control of bowel contents and removal of the bladder.


3. Congenital kyphosis

Definition and classification

In the first six to eight weeks of embryonic life, there is produced an abnormality or a fault occurs in the formation of segments of one or more vertebral bodies and discs. This malformation cause formation of a sharp spine angle as it grows.

Forward bending (sagittal plane) of the spine is called kyphosis and is believed to be congenital, in this case, because it develops before birth. Congenital kyphosis is not genetically transmitted but starts in fetal life for unknown reasons.

There are two main types of congenital kyphosis, resulting from a defect of formation or segmentation. Formation failure (type I deformation) from the level of one or more vertebrae and is growing worse as the person. Deformation is visible, usually at birth, as a prominent bulge or column located on the child’s spine.

Segmentation fault (type II deformation) occurs in two or more vertebrae that are not separated, while discs and bones are abnormal. This type of congenital kyphosis is often diagnosed later as a result of faulty gait of the child.

Investigation and assessment

In X-ray radiograph, the vertebrae are nearly rectangular when viewed from the side. Thoracic vertebrae from the front are smaller than the rear when kyphosis, while lumbar vertebrae are opposite when occurs the lordosis.

Congenital kyphosis causes a more pronounced kyphosis than in other situations, for a certain region of the spine. After confirming the diagnosis of congenital kyphosis, following X-ray radiography, the doctor may order additional tests to determine if there are any occult abnormalities in the bone marrow, kidney, heart or gastrointestinal tract system.

MRI can provide additional information about the potential abnormal growth and can help spinal deformity progression. More severe kyphosis can exert strong pressure on the spinal cord which causes myelopathy (spinal cord compression).

Young children who suffer from this condition learn to walk upright quite late, when spinal cord compression is already present.

Forecast

Type I deformation involves changing the column with 30-60 degrees. With the rapid growth of the skeleton, during the first year of life, disease progression is highly probable.

Segmentation fault has a slower rate of deterioration and will not require surgery at least until adolescence.


4. Nonsurgical treatment

Observation is usually the first method of treatment for a child with a deformity of the spine. Time distance between doctor visits will depend on the possibility of a significant change of the spine, which can be ascertained from the radiography performed at each visit.

In case of type I deformation, may be necessary several visits to a doctor every year. Severe congenital malformations or progressive congenital kyphosis sharper than 45 degrees or kyphosis associated with neurological disorders are usually treated surgically.

Early surgery gives the best results and can stop the progression of the curve. Type of surgical procedure depends on the nature of the anomaly.


5. Surgery

In situ fusion

Surgery most often used for a progressive kyphosis deformation is in situ fusion or deformed vertebrae arthrodesis. This fusion may involve raising or lowering of normal vertebrae in the affected area.

Bone graft or tissue will be placed posterior, along the abnormal area. In case of sharp curves, additional bone grafts can be placed both the anterior and posterior spine.

In situ fusion does not require the use of tools if the angulation correction is not done. Bone graft will take 4-6 months to mature and turn into a solid mass fusion. During the postoperative period of fusion, the patient will wear dentures that are designed to protect the affected area until the radiography demonstrates that there is a solid fusion.

Surgical fusion and osteotomy

In older children, who suffer from progressive kyphosis curvature of the spine may be necessary to use various tools (rods, hooks, screws) that will help correct the deformity.

In some cases, the surgeon may recommend osteotomy (procedure that involves bone cutting) to realign the spine. The surgeon can recommend distinct approaches in the front and the back of the spine.

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