kyphosis (hyperkyphosis, Dowager's hump)

Introduction

A deformity of the spine characterized by extensive flexion (hump back).

Etiology

• vertebral fractures (37%) <osteoporosis>
• postural changes
  • cervical lordosis & lumbar lordosis
  • inability to correct posture to an erect stance
• degenerative disk disease
• muscle weakness, back muscles & muscles of upper extremities
• loss of intervertebral ligament elasticity
• genetic factors

Epidemiology

• affects 20-40% elderly

Diagnostic procedures

• pulmonary function test to evaluate dyspnea

Radiology

• bone mineral density (DEXA) with vertebral fracture assessment
• radiography of lumbar spine & thoracic spine to assess for vertebral fracture
  • pathologic fracture makes diagnosis of osteoporosis

Complications

• impaired pulmonary function
  • restrictive lung disease
    • decreases mobility of the chest wall & restricts lung expansion
• diminished physical function
• falls in the elderly
• fractures, associated with osteoporosis
• increased mortality

Management

• treat osteoporosis
  • hormone replacement therapy may prevent age-related hyperkyphosis
• spinal orthoses
• back strengthening exercises
• kyphoplasty & vertebroplasty may help painful fractures & improve function
• non-invasive positive pressure ventilation
  • BiPAP for atelectasis from hypoventilation due chest wall restriction from kyphosis

More general terms

• abnormal curvature of the spine

More specific terms

• kyphoscoliosis

Additional terms

• scoliosis