A growing number of patients complain about the poor posture and kyphotic appearance of their children. Fortunately, only a very small percentage of children I examine have kyphosis requiring treatment. In most children, the abnormal shape noticed by the parents is diagnosed as a postural or positional deformity, which is a slight gibbosity due to poor posture.
What Causes Severe Kyphosis Requiring Treatment?
When we observe the spine from the back, we see that it is a straight column formed by alignment of the vertebras on top of each other, with a projection passing from the midpoint of the head and the pelvic bone. When the human spine is observed from the side, we see not a straight line, but some physiologic curvatures formed by angulation of the vertebras with each other. For example, the chest-upper back has a definite gibbosity, and the adjacent lower back has a hollowness.
The kyphosis (gibbosity) in the chest-upper back shows a wide variation between individuals. Some people have a more erect posture than others. Normal angular measurements performed on a lateral (side) X-ray of the human spine, taken when a person stands comfortably, range between 20 and 55 degrees. Therefore, a kyphosis of 20 degrees or 55 degrees are considered within normal limits. As a result, it is absolutely normal for one family member to be more or less kyphotic than another.
What is Structural Kyphosis or Scheuermann's Kyphosis?
Structural kyphosis is a type of kyphosis greater than 55 degrees, even when the person is in physiologic standing position, often due to an underlying bone and/or soft tissue pathology. This kyphosis may be due to congenital vertebra anomalies (congenital kyphosis), some bone diseases (skeletal dysplasia, neurofibromatosis, etc.), spine infection (spinal tuberculosis, etc.) or injury of the spine due to vertebral fractures, and various nerve-muscle diseases.
However, in growing patients, the most common reason for structural kyphosis is Scheuermann's disease. In this disease, the vertebrae lose their rectangular shape and attain a wedge shape due to an affection without a known cause, resulting in a kyphosis. When Scheuermann's disease is not treated, it may result in an increase in kyphosis, reaching dangerous levels.
How are Severe Kyphosis and Postural Kyphosis Distinguished?
One test, easily applied by parents, can distinguish between severe and postural kyphosis. Tell your child to straighten his/her back. If the kyphosis straightens, then he or she probably has postural kyphosis. When the most prominent part does not display an obvious correct or shows only a slight correction, you may need to visit your doctor and receive professional help.
There is no consensus on the threshold magnitude of Scheuermann’s kyphosis, which may necessitate surgical treatment. However, the general consensus is to reserve surgical treatment for patients exhibiting more than 75 degrees of kyphosis. Most common surgical treatment for Scheuermann’s Kyphosis is posterior fusion and instrumentation. However, few surgeons may prefer to operate patients via an anterior approach.