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View Full Version : Difference between Thoracic & Rigid kyphosis?


Seeking_help
11th September 2007, 02:53 AM
Hi all,

While doing some research I've noted a few resources citing the threshold for surgery for kyphosis as

Thoracic kyphosis > 75 degrees
Rigid kyphosis > 55 degrees

What is the difference?

Thanks!

titch
11th September 2007, 10:34 AM
How my dear little son manages so often to click the exact keys required to change page abruptly and lose replies when mashing my keyboard, I really do not know, so anyway - attempt no 2 :P

I'm sure all that is meant when referring to rigid kyphosis is the degree of flexibility. For example, a Scheuermann's curve (which commonly have their apex around the T8/T8 region as I recall) will be naturally less flexible, certainly at it's apex, than a round-back type kyphosis where the curve is smoother.

A more flexible curve is likely to be easier for the body to deal with and compensate for, but also as is known with scoliosis, the greater the rigidity, the poorer the correction - so to that extent, earlier intervention with a rigid kyphosis is probably a good idea as they prefer to do simpler surgeries where possible, and the smaller the curve and the greater it's flexibility the higher the chances are that they can get a good correction with a posterior only approach. That said, you'll still need a surgeon who actually believes in the worth of operating for kyphosis, as there's still too many out there who just aren't interested and will try to dismiss saying that it'll never progress. (On a tangent, thinking about how often people with scoliosis who are only diagnosed or seek treatment once they've already stopped growing are pretty much dismissed and told nothing can be done, cosmetic only, it won't progress, I do wonder whether this is a similar thing with the kyphosis, as anecdotally it seems to me that people with kyphosis are typically much older before they first see a surgeon, so perhaps they're handing out a standard sentence based on age rather than really looking, regardless of what curve type? Don't really know, this is just a bit of thinking aloud here.)

Seeking_help
11th September 2007, 04:58 PM
http://www.spineuniverse.com/displaygraphi...manns_11-BB.jpg (http://www.spineuniverse.com/displaygraphic.php/3403/bridwell_scheuermanns_11-BB.jpg)

http://www.pediatric-orthopedics.com/Treat...hosis/LK_20.jpg (http://www.pediatric-orthopedics.com/Treatments/Kyphosis_Lordosis/Kyphosis/LK_20.jpg)

The first link I've posted is a picture of sheuermanns Kyphosis (notice the nice rounding of the spine) and the second picture is regular kyphosis (more of a sharp prudrudence).

So the first (sheuermanns kyphosis) is an example of rigid kyhosis and the the second (regular kyphosis) would be considered Thoracic kyphosis?


And to address your side tracking - the average age of kyphosis surgery seems to be higher than scoliosis (from anecdotal evidence from online forums) but I think this can probably be explained by:

1. The number of ppl with kyphosis is much smaller than scoliosis therefore its hard to gauge the actual stats based on the few who do post

2. Kyphosis seems to be a problem more easily "covered" up with clothing, etc - sort of out of sight out of mind

3. The level of advancement in spinal fusion technology and procedures has jumped significantly even within the last 10-15 years. I assume most of these patients were told 30yrs ago that surgery wasn't available because it was legitimately too risky. Even 15 years ago a common practice was the harrington rod which did not have the same level of correction now available with segmental instrumentation.

From the looks of it (based on anecdotal evidence of course) that younger people are having surgery now as they seem to be more informed (thanks to boards like this!!).

Just thinking aloud as well :)

Seeking_help
11th September 2007, 05:03 PM
Sorry - almost forgot to add - I think the biggest problem in early recognition and action is the sometimes appauling lack of knowledge shown by General Practioners (Family doctors). They really are the first line of defence. I've probably had kyphosis since I was 13 - my parents always noticed my back wasn't straight. I went into see my GP who said I needed more exercise! That was that. Fast forward 11 years and I see a different, younger GP. She says that surgery past the age of 13-15 is impossible and no correction can be given and was very reluctant to send me off for x-rays.

I know there are a lot more stories like this out there. People get turned away by inept GP's and then figure out they need surgery 30 years later because the curve has increased significantly and so has the pain and medical complications.

Thats my venting for the day :spin:

titch
11th September 2007, 11:17 PM
Whether the kyphosis is thoracic or not refers only to it's location and nothing else - the rigidity of the curvature is a different matter.

The second image that you've linked there, is actually anything but a standard kyphosis - it's actually one form of gibbus deformity (ETA that it is not thoracic either, it's marked on the scan as being the L1 vertebra) which is a specific form of fixed structural kyphosis that is very sharply angled. This particular instance is the kind of curve that they're most likely to have to do a vertebrectomy (complete removal of the affected vertebra) for in order to get good correction.

Scheuermann's kyphosis is related in that there are 3 (or more? - need to check that) adjacent vertebrae which are wedge shaped - the wedging is of at least 5 degrees on each affected vertebra - you can actually see the wedging on the xray linked above at the apex which is diagonally above the degree label, and if you imagine them squared off, you can see how much this would reduce the kyphosis immediately. The differences between this and the gibbus deformity shown above is that Scheuermann's affects more than one vertebra, and develops as you grow, whereas the gibbus deformity - at least of the type shown above - is typically congenital.

Because Scheuermann's kyphosis is also a structural deformity with wedging of the vertebrae, it's likely to be somewhat rigid than a kyphosis that does not have the same kind of vertebral wedging. That said, if the wedging is not severe, and the spine is otherwise flexible so that a lot of the apparent kyphosis is functional ie just in response to the affected vertebrae, a Scheuermann's curve may be relatively flexible overall, so I think with Scheuermann's a lot does come down to the individual. The curve can be quite smoothed and rounded because of the adjacent parts of the spine joining in to maintain balance - the spine prefers to be in a single long, smooth curve than to have a sharper, shorter curve that it straightens out again a bit at either end of. I suspect that with a lower apex it would be more likely that you would straighten up above it rather than continue into the curve (not sure that description makes sense - it's late!! Anyway - my 34 kyphosis, which had advanced to around 45-50 was fixed T10-L2 and apexed at T12, so there was a lot of spine above it to try to compensate - even so, if I'd spent much more time like it I'd have ended up completely bent double at the waist as the upper portion of my spine became unable to attempt to compensate, something that was starting to happen by the time I got to my revision surgery - perhaps that helps explain what I mean?)

Other forms such as hyperkyphosis are due to things such as osteoporosis or arthritis, and will tend to represent a smoother curve. http://www.spineuniverse.com/displayarticl...rticle1437.html (http://www.spineuniverse.com/displayarticle.php/article1437.html) is a good overview article in terms of types of kyphosis.

Hope that doesn't read like too much gibberish, as I've got to get off now. I agree with your complaint about GPs and local orthos should be added to that list! Like with so many things, if you get someone with an interest in the first place, and then sent to a genuine specialist, it's a different matter. Still, as you say, things are changing, not least because there is so much excellent information out there these days :-)

Seeking_help
12th September 2007, 05:30 PM
lol - you truly are an encyclopedia!

Thanks!

Jennycat
12th September 2007, 08:03 PM
I have posted here in the past (not very often). My 15 month old son has a hemi-vertebra in his L2. His curve is at 45 degrees. I thank those who have posted as it has given me some answers to questions I have.

We have seen a pediatric orthopedic surgeon who said he will just be monitoring Wesley at this point and if his curve reached 60 degrees he would first try bracing. He pushed in on his back and said that he had lots of room for movement and that was a good sign.

We go to get Wesley's heart and kidneys checked at the end of the month just to be sure that they were not affected in utero.

titch
13th September 2007, 09:42 PM
Fingers crossed on the heart and kidneys, although I would suspect that you'd know by now if there was a serious issue with either.

Out of curiousity (and sorry if you've said in another thread) who is your surgeon? I'm just wondering if it would be worth trying to see a Shriners doc - Randall Betz I think is at the Philadelphia Shriners and performs VEPTR surgery. It's similar to a growth rod, but can be particularly useful in some cases of infantile and juvenile scoliosis, especially some congenital cases. It could be worth trying to pursue a consult even if only to get a second opinion.

Please let us know how the check up goes!

Jennycat
15th September 2007, 03:23 PM
We are in Canada, We have a been referred to a very reputable Pediatric orthopedic surgeon who specializes in this area. I hope all goes well with the other two tests, I just keep telling myself that we would probably know by noe if there were any major issues with his heart and kidneys.

I'll keep you all posted