What Is Kyphosis?
Kyphosis is one of the most common diseases of the spine. A kyphosis – or popularly “round back” – is a convex (dorsally convex) form of the back in the area of the thoracic spine. The tendency towards a rounded back, the so-called kyphosis, can also manifest itself in the middle (thoracolumbar) and the lower (lumbar) section of the spine. Kyphosis is physiological up to an angle of approx. 40 ° according to Cobb in the area of the thoracic spine. To determine whether there is a pathological change in the vertebral body, several factors must be checked. There are two main groups of kyphoses: the congenital and the acquired. A distinction is also made between the so-called arcuate (arc-shaped) and angular (angular) kyphoses. The causes of the angular are growth disorders (congenital wedge vertebrae) or certain diseases such as osteoporosis or ankylosing spondylitis. The arcuaries are usually based on traumatic or pathological changes caused by tumors or inflammation. A pronounced hump, the so-called Gibbus, can often be seen in the angular. Angular kyphoses can damage the spinal cord. (Illustration: patient with Scheuermann’s disease in the thoracic spine, the rounded back is clearly visible.)
How is kyphosis diagnosed?
To determine whether it is a structural change in the spine or a poor posture, the postural test according to Matthias is used – especially in children. The patient stands upright with arms outstretched. If he can hold the position for more than 30 seconds, one assumes “posture health”. Posture weakness exists if the 30 seconds are not reached. If the position cannot be taken at all, there is a decline in posture. High-grade kyphoses, such as ankylosing spondylitis, can hinder human upright walking. (Figure: The Matthias posture test is used to diagnose Scheuermann kyphosis.)
How Common Is Scheuermann’s Disease?
Scheuermann’s disease is the most common spinal disease. Scheuermann’s disease is present in about 30% of the population. It usually occurs in male patients between the ages of eight and thirteen. The wedge vertebrae can be clearly seen on the x-ray, this is osteoporosis. Due to the fact that it is extremely difficult to separate a pathological from a physiological kyphosis, the frequency indication is subject to large fluctuations. In addition to a flaccid posture, a metabolic disorder is decisive for the development of this disease. This is the reason for the reduced resilience of the vertebral bodies. A strong mechanical load on the vertebral bodies as in competitive sports (gymnasts, trampoline jumpers) can also be the cause of a Scheuermann’s disease. The result is a deformation of the vertebrae. The deformed vertebrae are called wedge vertebrae. The therapeutic measures aim to reduce the pressure on the vertebral bodies and prevent further deformation.
In the case of kyphosis, special trunk orthoses (braces) can be very effective and, if used correctly, can stop the damage to the affected spinal segments.
Treatment with physiotherapy and TLSO trunk orthoses
There are various therapies based on the cause of the kyphosis.
In the case of poor posture or minor growth-related changes in the spine, physiotherapeutic measures are usually promising.
For higher-grade kyphoses, trunk orthoses are used. Special trunk orthoses (corsets) are very effective and can prevent damage to the affected spinal segments when used correctly. Corsets for the treatment of Scheuermann kyphosis can be manufactured in a stable frame construction. Modern TLSO (thoraco-lumbo-sacral-orthosis) trunk orthoses are manufactured using CAD technology. You straighten the spine in the affected segment.
In severe cases, the corresponding area of the spine is surgically straightened or stabilized.
Treatment Of Kyphosis With Trunk Orthoses (Braces)
Modern trunk orthoses for patients with kyphosis are manufactured using CAD technology. The materials and the special biomechanical requirements of the corsets are precisely tailored to their function. The kyphosis braces are available as robust, lightweight frame constructions from specialized orthopedic companies. Patients and parents should clarify in advance exactly where they can be supplied with a TLSO corset. Practice shows that there are big differences in the quality of the trunk orthoses and the associated overall care of the patients. Therapy with a corset is tailored precisely to accompanying physiotherapy by experienced specialists. In addition, regular checks by the orthopedic technician are required to check the trunk orthosis.