II. Epidemiology

  1. Most common structural kyphosis in teenagers,with typical onset age 10-12 years old (as early as 8 years old)

III. Pitfalls

  1. Often misdiagnosed as poor Posture (postural kyphosis)

IV. Pathophysiology

  1. Osteochondrosis affecting the Vertebral epiphyseal Growth Plates
  2. Vertebral end plate disorder results in Vertebral body wedging
  3. With growth spurt, kyphosis increases

V. Symptoms

  1. Stooped Posture
  2. Upper back pain
    1. Gradual onset
    2. Worse at end of day
    3. Relieved with rest

VI. Signs

  1. Rigid kyphosis (humpback deformity) that does not improve with back extension or lying supine

VII. Diagnosis

  1. Three or more adjacent Vertebrae wedged >5 degrees and thoracic disc space narrowing
    1. Draw lines from parallel to the top and bottom of the Vertebral bodies extended anteriorly
    2. Measure wedging angle at the point at which the 2 lines intersect
      1. Lines do not intersect in a normal, non-wedged Vertebrae

VIII. Differential Diagnosis

  1. Congenital kyphosis (formation or segmentation failure in development)
  2. Neuromuscular kyphosis (Cerebral Palsy, Myelomeningocele, Syringomyelia, polio)
  3. Postural kyphosis

IX. Imaging

  1. Thoracolumbar Xray
    1. Lateral: Diagnosis requires 5 degrees or more of wedging in at least 3 adjacent Vertebrae
    2. Also evaluate for Scoliosis and disc space narrowing
  2. Thoracolumbar MRI
    1. Indicated in severe symptoms and non-diagnostic XRay

X. Management

  1. Physical Therapy
  2. Bracing indications
    1. Kyphosis 55-80 degrees before skeletal maturity
  3. Surgery indications
    1. Kyphosis >80 degrees in Thoracic Spine
    2. Kyphosis >65 degrees in thoracolumbar spine
    3. Progressive or refractory course resulting in pain, neurologic deficit or balance concerns
    4. Restrictive Lung Disease related symptoms and signs

XI. Course

  1. Progression is most pronounced during growth spurt and then slows after reaching skeletal maturity

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