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kyphosis/ hump
Curvatures in the anterior-posterior axis of the spine are called kyphosis (popularly humpback). This situation disrupts the sagittal balance, which has become more important recently. Sagittal balance is the harmony of cervical lordosis, thoracic kyphosis and lumbar lordosis, which form the normal spinal alignment in the person. If it is in harmony, the vertical line drawn from the middle of the cervical 7th vertebra is expected to end in the sacral promotorium. It is essential to ensure this balance in the treatment.
This curvature of the spine can cause various complaints such as difficulty in breathing, fatigue, back pain, hump appearance, tenderness and stiffness. Due to the curvature, lung capacity decreases, it can cause severe pain, it can show serious neurological findings including decreased muscle strength and even paralysis. But the most well-known among them is the humpback deformity.
We can evaluate kyphosis in 3 main types.
Postural Kyphosis
It is the most common type of kyphosis. It is more common in girls and adolescents. It is characterized by poor posture, muscle and ligament weaknesses. It gets progressively worse. Muscle aches and fatigue can be observed.
Scheuermann's Kyphosis
It is a rigid type of kyphosis of late childhood characterized by wedging of the vertebral body. Flexibility-lateral extension graphy is valuable in the diagnosis. End-plate irregularities, Schmorls nodules, and disc space narrowing can be seen on the radiograph. 3 consecutive vertebrae (Sorenson) that wedge at least 5 degrees; In immature children with kyphosis (Bradford) above 45 degrees, in which at least 1 vertebra can wedge more than 5 degrees, the diagnosis is made in line with the common opinion of physicians in the measurement of wedging. It can also be seen in adolescents with a normal kyphosis angle.
Congenital Kyphosis
It is the least common type of abnormal kyphosis. It develops due to congenital abnormal development of vertebra such as formation defect type 1, hemivertebra, butterfly vertebra, wedge vertebra, segmentation defect type 2, mixed type 3.
Kyphosis may develop due to various reasons such as these 3 main types of external endocrine disorders, ankylosing spondylitis, trauma, connective tissue disorders, infection (tuberculosis, Potts disease), muscular dystrophy, polymyelitis, spina bifida, and tumor.
Diagnosis
AP lateral direct radiograph (occiput-femoral head standing); dynamic radiography flexion-extension neutral lateral radiography; BT-3D reformat; Various radiological imaging techniques such as MRI (tensioned cord, cavity, disc compression) can be used. These images are also interpreted with various techniques such as the pelvic radius technique, the Duval-Beaupere method, and the Roussouly tangential circle method.
Treatment
Conservative treatments such as exercise (especially swimming is recommended), corset treatment and intercostal block injection for pain can be mentioned. However, as a result of progressive neurological damage, progressive deformity, pain that does not go away with conservative techniques, thoracic curves above 40 degrees, thoracolumbar curves above 65 degrees and cardiopulmonary problems, surgical treatment, which is the only way to correct this deformity, may be necessary.
Rod
Smith Peterson Osteotomisi
Ponte Osteotomisi
Rod
Surgical
It has been reported that following the posterior approach in the surgery to be performed shortens the surgical time, reduces blood loss, accelerates wound healing, and neurologic recovery is relatively higher. In surgery, deformity should be selected among various techniques such as rod reduction and fixation (degenerative kyphosis and Scheuermann kyphosis), Smith-Petersen osteotomy (ankylosing spondylitis kyphosis) and Ponte osteotomy (Scheuermann kyphosis). With the right surgery, reduction in pain, neurological improvement, and reduction of deformity are expected.
In addition to all these treatments, it should not be forgotten that the prevention of kyphosis is easier than its treatment. In this respect, it is of great importance to inform families who are raising children.