What is Kyphoscoliosis?
Kyphoscoliosis is a musculoskeletal disorder, which is a combination of kyphosis and scoliosis where there is abnormal posterior and sideways curvature of the spine in both the coronal as well as the sagittal planes. Kyphoscoliosis commonly causes other problems, such as pulmonary hypertension, under-ventilation of lungs, psychological problems, such as anxiety, difficulty in doing activities of daily living. Kyphoscoliosis can also occur in other medical conditions, such as Friedreich's ataxia, syringomyelia and Duchenne muscular dystrophy because of asymmetric weakening in the paraspinal muscles. Kyphoscoliosis occurring during the growth period without any obvious cause is termed as Idiopathic Kyphoscoliosis. Diseases of the spinal muscles and vertebrae can also cause Kyphoscoliosis.
Treatment of Kyphoscoliosis comprises of exercises, physical therapy, special braces and surgical correction in severe cases. Kyphoscoliosis is also referred as scoliokyphosis in some cases.
As Kyphoscoliosis is a combination of Kyphosis and Scoliosis, a brief description on both the conditions is given below:
Kyphosis is referred to abnormal convex spinal curvature in the thoracic as well as the sacral regions. The thoracic curvature is between 20 degrees to 45 degrees. If this curvature increases more than 45 degrees, then it is known as kyphosis. Depending on the degree or severity of the curvature, kyphosis can cause problems, such as difficulties in breathing and digestion, cardiovascular problems and neurological deformities. If curvature of the kyphosis is severe, then it needs surgery to correct and align the spine.
Types of Kyphosis
There are different types of kyphosis, such as postural kyphosis, which occurs due to slouching. Correcting the muscular imbalances helps in reversing such type of kyphosis up to some extent. Scheuermann’s kyphosis is a more debilitating type of kyphosis which is seen more often in adolescents.
Causes of Kyphosis
Some of the other causes of Kyphosis include nutritional deficiencies, congenital, post-traumatic and osteoporosis induced.
Treatment of Kyphosis
Treatment of kyphosis depends on the severity of the curvature, patient’s age and general health and comprises of physiotherapy, braces and in extremely severe kyphosis, surgery is required.
Scoliosis is a condition where there is lateral curvature or bending of the spine due to which the patient’s spine resembles a “C” or “S” shape. Human spine is normally straight, but in scoliosis, there can be a curvature of about 10 degrees in either direction. Treatment of scoliosis is similar to Kyphosis and includes physical therapy, bracing and surgery.
Signs & Symptoms of Kyphoscoliosis
- In some mild cases of Kyphoscoliosis, patients can be asymptomatic.
- Patient suffering from Kyphoscoliosis has an abnormal hunch or he/she slouches. The spine is shaped like the alphabet S or C.
- The length of the arms and legs is not same and is uneven.
- Kyphoscoliosis patient has other associated health problems, such as neurological disorders and hypertension.
- Patient walks with an abnormal gait.
- Patient also suffers from back pain.
- Due to the deformity of kyphoscoliosis, there is shortening of the patient’s height.
- There is impairment in the movements of the chest wall. There are signs of stiffness in the chest wall along with restriction in the lung volumes.
- There is increased dead space ventilation and small tidal volumes, due to which the patient also suffers from hypoventilation.
- Significant distortion of thorax and spine can be seen on chest radiographs.
- There is V/Q mismatch, which causes significant hypoxia and can further lead to symptoms of cor pulmonale.
- There are changes in the position of the mediastinum due to which there is increase in the regional changes in breath sounds, which can be heard during a physical exam.
- Pulmonary function tests show a restrictive defect.
Causes of Kyphoscoliosis
Kyphoscoliosis Caused due to Congenital Abnormalities: Kyphoscoliosis can occur from various causes in a patient in different stages of his/her life. Kyphoscoliosis can be present from birth itself from congenital defects, such as spina bifida.
Kyphoscoliosis Caused due to Infections: There are certain infections, such as general tuberculosis or vertebral tuberculosis, which can also lead to development of Kyphoscoliosis.
Kyphoscoliosis Caused due to Abnormal Posture: Sometimes, a person can also develop Kyphoscoliosis due to bad posture or due to slouching for prolonged periods of time. This causes abnormal curvature of the spine.
Kyphoscoliosis Caused due to Chronic Degenerative Diseases: Patients can also develop Kyphoscoliosis in later part of their life from chronic degenerative diseases, such as osteoarthritis and osteoporosis. Individuals who are above the age of 50 are at a greater risk for developing these types of conditions, which occur primarily due to structural changes in the spine and the adjacent tissues.
Kyphoscoliosis Caused due to Bone Disorders: Bone and cartilage disorders, such as osteochondrodysplasia can also cause kyphoscoliosis.
Kyphoscoliosis Caused due to Injury: In some cases, a traumatic injury to the spine or the back can also lead to development of Kyphoscoliosis.
Kyphoscoliosis due to Unknown Causes: In some cases, Kyphoscoliosis occurs due to idiopathic reasons where the exact cause of its development is not known. It is thought to develop as a result of genetic factors. In such cases, it is known as Idiopathic Kyphoscoliosis.
Treatment of Kyphoscoliosis
Treatment of Kyphoscoliosis comprises of the following:
Physical Therapy Treatment for Kyphoscoliosis: Physical therapy can be done where the spinal curvature of kyphoscoliosis is mild, i.e. if it is less than 50 to 55 degrees of kyphosis and if it is less than 30 degrees of scoliosis with the underlying cause of bad posture. In such cases, physical therapy is beneficial and is the first line of treatment for Kyphoscoliosis. Physical therapy for Kyphoscoliosis can also be done for other causes to prevent further development of abnormal spinal curvatures, which can occur in elderly patients who are suffering from degenerative disease of cartilage and bones. The aim of physical therapy is strengthening the spinal tissues to correct the curvature of the spine as much as possible and also to prevent further damage to the spine.
Braces for Kyphoscoliosis: Back braces can be used and are beneficial for treating kyphoscoliosis where the underlying cause of the deformity is bad posture, which is detected before the initiation of the growth phase of the bones. Braces help by supporting the muscles and bones, along with applying corrective pressure to the spine, which helps in reducing the abnormal curvature of Kyphoscoliosis. The braces which are used for Kyphoscoliosis need to be custom designed so that it is effective in both the abnormal curvatures present in coronal as well as sagittal plane (i.e. both scoliosis and kyphosis). The use of CAD/CAM is done these days in designing the braces for Kyphoscoliosis. This is available only in certain developed countries. It is important to maintain daily compliance with the wearing of braces for the period recommended by the doctor. In some cases, back braces can become psychologically and physiologically limiting, particularly in teenagers.
Surgical Treatment for Kyphoscoliosis
Kyphoscoliosis means that the patient is suffering from both types of curvature deformities, which are scoliosis and kyphosis. The selected treatment option depends on various factors such as patient’s age, the underlying cause of Kyphoscoliosis (congenital, postural) and the risks which are involved in surgery. Surgery needs to be done in severe cases of Kyphoscoliosis where the extent of deformity is large resulting in hindrance with physiological functions, such as digestion and breathing along with disturbing day-to-day activities of the patient. Surgery is also considered for Kyphoscoliosis if other treatment options are not beneficial and the deformity is cosmetically unacceptable to the patient. Surgery is also done if the patient is at such an age where other treatment options, such as braces and physical therapy does not prove to be effective.
Spinal surgery becomes mandatory in conditions where the deformity of Kyphoscoliosis starts to interfere with important physiological functions, such as breathing which causes extreme difficulty in performing daily activities. In some cases, patients who are in their early adulthood decide to get surgery done for treating this condition as the presence of this type of deformity causes social issues like acceptability among their peers and if this disability interferes with their work.
Schroth method of physical therapy is a standard treatment for kyphoscoliosis, which is practiced in Germany. This treatment is also used for scoliosis and kyphosis.
Surgical correction of kyphoscoliosis is done by fixing the spine to halt the progression of this deformity. Surgical correction comprises of use of spinal implants, such as VEPTR or the Harrington Rod. Some patients who have significant hypoxemia need oxygen on a long term basis.
In elderly patients where this deformity is triggered at a later stage, surgery is decided based upon factors such as underlying cause, the progress of Kyphoscoliosis, and if other conservative methods for treating it, such as physiotherapy, braces and medicines, are not giving relief from Kyphoscoliosis and its associated pain .
Risks of Corrective Spinal Surgery
Any type of surgery carries risks, and risks for corrective spinal surgery for kyphoscoliosis are no different. The decision to have corrective spinal surgery for kyphoscoliosis becomes inevitable when the patient’s quality of life is affected to an extent where the potential benefits of the surgery outweigh its risks. Patient should discuss with his/her doctor regarding the risks of the surgery for a successful outcome by carefully assessing factors like the experience and skill of the surgical team, the techniques which are used for spinal surgery and previous statistics of outcomes of such type of surgery.
The success rates of spinal surgeries have increased a lot lately and risks factors of spinal surgery are almost the same as other types of surgeries. The success rate in spinal surgeries is also more in patients who are of younger age than patients who are at an elderly age.