HYPERKYPHOSIS: GENERAL VIEW

Hyperkyphosis is a deformity characterized by an increase of kyphosis, sometimes associated with cervical or lumbar hyperlordosis. The physiological value of thoracic kyphosis in children is between 20–25 and 40–45 Cobb degrees. Below 20–25 Cobb degrees it is defined ‘‘Flatback Syndrome’’, while above the 45–50 Cobb degrees it is defined Thoracic Hyperkyphosis. The hyperkyphotic attitude is a paramorphism, not associated with skeletal abnormalities; it is due to a patient’s incorrect posture which depends on weakness of the erector muscles of the spine, which results in muscular and ligamentous imbalance. Moreover, there are also important neuromotor difficulties in postural control and, quite often, a psychological attitude of introversion. The hyperkyphotic attitude is self-correctable, associated with a scapular sliding forward. If untreated, it could affect normal bone growth. The Hyperkyphosis are classified into: congenital and acquired. Congenital kyphosis can result in infants whose spinal column has not developed correctly in the womb. Vertebrae may be malformed or fused together and can cause further progressive kyphosis as the child develops. The acquired ones include: idiopathic kyphosis, traumatic kyphosis, infective kyphosis (Pott’s disease, spondylodiscitis from SA), inflammatory kyphosis (ankylosing spondylitis), kyphosis associated with metabolic diseases (osteoporosis, osteomalacia, or mucopolysaccharidosis), kyphosis associated with myopathy, kyphosis associated with genetic dystrophies, neuropathic kyphosis (polio or encephalopathy). Scheuermann’s Disease or Juvenile Osteochondrosis of the Spine, is a self-limiting skeletal disorder of childhood; it affects the anterior part of the vertebral body with alterations of the cartilage matrix, thickening of the anterior longitudinal ligament and ossification of the ligamentum flavum and posterior longitudinal ligament. This structural deformity is classically characterized by anterior wedging of 5 degrees or more of three adjacent thoracic vertebral bodies at the apex of the kyphotic curve, thinning of the intervertebral discs and the possible presence of Schmorl’s hernias. According to Wenger and Frick, the incidence of Scheuermann’s Disease has been estimated between 1 and 8 % of the world population. The typical presentation is between 8 and 12 years old, with the most severe event between 12 and 16 years old. The Hyperkyphosis in the elderly increases the risk of developing fractures and it is associated with impairment of physical performance and quality of life. The gold standard for diagnosis of hyperkyphosis are the clinical and radiographic evaluations using the Cobb method (T2–T12) read on radiographs, performed in standing and lateral projection. Orthopaedic treatment of kyphosis includes physiotherapy, the use of plaster or body braces; the type of treatment is established depending on the severity of kyphosis. In case of hyperkyphotic attitude, with elastic and reducible curves between 45 and 50 Cobb degrees, the treatment is based on appropriate physiotherapy and sports. In case of mild hyperkyphosis, until 60 Cobb, not much reversible, semi-rigid, with or not partial bone deformity, the protocol provides a treatment with orthopaedic braces (antigravity Boston, antigravity Lyonnais, Milwaukee). In case of hyperkyphosis, with an over 65 Cobb curvature, the treatment will be with plaster brace, followed by an orthopedic brace. With a severe hyperkyphosis, over 75–80 Cobb, surgery represents the only effective therapy in childhood.