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paediatric kyphosis
Paediatric Kyphosis (Curvature of the Spine in Children)
It is normal for us to have a curved spine, especially when viewed from the side, but these can sometimes be exaggerated and are then referred to as a kyphosis. Infants who still lack muscle control of their spine and are developing truncal control have a long round c-shape to their entire spine. Fighting gravity takes time and over time the spine matures, with demonstrable improvements in muscle strength and shape of the bony elements.
The medical term for the sideways line of the body is ‘the sagittal plane’. After the age of 3 the spine should look more normal in this sagittal line. The neck and lower back are expected to have a rounded appearance (lordosis), whereas the thoracic spine (in the chest) has a gentle rounding. As we develop into adolescence, these are constantly changing… and then again as we age!
The sagittal plane is assessed medically when standing, not sitting. Our spines go into very different positions when seated on the floor or in a chair, and there is no ‘normal posture’ seated… much to the chagrin of all parents.
So when does it matter?
The classic idiopathic cause (we don’t know why it happens, but appears to be genetic) that progresses during adolescence is Scheuermann’s kyphosis. This is a structural kyphosis with disc changes, wedging of the vertebrae and an increased thoracic kyphosis (curvature in the chest section) of greater than 50 degrees. The apex (pointiest part) of the curve is seen as a gibbus (humpback) or sideways prominence because of the wedging. The apex can be high or mid thoracic or even at the thoracolumbar junction (where the chest meets the lower spine) – which is normally straight. Similar to scoliosis, assessment should be performed by a paediatric spine surgeon to best understand what is likely to happen to the curve over time. This will allow planning, management of the problem, and rule out any other possible issues. These patients are more likely to have back pain than the normal population. This is because they have altered mechanics and hamstring tightness, and a higher observed rate of pars defects (a crack in the bony arch at the back of the spinal vertebrae).
Treatment:
It is normal for us to have a curved spine, especially when viewed from the side, but these can sometimes be exaggerated and are then referred to as a kyphosis. Infants who still lack muscle control of their spine and are developing truncal control have a long round c-shape to their entire spine. Fighting gravity takes time and over time the spine matures, with demonstrable improvements in muscle strength and shape of the bony elements.
The medical term for the sideways line of the body is ‘the sagittal plane’. After the age of 3 the spine should look more normal in this sagittal line. The neck and lower back are expected to have a rounded appearance (lordosis), whereas the thoracic spine (in the chest) has a gentle rounding. As we develop into adolescence, these are constantly changing… and then again as we age!
The sagittal plane is assessed medically when standing, not sitting. Our spines go into very different positions when seated on the floor or in a chair, and there is no ‘normal posture’ seated… much to the chagrin of all parents.
So when does it matter?
- Kyphosis (curvature) in the wrong spot on the spine, or that is markedly increased with a structural component is concerning.
- A global kyphosis is less concerning than a short, sharp kyphosis.
- Kyphosis that is progressive (gets worse with time) is concerning.
- Kyphosis associated with pain or neurological symptoms (things like numbness or tingling in the legs) needs prompt review by a specialist.
The classic idiopathic cause (we don’t know why it happens, but appears to be genetic) that progresses during adolescence is Scheuermann’s kyphosis. This is a structural kyphosis with disc changes, wedging of the vertebrae and an increased thoracic kyphosis (curvature in the chest section) of greater than 50 degrees. The apex (pointiest part) of the curve is seen as a gibbus (humpback) or sideways prominence because of the wedging. The apex can be high or mid thoracic or even at the thoracolumbar junction (where the chest meets the lower spine) – which is normally straight. Similar to scoliosis, assessment should be performed by a paediatric spine surgeon to best understand what is likely to happen to the curve over time. This will allow planning, management of the problem, and rule out any other possible issues. These patients are more likely to have back pain than the normal population. This is because they have altered mechanics and hamstring tightness, and a higher observed rate of pars defects (a crack in the bony arch at the back of the spinal vertebrae).
Treatment:
- The vast majority of kyphotic curves of the spine do not need surgical treatment.
- Bracing is a good option in the growing spine. This is in addition to physiotherapy and exercise programs. It does not work in all cases.
- Surgery is reserved for significant curves. This is generally in patients with pronounced concerns about their appearance, those at risk of progression over their life, and those where the kyphosis could lead to major ongoing problems if not addressed.