Causes
Postural Kyphosis: A deformity that can usually be detected in school screenings in children. It is generally seen during adolescence and is more common in girls. The curvature is below 60º and the spine is flexible. There is no structural abnormality of the spine on X-rays.
Scheuermann Kyphosis: A structural curvature of the thoracic (back) and thoracolumbar (back + lower back) spine, seen in 0.4–8.3% of the population. It is more common in males (M/F: 7.3/1). Although there are many different interpretations of its etiology, the most widely accepted cause is avascular necrosis occurring in the ring apophyses of the vertebrae. It is usually seen during the adolescent growth spurt. Presenting complaints are either back or lower back pain or a postural disorder. The diagnostic criteria are wedging of more than 5º in at least 3 adjacent vertebrae at the apex of the kyphosis, irregularity of the vertebral endplates, and a thoracic kyphosis greater than 45º. Adolescents with a mildly increased kyphosis that does not progress beyond 50º can be monitored with lateral radiographs taken every 4–6 months; no monitoring is required once growth is complete. In conservative treatment, if the curvature is between 50º and 80º and the patient is in adolescence, a brace may be tried. If the curvature exceeds 80º, surgical treatment is required. Surgical treatment generally combines anterior release with posterior instrumentation and fusion. Brace use is not required after surgery. The patient is mobilized as early as possible; the patient is seated on the first day after surgery, and lower back exercises begin 6 months later.
Congenital kyphosis: Develops due to a vertebral anomaly present at birth. The cause of the vertebral anomaly may be a formation defect, a segmentation defect, or a combination of both. Due to a formation defect, a wedge vertebra forming anteriorly in the vertebral body, or a hemivertebra resulting from incomplete formation of the anterior part of the vertebral body, may cause kyphotic deformity. Similarly, due to a segmentation defect, kyphotic deformity may develop as a result of adjacent vertebral bodies being fused or a connecting bar (unsegmented bar).
Paralytic kyphosis: Kyphosis that develops after diseases such as poliomyelitis, CP (Cerebral Palsy), and spinal muscular atrophy.
Myelomeningocele: Along with meningocele and myelomeningocele, kyphotic deformity may also be present in 8–15% of cases.
Posttraumatic: Kyphotic deformity may develop due to wedging following vertebral fractures.
Inflammatory: Among infections, the first to come to mind are specific infections such as tuberculosis and brucellosis. Among inflammatory diseases, ankylosing spondylitis and rheumatoid arthritis.
Postsurgical: Kyphosis may develop after fractures that were surgically treated but inadequately reduced or inadequately fixed.
Metabolic: May develop as a result of osteoporosis, osteomalacia, and osteogenesis imperfecta.
Developmental: Kyphosis may develop as a result of diseases such as achondroplasia and mucopolysaccharidoses.
Diagnosis of Kyphosis
When the patient is viewed from the side, the head is tilted forward and a hump is visible on the back. Back and neck pain are commonly reported complaints.
What families should do
It is important to ensure that children's study desks and chairs are at the appropriate position, angle, and height, and to adjust monitor and keyboard heights to suitable positions. With these adjustments, we can help our children become accustomed to the ideal posture that keeps their spines within physiological limits. Sports will help prevent postural hunchback by increasing the child's physical fitness and the strength and endurance of the muscles that keep the spine upright. The best proof of this is that you will notice fewer complaints in the summer months, when your child is more physically active in sports and less troubled by the hunchback complaint. Be sure that at least 3 days a week of one hour of sports activity will solve all problems. Exercises such as reverse crunches, Pilates, and aerobics are also very important, especially for adolescents.
