Causes, symptoms and treatment methods for kyphosis of the thoracic spine. Kyphosis of the thoracic spine - how to treat

Kyphosis refers to both pathological and physiological curvature of the spine in the anteroposterior direction. Physiological kyphosis is determined in all people in the thoracic spine. Pathology is indicated in cases where the bending angle is 45 degrees or more.

More details about what this disease is, why it occurs in people and how to treat it are further in the article.

What is kyphosis?

Kyphosis is a bend spinal column posteriorly Normally, the adult spine has two such curves: in the thoracic and sacral regions, in contrast to which there are also two anterior curves: in the cervical and lumbar spine. This structure provides the best shock-absorbing qualities and reduces the load on each individual vertebra and intervertebral disc.

The area of ​​the back (spine) in which curvature occurs during kyphosis is most often the thoracic region, which is why this disease is also often called “thoracic kyphosis” or “thoracic kyphosis.” However, the medical literature describes cases where the curvature of the back occurred in the neck and lower back (sacrum).

Physiological sacral and thoracic kyphosis are formed in early childhood, while in adults the curves of the spinal column are fixed. In the elderly, as well as old age There is an increase in thoracic kyphosis.

Quite often kyphosis develops in a mixed form, in this variant of its manifestation it is called kyphoscoliosis. This form of the disease is quite rare; it simultaneously combines signs of a pathological process that are relevant for kyphosis and signs of scoliosis.

Kinds

Kyphosis manifests itself in different ways - from a barely noticeable stoop to a pronounced hump. Curvatures can be observed in various parts of the thoracic region - cervicothoracic, upper thoracic, thoracolumbar.

By form:

1. Angular kyphosis (kyphosis angularis), or hump. Characterized by an angular convexity of the back, with the apex backwards.
2. Arc kyphosis. It is characterized by a convexity of the back in the form of a short or long arc.
3. Physiological kyphosis(kyphosis physiologica). Typically a stage of spinal development. It is characterized by a slight tilt of the spine - up to 30 degrees. It can be present in the thoracic region up to 7 years, in the lumbar region (sacrum) - until puberty.

Functional thoracic kyphosis

This type of pathology is also called common stoop. Most often it occurs due to weak back muscles, constant stooping, excessive physical exertion, and improper body position while working at a desk. If you place such a patient on a flat surface, the bend will disappear on its own.

When performing fluoroscopy, no changes in the vertebrae will be noted in the images. To treat this type of disease, conservative treatment, primarily aimed at strengthening the muscles, is sufficient.

Dorsal juvenile kyphosis (Scheuermann-Mau disease)

Scheuermann-Mau disease develops in adolescence predominantly in boys, and is expressed in the formation of wedge-shaped vertebrae in the lower thoracic or upper lumbar spine and changes in the ligamentous apparatus

Congenital kyphosis

It's conditioned genetic mutation and inherited defect in the development of vertebral bodies (anterior sections)

Paralytic kyphosis

Paralytic kyphosis is caused by diseases accompanied by paresis and paralysis of the back muscles (poliomyelitis, etc.). With cerebral palsy, there is an increase in thoracic kyphosis and an increase in its length (the bend extends to top part lumbar region). Kyphosis can be combined with scoliosis. Characteristic is a gradual progression of the deformity. Treatment is usually conservative, complex, and long-term.

Rachitic

Develops in children with rickets starting from the sixth month of life. However, rachitic kyphosis often develops in older children or adolescents who suffered from rickets in early childhood.

Post-traumatic kyphosis

The cause of the development of the disease is previous injury to the spine. The progression of the disease further causes compression in the spinal column nerve structures. When the spine is fractured in the thoracic or lumbar region, kyphosis of one degree or another develops; based on the severity of the injury, the appropriate treatment is determined, which, in turn, can be either conservative or surgical.

Postoperative

It develops infrequently after operations on the spinal column due to trauma, anterior displacement of the vertebra due to congenital non-fusion of the vertebral arch with its body (spondylolisthesis), replacement of the intervertebral disc, and others.

Senile (degenerative) kyphosis

This type of curvature is caused by degenerative changes in the vertebral bodies and intervertebral discs, which are accompanied by the so-called “subsidence of the spine”, as well as weakening of its ligamentous apparatus

Causes

Kyphosis can occur in both children and adults, as well as the elderly. And in each case, different reasons lead to it, therefore, depending on them, several main types of kyphosis are distinguished.

Statistics indicate that up to 10% of people worldwide live with kyphosis of varying severity. Male children and adolescents are more susceptible to it.

There are many reasons that can cause kyphosis. Acquired curvature of the thoracic spine can result from:

• Operations performed on the spinal column or accompanied by opening of the chest.
• Spinal injuries, especially with vertebral fractures.
• Degenerative changes, most often - intervertebral disc herniation, as well as spondylosis.
• Age-related disorders occurring in the vertebrae and intervertebral discs.
• Partial paralysis of the back muscles, weak muscle corset.
• Pathological changes in the ligamentous apparatus.
• Poor posture, passive lifestyle.
• suffered in infancy.
• Tuberculosis of bones.

Taking into account the angle of curvature, normal, increased (with an increased angle) and straightened (with a reduced angle) kyphosis are distinguished.

Thoracic kyphosis is most widespread. It can be considered pathological if the curvature exceeds 31 degrees. Depending on the severity of the bend, there are 4 degrees of thoracic kyphosis:

True kyphosis should be distinguished from kyphotic posture associated with muscle weakness. With it, lying on your stomach on a hard surface, your back is leveled.

Kyphosis may also differ in the progression of the deforming process. Thus, when the inclination increases to 7 degrees per year, they speak of a slowly progressive form of kyphosis. Accordingly, with rapidly progressing kyphosis pathological change the angle of inclination ranges from 7 degrees or more per year.

Symptoms of kyphosis of the thoracic spine

In the vast majority of cases, kyphosis is diagnosed in childhood or adolescence, during the formation of the spine. The following external symptoms are noteworthy:

• bent back,
• sunken chest
• protruding belly
• retracted shoulders and separated shoulder blades.

But the problems are not limited to just the aesthetic side. Although the deterioration of appearance in itself is a serious psychological trauma, especially for children and adolescents.

Due to the formation of a hump, a person experiences the following symptoms:

• pain in the heart (a person may mistake such pain for a manifestation of cardiovascular pathologies);
• breathing problems, shortness of breath with little physical exertion and even at rest;
• various manifestations of disorders of the digestive tract.

Pain with kyphosis is observed in most cases. The pain syndrome is caused by strong tension in the back muscles, as well as compression internal organs and partial destruction of intervertebral discs.

With kyphosis, the vertical axis of the body shifts, and with it the center of gravity. An excessive load is created on the feet, and as a result, it is formed.

In young children, the culprits of kyphosis of the thoracic spine are bone tuberculosis and rickets. The risk of developing the disease increases during adolescence, and boys are especially susceptible to it. In young people under 30 years of age, disorders can develop as a result of engaging in heavy types of work and often being in the wrong position. In old age, it most often affects women.

Complications

It is a mistake to think that such a disease is not dangerous. If left untreated, pressure on the spine increases, causing osteochondrosis and intervertebral disc herniation. In addition, a hump gradually forms.

Due to excessive pathological curvature of the spine, it appears Negative influence on the spine itself, as well as on all nearby organs. This reduces the volume of the chest and, as a consequence, maximum capacity lungs. As a result of such changes, blood circulation and oxygen saturation of tissues are impaired. It also has a negative impact on the heart and leads to dysfunction. of cardio-vascular system.

With severe curvature of the spine, the following diseases develop:

• liver inflammation;
• inflammation of the large and small intestines, sometimes obstruction;
• cardiovascular failure;
• cerebral circulatory disorders.

Diagnostics

Diagnosis of kyphosis of the thoracic spine is the responsibility of an orthopedic doctor.

1. First, the patient is interviewed, after which the doctor examines him. It is important to clarify the characteristics of pain, their localization, and the presence of neurological disorders.
2. During the examination, the orthopedist palpates the neck and back, checks muscle strength and skin sensitivity.
3. In addition, the doctor listens heartbeat and lungs, evaluates tendon reflexes using a specialized battery of tests.

Not only the main manifestations of the disease, but also the treatment tactics depend on the degree of kyphotic curvature pathological condition. Therefore, before treating kyphosis of the thoracic spine, the doctor will necessarily refer the patient for an X-ray examination of the spinal column, computed tomography or MRI.

Additional instrumental studies necessary to determine the degree of kyphosis and identify associated pathologies. These include:

• X-ray of the affected part of the spine in two projections. The doctor determines the degree of kyphotic deformity on a lateral radiograph by calculating the angle of inclination of the spine;
• MRI, CT – are indicated for more detailed diagnostics; they visualize the bone structure of the vertebrae, intervertebral discs, and ligaments;
• angiography (vascular examination) – relevant for cervical kyphosis.

How to independently identify thoracic kyphosis?

There are several tests you can do to diagnose thoracic kyphosis yourself and to seek treatment.

1. Stand with your back to the wall and lean on it, try to reach the back of your head to the surface without moving your head back. If you have a disease, this will be difficult to accomplish.
2. Bend forward towards the floor and look at your curve in the mirror. If there is deformation, the ridge will not fully straighten.

How to treat thoracic kyphosis?

Treatment of kyphosis begins with a mandatory visit to the doctor and a thorough diagnosis of the disease, after which an individual course of therapy is prescribed:

• Manual therapy;
• Therapeutic gymnastics (therapeutic exercises);
• Wearing posture correcting devices;
• Physiotherapy;
• Symptomatic treatment;
• Surgical treatment (operation);
• Spa treatment.

In case of severe pain, the use of various groups analgesics, more often non-steroidal anti-inflammatory drugs (ketorol, etc.), which can not only get rid of obsessive pain, but also reduce inflammatory damage. These drugs are indicated to be taken as prescribed by the doctor daily, and not during painful attacks. manual therapy

Manual therapy (massage)

Severe curvature of the spinal column should be treated using manual therapy and massage. The osteopathic doctor presses on certain areas of the back, thereby helping the vertebrae fall into place. The basis of manual therapy is the application of a certain pressure to a specific area of ​​the motion segment.

This treatment method relieves tension from muscles and nerves. Kyphosis of the thoracic spine requires manual procedures every 3-4 days. Thanks to therapeutic massage, blood flow is activated and muscle tone increases.

Treatment of kyphosis with exercise therapy

Before correcting kyphosis of the thoracic spine, the doctor prescribes a set of diagnostic measures to the patient aimed at determining the degree of the disease and assessing the condition of the vertebrae, the presence of hernias, etc. If a person is diagnosed with a first or second degree curvature, then exercises for kyphosis of the thoracic spine are indicated for him.

Their essence is to strengthen the muscular corset of the back, restore normal blood supply to the damaged area and increase the mobility of the vertebral joints.

Exercises:

1. Press your palms and chest against the wall, bend your back as far as possible. Stand in this position for 3-4 minutes daily.
2. Turn your back to the wall, throw your arm back above your head and rest it. Keep your back in an arched position for 30-40 seconds, then change your hand and repeat the exercise for kyphosis.
3. Lie on your stomach, touch your shoulders with your hands. Next, while inhaling, try to throw your head back while simultaneously lifting your chest. Try to rise as high as possible. Exhaling, return to a lying position.
4. Feet shoulder width apart. We place the stick behind the back, pressing it against the shoulder blades. Inhaling, we raise the stick up, throwing our head back. Exhaling, we return to the starting position.

Wearing cores

For an adult with kyphosis, a corset will help prevent the development of pathology, but it is not capable of straightening an already formed spine. In childhood, the basis of the skeleton is subject to changes due to its cartilaginous structure, so wearing a corset will help completely correct the deformity.

Corsets are used for fixation different departments spinal column: lumbar, sacral, thoracic or cervical.

Corset tasks:

• formation correct posture
• maintaining the spine physiologically correct position during curvature
• fixation of the spine after surgical interventions or injuries, in the presence of a herniated disc and other diseases

Rules for wearing a corset:

• no more than six hours a day
• must be removed at night
• do not tighten too tightly, as local blood circulation is impaired
• put on if necessary: ​​execution physical work, travel in transport and so on
• wear over underwear so that the corset details do not rub the skin

Spine surgery for thoracic kyphosis

Indications for surgical intervention are:

• Persistent pain syndrome, which cannot be eliminated by conservative methods.
• Rapid progression of kyphosis, especially accompanied by neurological disorders, as well as impaired lung and heart function.
• A cosmetic defect that significantly reduces the patient’s quality of life and interferes with the performance of professional duties.

The task facing the surgeon is to correct the angle of the spinal column and stop the progression of the disease. It is important to eliminate pinching of the nerve endings, as well as to prevent their compression in the future.

The surgical intervention is carried out in two stages: first, the surgeon eliminates the defect, and then corrects the spine using a metal structure. The transpedicular structure consists of rods and screws. The surgeon always weighs the risk surgical complications and the benefit of the intervention.

Lifestyle after surgery

After completion surgical correction spine, the patient gradually returns to normal life, following all the doctor’s instructions:

• exercise therapy complexes that differ in load intensity in the postoperative and late recovery periods;
• massage, physiotherapy;
• elimination of unfavorable factors influencing the formation of incorrect posture;
• swimming lessons, ball games;
• skiing, walking;
• good sleep, nutrition.

Prevention

It is possible to prevent the development of the disease! To do this, just follow some recommendations:

1. Treat in time infectious diseases, treat chronic diseases, pay attention to the spine.
2. Sleep on a hard mattress and a comfortable pillow.
3. Properly organize your workspace to ensure correct posture throughout the day.
4. Fight excess weight, avoid overeating.
5. Lead a healthy and active lifestyle. During sports activities, take care of your back and neck and prevent injuries.
6. Regularly carry out a gymnastic complex for correct posture.
7. Elderly people need to think about the health of their spine as early as possible. Taking vitamins and chondroprotectors, as well as daily exercise therapy will help you stay in shape for a long time and forget about problems with the spine.

Due to upright posture, the human spine has physiological curves that help distribute the load. The forward bend is called lordosis, the backward bend is called kyphosis. As a result, when viewed from the side, the spine has an S-shape. There is lordosis in the lumbar and cervical regions and kyphosis in the thoracic and sacral segments.

It happens that these curves become more pronounced or smoothed out. One of these conditions is increased (pathological) kyphosis in the thoracic spine.

Why does kyphosis occur?

Thoracic kyphosis can be genetically determined, in which case a family history of this pathology is revealed. Congenital curvature occurs due to developmental anomalies with fusion of the vertebrae, changes in their shape and position.

The acquired form of kyphosis is more common and can be caused by various reasons:

• rickets in early childhood, leading to changes in bones and muscles;

• weakness of the back muscle corset at a young age, leading to the development of postural kyphosis (stooping);

• degenerative-dystrophic changes in intervertebral discs;

• bone tuberculosis with destruction of vertebral bodies;

• pathological compression fracture of altered vertebrae;

• consequences of operations on the spine or chest;

• age-related changes in the musculoskeletal system;

• partial paralysis of paravertebral muscles with neurological diseases(poliomyelitis, cerebral palsy, muscular dystrophy, etc.).

The primary ones may be a change in the shape of the vertebral bodies, when they are destroyed or become wedge-shaped. The resulting uneven load on the intervertebral discs and ligaments leads to their degeneration and deformation. If changes in the discs and joints appear first, then gradually developing dystrophic disorders in the vertebrae intensify this process. So, both bone and cartilaginous structures always take part in the occurrence of thoracic kyphosis.

Classification

Kyphosis of the thoracic spine can have varying degrees of severity. When making a diagnosis, the angle of bending (KU or kyphosis angle) is assessed. To calculate it, it is necessary to draw 2 tangent lines - one near the II-III and XII thoracic vertebrae. Normally, KU is 15-30º, and the apex of physiological kyphosis should be located approximately at the level of the V thoracic vertebra. With pathological curvature, this angle increases.

Degrees of severity of thoracic kyphosis:

• I degree, mild, KU 31-40º;

• II degree, average, KU 41-50º;

• III degree, pronounced, KU 51-70º;

• IV degree, strongly expressed, KU more than 70º.

By type of deformation There are arcuate and angular.

By the presence of compensatory bends in adjacent parts of the spine, compensated and uncompensated kyphosis are distinguished. If only the thoracic region is involved, and the shoulders and pelvis are in the same vertical plane, they speak of a compensated form. With more severe damage, the shoulders are pulled back and the pelvis moves forward with hyperextension hip joints and increased lumbar lordosis.

By localization kyphosis can be thoracic (VI-X thoracic vertebrae are involved) and thoracolumbar vertebrae (X-XII thoracic and I-II lumbar vertebrae are affected).

Classification by etiology includes the following pathological forms:

• rachitic;

• senile;

• postural;

• tuberculosis;

• degenerative;

• compression and post-traumatic;

• paralytic;

• infantile (passes on its own).

Kyphosis is not an independent disease; it is a syndrome associated with various pathologies.

Manifestations

The presence of kyphosis of the thoracic spine is visible even to a non-specialist. This is defined as a back deformity of varying degrees of severity. But besides these obvious manifestations, there are other signs.

Symptoms:

• changes in the position of the shoulder girdles, which move forward and down;

• narrowing of the chest, decreased lung capacity;

• weakness of the anterior muscles abdominal wall, protrusion of the abdomen;

• muscle weakness along the spine;

• changing the shape and position of the diaphragm;

• change in the position of the shoulder blades;

• with severe deformations, the functioning of the internal organs is disrupted, which is revealed when functional tests or can be traced in the patient’s complaints;

• pain due to back muscle tension or radicular compression syndrome;

• flat feet;

• when nerve structures are compressed, paralysis of the limbs, changes in sensitivity, and pelvic disorders are possible.

Upon examination, additional signs may be identified. For example, when bending forward, the kyphotic deformity increases, whereas normally all bends are smoothed out. When looking at the patient from the front while bending down with arms down, a change in the shape of the back is visible. It becomes angular and resembles a coffin lid due to the displacement of the shoulder blades.

Kyphosis can be combined with deviation of the spine from the median axis. This condition is called kyphoscoliosis.

Diagnostics

The examination allows you to identify pathological curvature and evaluate secondary neurological symptoms and the condition of internal organs. This requires consultation with an orthopedist and neurologist, and a therapist will help clarify the functioning of the heart and lungs.

Additional examination methods are necessary to accurately determine the degree and etiology of kyphotic curvature of the spine. The main study is radiography in lateral projection. In this case, the angle of kyphosis, the condition of the vertebrae and discs between them are determined. Often this allows us to identify the cause. It is also necessary to determine the position of the ribs, dome of the diaphragm, heart and lungs.

To get complete clinical picture Your doctor may also prescribe:

• EMG (registration of potentials from muscles to determine their activity);

• spirography (determination of lung volume and type of respiratory failure);

• if an infectious etiology is suspected - immunological and bacteriological studies;

• in children - studies to detect rickets.

Kyphosis is not an independent disease; it is a manifestation of a primary pathology affecting the spinal column. Therefore, when making a diagnosis, the etiology is first indicated, then the presence of kyphosis and the degree of its severity, the degree of dysfunction of the internal organs and neurological manifestations are indicated.

Fitness for military service

For young men of military age, the question of fitness for military service in the presence of kyphosis of the thoracic spine is relevant. On January 1, 2014, the Decree of the Government of the Russian Federation dated July 4, 2013 came into force. Article 66 of this resolution states that it is necessary to evaluate:

• For grade 2, take into account the presence of restrictive respiratory failure, wedge-shaped deformation of 3 or more thoracic vertebrae and the degree of dysfunction (must be at least minor). If at least one of these signs is detected, the young man is recognized as partially fit for military service. In peacetime he is not subject to conscription, but during general mobilization in wartime he is called up.

  Treatment

  Taking various medications for kyphotic curvature is rather auxiliary in nature to reduce pain, relieve tonic muscle tension and alleviate neurological complications. The exception is etiotropic therapy - taking anti-tuberculosis drugs or chemotherapy for cancer.

  There are 2 types of treatment: conservative and surgical.

  Therapeutic exercise is the main method of intervention for any degree of poor posture. In adults, exercises will not completely correct obvious curvatures. But regular, correct loading will reduce the rate of increase in deformity and reduce pain. The exercises are simple, but balanced, and it is advisable to do them daily. Training is carried out by a physical therapy instructor or a doctor.

  In addition to exercises, in some cases the doctor prescribes wearing a corset to relieve stress on the spine. It comes in different designs and degrees of rigidity and is selected individually. constantly, because insufficient muscle work leads to their gradual atrophy, which aggravates the situation and contributes to the progression of the deformity.

  Physiotherapeutic, manual and osteopathic treatment is also prescribed. They are especially effective on initial stages curvature of the spine.

  Surgical treatment is carried out if there is a rapid increase in the degree of kyphosis with persistent severe pain, compression of the spinal cord or spinal nerve roots, and disturbances in the functioning of the heart and lungs. An indication may also be a disturbance in the patient's social functioning.

  During the operation, compression of the nerve structures is eliminated, the curvature of the spine is corrected, and the new position of the bones is fixed using special devices. Metal structures are implanted into the patient’s body for a long period of time.

  

  In case of severe impairments that lead to permanent disability of the patient and limit his self-care, the issue of disability is resolved.

  Kyphosis of the thoracic spine requires clarification of the cause of its occurrence. In the presence of such deformation, daily gymnastics is necessary, which, when mild degree and unstable initial deformation will help correct posture and have a preventive effect. Therefore, if there are signs of incipient curvature, you should consult a doctor to select the necessary treatment and prevention measures.

Our body is designed in such a way that its work is aimed at reducing the load on the spine. When a person’s spine is curved, after an examination, specialists notify the patient that he has kyphosis. Most often the disease is observed in the thoracic region.

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What is kyphosis of the thoracic spine

This disease develops curvature of the spine in a person at chest level, and also over time a hump may appear. Due to the fact that the spine takes on an unnatural shape, a person starts to slouch a lot. Very often, this disease manifests itself in boys at an early age, when active growth is underway. Kyphosis appears due to the fact that a certain part of the spine weakens, as a result it begins to bend more and more.

Physiological and pathological

Physiological and pathological thoracic kyphosis has its own characteristics. The first is characterized by the fact that kyphosis can be observed as early as the age of seven years, the back bends by 15–30 degrees. Physiological kyphosis occurs in almost the entire population, while the back bend can be up to 45 degrees.

• shoulders lean down and forward;
• the patient's chest narrows significantly;
• the muscle tissue of the back and abdominal cavity weakens;
• the back takes on a round shape, the stoop is pronounced;
• if the pathology is already at an advanced stage, then a hump appears;
• flat feet

In addition to the symptoms described above, the patient also experiences severe pain. Painful sensations may make themselves known on the middle part of the back, as well as in the neck and lumbar spine. A burning sensation appears, it is difficult for a person to move, he feels constrained and insecure.

When the pathology begins to actively progress, the patient simultaneously develops a disease.

Degrees

The acceptable degree of back bend is considered to be 15–30 degrees. If bend exceeds 30 degrees, then the doctor diagnoses kyphosis. The disease is divided into several degrees ():

• First degree. Considered the mildest, the disease of this form can be quickly cured. The first degree is characterized by a back bend of 31–40 degrees.
• Second degree. It is considered moderate, the level of bending reaches up to 60 degrees.
• Third degree. Considered the heaviest. The bend level is greater than 60 degrees.

How to correct thoracic kyphosis

depend on the stage of the disease. If a person is diagnosed last stage, then it is not possible to recover at home, since the third stage is also characterized by paralysis of the legs.

It will be an excellent treatment solution. Such procedures are prescribed by the attending physician, because only a specialist can evaluate general situation patient and prescribe the necessary treatment.

There is also another method of treatment - massage. Such procedures effectively cope with spinal curvature of various degrees.

Conclusion

If you notice any symptoms of this disease, it is recommended that you undergo an examination so as not to start or worsen the disease. To prevent the manifestation of kyphosis, it is recommended to take the following preventive measures:

• treat infections and diseases in a timely manner to prevent complications and the development of others, in particular those related to the spine;
• It is best to sleep on a firm mattress;
• you need to provide yourself with a comfortable workplace so as not to slouch;
• Obesity should not be allowed;
• be sure to wear special back protection when exercising to prevent overexertion;
• For older people, regular exercise therapy will be an excellent preventative measure.

Kyphosis is a posterior curvature of the spine in the sagittal (antero-posterior plane). This term is derived from the ancient Greek word kyphos, which means hunchbacked, bent.

Like another anterior sagittal curvature of the spine, lordosis, kyphosis can be physiological or pathological. The only difference is in the degree of expression.

Physiological lordosis and kyphosis are formed in early childhood as the child’s motor activity expands. As soon as the baby begins to hold his head up, sit, stand and walk, his spinal column loses its original straightness.

4 bends appear in it - 2 anterior, lordosis, and 2 posterior, kyphosis. These curves correspond to each part of the spine, and alternate with each other; cervical lordosis, thoracic kyphosis, lumbar lordosis, sacral kyphosis.

These physiological bends are vital in order to minimize the load on the spine in Homo erectus and protect the vertebral structures (vertebrae, discs, ligaments) from damage and premature wear.

Like lordosis, kyphosis becomes pathological when it is excessive. True, pathological kyphosis can develop only in the thoracic region. This section is reinforced by the ribs and sternum, but this is not enough to ensure absolute fixation.

But the sacral vertebrae are articulated into a single sacral bone with a given curvature, the degree of which does not change. Therefore, pathological kyphosis does not occur in the sacral region, but is formed only in the thoracic spine.

The main causes of thoracic pathological kyphosis (hereinafter referred to simply as kyphosis):

• Hereditary and congenital genetic abnormalities. A predisposition to thoracic curvature may be a consequence of certain gene mutations, and is inherited from parents. If any of them suffers from kyphosis, then there is a high probability that a similar defect will appear in the child. Although parents may be externally and genetically healthy, kyphosis develops due to spontaneous mutations in the prenatal period.
• Severe congenital and acquired diseases of the central nervous system: cerebral palsy, polio, cerebral strokes, leading to paralysis of the muscles of the back, chest, neck, stabilizing the spine.
• Exchange disorders. Rickets due to vitamin D deficiency, pathology of the parathyroid glands, and many other endocrine disorders accompanied by calcium deficiency and osteoporosis can be complicated by kyphosis.
• Injuries of the thoracic spine - compression fractures of the thoracic vertebrae sometimes later transform into kyphosis.
• Spinal tumors. Primary or metastatic tumors of the thoracic spine sometimes lead to kyphosis.
• Infections. Some types of specific infectious lesions bone tissue vertebrae, for example, tuberculosis, syphilis, can lead to an increase in thoracic curvature.
• Surgical interventions on the spine. Sometimes, especially with incorrect technique, they can be complicated by kyphosis.
• Ankylosing spondylitis. With ankylosing spondylitis, structural disorders in the spine lead to increased cervical lordosis and thoracic kyphosis.
• Scheuermann-Mau disease. A disease with unclear causes and mechanism of development. Another name is juvenile kyphosis. Develops in adolescence, mainly in boys. A distinctive feature of this disease is a wedge-shaped deformation of the vertebral bodies. The height of the anterior sections of the vertebral bodies decreases in comparison with the posterior ones, as a result of which the curvature of the thoracic region increases and the spine bends.
• Age-related changes. With age, the bone tissue of the vertebrae loses its strength, resulting in various types of curvatures, incl. and thoracic kyphosis.

All these types of kyphosis are fixed - their magnitude remains unchanged when changing body position. This is how they fundamentally differ from unfixed or functional kyphosis, which are quite common among children and young men. Their main reason is regular poor posture while preparing homework or sitting at the computer for a long time.

Functional kyphosis is sometimes observed in myopic people who, due to low vision forced to tilt your head and neck forward. Often, kyphosis, along with other types of curvatures, occurs in adolescence, during a period of rapid growth of bones and the spine in length with weak and not yet strong muscles.

Some young people (this is mainly typical for girls) are embarrassed by their tall height, and in order to somehow reduce it, they deliberately slouch, as a result of which the thoracic curvature increases.

Symptoms of kyphosis

There are 4 degrees of kyphosis. Each degree is determined by the angle of curvature of the kyphotic arch of the thoracic region. An angle from 15 0 to 30 0 is considered normal. Conditions in which it decreases to less than 15 0 are called hypokyphosis.

Flattening of the back with hypokyphosis of the thoracic spine is rare in clinical practice. In the vast majority of cases, the pathological curvature in the thoracic region has the character of hyperkyphosis of 4 degrees with different angles of the kyphotic arch:

1. 31 0 -40 0
2. 41 0 -50 0
3. 51 0 -70 0
4. More than 71 0.

In grade I with a minimal angle, kyphosis, especially in clothing, is invisible. As the angle of curvature increases, stooping and a change in the shape of the back (“round back”) become apparent. With severe curvatures, a pronounced cosmetic defect is formed in the form of a hibus (Latin hibus - hump).

The kyphotic curvature itself can have an arched angular shape, or take the form of an angle with an apex on a vertebra damaged by disease or injury. It is angular kyphosis that most often manifests itself as hybus. Although hybus also occurs with arcuate kyphosis with a large angle of curvature.

The angle itself can be constant, or change at different speeds. In this regard, rapidly progressive and slowly progressive kyphosis are distinguished. In the first case, the kyphotic angle increases by 7 0 or more per year, and in the second case - less than this value.

A serious cosmetic defect often leads to an inferiority complex and depression in young people who are well aware that they are not like everyone else. But in addition to moral suffering, there are also physical ones associated with structural and functional disorders musculoskeletal system and internal organs with kyphosis.

Due to an increase in the convexity of the thoracic spine, the configuration of the shoulder girdle and chest changes. The head is pulled into the shoulder girdle, the bones of which move slightly anteriorly and upward. The shoulder blades spread to the sides, their corners protrude from behind. The chest becomes sunken. Her excursion (mobility during breathing) decreases.

For this reason, chronic respiratory failure develops. Hibus, in combination with an altered configuration of the chest, leads to displacement of the heart and large vessels - along with respiratory failure, heart failure is formed.

The diaphragm moves downwards. The displacement of the diaphragm, combined with weakness of the abdominal muscles, which protrudes forward, leads to an increase in intra-abdominal pressure. The consequence of this is digestive disorders caused by disruption of the stomach and intestines. Girls often experience violations menstrual cycle and reproductive disorders.

With kyphosis, the center of gravity of the body shifts posteriorly. Due to the increased load on the heel bones, flat feet occur. The load on the large joints of the lower extremities – the knees and hips – also increases. Over time, these joints undergo arthritic changes with movement restrictions.

Significant negative changes also form in the spine itself. Kyphosis is one of the causes of rare cases thoracic osteochondrosis and infant disc hernias. Intervertebral hernia in the thoracic region they are manifested by shortness of breath, intercostal neuralgia, and a feeling of palpitations.

Quite often, kyphosis is combined with other types of spinal curvature. In order to at least to some extent compensate for the shift in the center of gravity during thoracic kyphosis, enhanced lordosis - hyperlordosis - is formed in the cervical and lumbar spine.

With muscle weakness and insufficient strength of the vertebrae, the spinal column in the thoracic region can not only bend backwards, but also deviate to the side - along with kyphosis, scoliosis (kyphoscoliosis) develops. The combination of lateral and sagittal curvatures only aggravates the severity of kyphosis.

Diagnosis of kyphosis

It is not difficult to detect kyphosis even at the initial stage with a minimal angle of curvature. To do this, it is enough to conduct one simple test - ask the subject to reach with his hands to the floor while bending forward and straightening his legs. Difficulty bending and reaching indicates early kyphosis.

The curvature of the spine and the destruction of the bone tissue of the vertebrae can be determined using radiography performed in 3 standard projections - straight, oblique, and lateral. To diagnose concomitant changes in the intervertebral discs and musculo-ligamentous apparatus, computed tomography and nuclear magnetic resonance are performed.

Respiratory and cardiovascular system disorders are diagnosed using spirometry, electrocardiography, cardiac ultrasound (echocardiography), and plain radiography chest organs.

Treatment of kyphosis

The earlier treatment for kyphosis is started, the greater the chances of a favorable outcome and complete stabilization of the spine. Functional kyphosis in children caused by poor posture is especially treatable. With the help of specially selected exercises, you can strengthen the muscles of the back and chest, and eliminate existing defects - sunken chest, round back, retracted shoulder girdle, and bulging stomach. The loads must be correctly selected, strictly dosed, and not cause pain, severe shortness of breath, and other unpleasant sensations.

For the treatment of kyphosis, as well as for some other diseases of the spine, exercises in the swimming pool are indicated. Water environment has a beneficial effect on the spine and muscles, because in water a person’s body weight decreases. Along with health-improving exercises, patients with kyphosis are advised to undergo a massage course.

During massage treatments muscles are strengthened, local blood circulation is improved, and the spine is stabilized. Treatment of kyphosis must necessarily be accompanied by wearing a special corset that corrects posture.

All these conservative measures are effective only for incipient kyphosis. Severe thoracic curvature, a rapid increase in the kyphotic angle, a large hybus with concomitant respiratory and heart failure, constant severe back pain, the threat of compression of the spinal cord - all this requires surgical intervention.

The type of surgery depends on the cause and degree of kyphosis. Vertebral plastic surgery is performed, or even their complete replacement with artificial implants. Curved areas of the thoracic region that have undergone destruction are fixed with metal rods or screws. Such patients after surgery require long-term rehabilitation, including drug support, physical therapy, massage, and physiotherapeutic treatment.

Dear visitors of the Farmamir website. This article does not constitute medical advice and should not serve as a substitute for consultation with a physician.

Kyphosis- excessive arched curvature of the thoracic spine, convexity facing posteriorly. Externally, it is manifested by the formation of a hump on the back.

The term "kyphosis" comes from the word "kyphos", which translated from ancient Greek means "crooked", "bent", "hunched over".

Statistics

Around the world, about 8-10% of the population has kyphosis to varying degrees. It occurs in people of all ages, but children and adolescents are most susceptible to developing kyphosis. Moreover, the tendency is greater in boys than in girls. People at all times had ambivalent attitudes toward hunchbacks: some considered them an evil force, others ridiculed them for their ugliness or despised them, and some admired them.

One of the characters Ancient Greece- poet-fabulist Aesop. According to legend, he was a slave, had an ugly appearance and a hump. It is still unknown whether Aesop actually existed. However, in numerous tales of which he became the hero, he always turned out to be smarter and more resourceful than his master, as well as the official sages. Therefore, ordinary people have always treated this character with admiration.

Let's turn to more recent literature and remember the great work of the French writer Victor Hugo - the novel “Notre Dame Cathedral”. One of its main characters is the cathedral bell ringer, the hunchback Quasimodo. In addition, he was also deaf and one-eyed. According to the plot simple people they treated him like the devil who had come to take their souls. Although in fact Quasimodo was a sick man in love with the beautiful Esmeralda.

Let's remember M. Yu. Lermontov- a talented poet, prose writer and artist. He was short, limped, had crooked legs, a large head and a hump. This is probably why his soul felt uncomfortable in the ugly figure. Which was manifested in his causticity, vindictiveness, cockiness, mercilessness towards the weaknesses of others. However, this did not stop him from writing truly immortal works.

Times have changed. Now everyone knows that kyphosis is a disease in which there is nothing mythical.

Anatomy of the spine

Spine- the supporting structure of the body, without which a person would not be able to walk or even sit.

The spine consists of 32-34 vertebrae located on top of each other.

Each vertebra consists of a body, an arch and processes. The vertebral arches surround the spinal cord, forming a canal for it.

Joints are formed between the processes of the vertebrae, which are similar in structure to the knee or elbow joint.

At the level of each vertebra, the anterior and posterior roots of the spinal cord (long processes of motor and sensory cells) depart, which, uniting with each other, form the trunk of the spinal nerve. In turn, the nerve leaves the spinal cord canal through a special opening formed by two adjacent vertebrae. Each nerve is responsible for the innervation of certain anatomical structures(muscles, internal organs, etc.). When the spinal cord roots are pinched, the work and nutrition of the organ or tissue they innervate is disrupted.

The vertebrae are connected to each other by:

• Intervertebral discs, which are a lining consisting of cartilage tissue. As you age, the disc loses water and becomes less elastic. The functions of the discs are to absorb stress during physical activity.
• Bundles, which connect the vertebrae. They are elastic fabric.
• tendons, extending from ligaments and connecting bones to muscles.

Back muscles provide free movement and support the spinal column.

Due to the fact that all these anatomical structures of the spinal column are closely interconnected, the stability of the spine is ensured, and it is possible to bend back and forth, left and right, and rotate the torso.

Normally, there are four physiological curves in the spinal column(side view):

• In the cervical and lumbar regions there are convexities forward - two lordoses.
• In the thoracic and sacral regions there are convexities back - two kyphosis. In the thoracic region, kyphosis is formed by the age of 7 years, in the sacral region - by the period of puberty.

The bulges are insignificant, and their severity and size are not always the same. In addition, they largely depend on the characteristics of each person.

Thanks to physiological curves, the spine is elastic, mobile and can withstand enormous loads.

Causes, types and mechanisms of development of kyphosis

Kyphosis can occur in both children and adults, as well as the elderly. And in each case, different reasons lead to it, therefore, depending on them, several main types of kyphosis are distinguished.

Kyphosis occurs in form:

• Angular - curvature of the spine in the form of a smooth round arc. Its apex is the spinous process of one or, rarely, two vertebrae.
• Arc-shaped - in the shape of a short, highly elongated arc.

Types of kyphosis

Postural (postural) or functional kyphosis

The result of poor posture. Sometimes called round back, it is most common in children, adolescents and young adults under 30 years of age. Girls get sick more often.

Causes

• Constant slouching in a standing or sitting position, due to the situation at school or the characteristics of the profession.


• Overloading your shoulders with inappropriate clothing in the cold season. This reason is especially relevant in children.


• Often teenagers or young adults feel self-conscious about their height, so they constantly slouch. In addition, it should be taken into account that they live in uncomfortable conditions. Since all furniture, height of doorways or doors public transport are made based on the height of the average person - 180 cm.


• Back muscle weakness due to insufficient physical activity.

On a note

A distinctive feature of functional kyphosis is when the patient lies on his stomach, the rounded shape of the back easily disappears, and there are no structural changes in the vertebrae.

Formation mechanism

Under unfavorable conditions (improper organization of the workplace, and so on), the spinal ligaments are overstretched and vertebral shapes that do not correspond to the norm arise, so a forward tilt gradually develops.

Simultaneously with these changes, the load on the cervical and lumbar spine increases. As a result, compensatory hyperlordosis (excessive anterior curvature of the spinal column) forms in these segments, which further aggravates the course of the disease.

Juvenile kyphosis (Scheuermann-Mau disease)

Spinal deformity occurs like kyphosis in the period intensive growth child - at 14-16 years old. Boys are more prone to it than girls.

Occurs in 1% of children. In 30% of cases it is combined with scoliosis.

What causes this form of kyphosis is not precisely established.

Alleged causes:

• congenital excess bone growth on the vertebral body or necrosis of hyaline cartilage (located between the vertebra and the disc), as well as impaired blood supply to the vertebrae


• result of microtrauma of the vertebrae that arose as a result of osteoporosis (partial resorption of inert substance and increased bone fragility)


• pathological abnormal development of the back muscles

Formation mechanism

The shape of several vertebrae changes: their anterior part narrows, and they themselves take on a wedge shape. In addition, gradual degeneration (loss of function) occurs and contracture (shortening) of the muscles of the anterior abdominal wall and pectoral muscles develops.

And at the same time, the back muscles are stretched, and their fatigue also develops, so they cease to perform their functions. As a result, the thoracic spine tilts forward and kyphosis is formed.

Congenital kyphosis

Develops as a result of a disorder intrauterine development fetus In 20-30% of cases it is combined with an anomaly in the development of the urinary tract.

Causes

• Anomaly of the development of the vertebrae themselves. Vertebrae are formed various forms: wedge-shaped, butterfly-shaped, hemivertebrae and so on. The frequency of this type of kyphosis is about 70% of all congenital kyphosis.


• Disorders of separation into individual vertebrae: They seem to stick together. Frequency - 11-21%.


• Rotational dislocation of the spine- when kyphosis is located between two parts of the spine, which are based on scoliosis (curvature of the spine) and lordosis (excessive forward bending) at the same time.

A pathology that, as a rule, leads to gross deformation of the spine, as well as the spinal cord and disruption of its functions. Therefore, this form of kyphosis is accompanied by neurological symptoms, which depend on the level at which the congenital malformation is present: urinary impairment, paralysis in the lower part of the body, and so on. This form of kyphosis is rare.

Formation mechanism

The formation of the spine and the beginning of ossification of the vertebrae in the fetus occurs at 5-8 weeks of intrauterine development. If at this moment the mother’s body is affected by unfavorable factors (stress, various diseases and others), this can lead to the formation of abnormalities in the development of the spine, as well as congenital weakness of the back muscles.

Paralytic kyphosis

Occurs due to paralysis of the spinal muscles.

Causes

Any disease that causes paralysis of the back muscles: polio, childhood cerebral paralysis, muscular dystrophy and others.

Formation mechanism

Kyphosis develops slowly, because after the onset of paralysis, the back muscles gradually atrophy and cease to perform their functions. It should be remembered that with spastic paralysis, muscle tone increases, and with flaccid paralysis, it decreases.

However, in both cases, the strength of the back muscles is reduced or absent altogether. In addition, the back muscles gradually atrophy (reduce in size). Therefore, they can no longer perform their functions (ensure stability of the spine, bending, turning, and so on). As a result, during physical activity (even moderate) the very shape of the vertebrae changes and they shift.

Post-traumatic kyphosis

It accounts for about 40% of all kyphosis and progresses quickly. With spinal trauma, kyphosis develops quite often: according to some reports, in 70-90% of cases. The severity of kyphosis depends on the severity of the injury and its extent.

Causes

Degenerative-dystrophic changes in the vertebrae and intervertebral discs themselves, as well as weakening of the muscular-ligamentous apparatus that supports the spinal column.

Formation mechanism

With the gradual development of degenerative processes, the shape of the vertebral bodies is deformed. In addition, intervertebral discs sag or disc herniations form, back muscles and ligaments in the affected area are weakened. As a result, the spinal column begins to bend, unable to withstand even minor loads.

In addition, in the initial stages of kyphosis formation, an imbalance of body weight and a redistribution of the load on the body develops. separate structures spinal column. Therefore, the parts of the spine that are not initially involved in degenerative processes (healthy) take on most of the load and, as a result, wear out faster. Thus, a vicious circle is formed.

Senile (senile) kyphosis

It develops in older people and is most common in women.

Causes

Reverse development of anatomical formations (aging) that form the spine: intervertebral discs, ligaments, vertebrae, muscles.

Formation mechanism

The vertebrae become softer, the muscles and ligaments become less elastic, and the intervertebral discs sag. Therefore, the spine gradually ceases to withstand loads, even moderate ones. As a result, as it progresses age-related changes, the spinal column is curved.

Rachitic kyphosis

Develops in children with rickets, starting from the sixth month of life. However, rachitic kyphosis often develops in older children or adolescents who suffered from rickets in early childhood.

Cause

Rickets is a disease caused by a lack of vitamin D, which leads to changes in metabolism. What is manifested by a violation of bone formation (bones become soft), work nervous system and some internal organs.

Formation mechanism

Due to the softness of the vertebrae, as well as weakness of the muscles and ligaments, the spinal column can no longer withstand adequate loads. Therefore, the vertebrae change their shape and shift.

Other reasons

Kyphosis often develops with tumors of the spinal column or spondylitis (chronic inflammatory diseases of the spine): infectious (for example, tuberculosis) and non-infectious (for example, ankylosing spondylitis)

With prolonged course and irrational treatment of these diseases, the vertebral bodies are destroyed, the intervertebral discs sag, and the ligaments and muscles are weakened. Therefore, the spinal column itself is deformed, unable to withstand the load.

Degrees of spinal kyphosis

Normally, the angle of physiological kyphosis of the spine ranges from 15° to 30°. Anything more is pathology.

There is a difference between physiological kyphosis and pathology: normally, the apex of kyphosis is at the level of the fifth thoracic vertebra, whereas with disease it is displaced.

Classification of kyphosis according to the severity of the angle of inclination

• I degree. The tilt angle ranges from 31 to 40°
• II degree. Angle - from 41 to 50°
• III degree. Angle - from 51 to 70°
• IV degree. Angle - 71° or more

Diagnosis of kyphosis

The severity of the angle of inclination is difficult to determine by eye.

Special methods are used for this:

1. X-ray of the spinal column. The picture is taken in a lateral projection with maximum extension of the spine.

   Then on Three points are marked on the x-ray film:

   • the first is the center of the vertebra, which is located at the top of the bend
   • second and third - the centers of the two outer vertebrae of the bend
   These three points are then connected to form a triangle.
   • Tilt angle. To do this, the lines intersecting at the top of the bend (legs) are extended. And the resulting outer angle (lateral) in relation to the legs is the actual angle of inclination of the kyphosis.
   • Kyphosis coefficient. To determine it, from a point located on the rise of the arc (vertex), draw a perpendicular to the base of the triangle. The ratio of the length of the base to the height of the perpendicular is the kyphosis coefficient. It is necessary to establish whether the curvature is a disease or normal. If it is less than 10, then kyphosis is considered a pathology.
2. Magnetic resonance imaging used to clarify and also identify the degree structural changes in intervertebral discs (flattening in the anteroposterior direction, the presence of a hernia), vertebrae and others anatomical formations spine.

   Also, if necessary, studies of the function of other organs and systems are carried out to determine how disrupted their work is (for example, ultrasound of internal organs).

Signs of kyphosis depending on the severity of the angle of inclination

Kyphosis first degree

The angle of inclination is small, so the stoop is not pronounced, and kyphosis itself is easy to treat.

Signs

Posture is moderately impaired, patients complain of fatigue back muscles, as well as slight back pain, which intensifies with minor physical exertion.

It is in such mild symptoms that the problem lies: many perceive stooping as a temporary disadvantage. This is especially true for parents who believe that as the child grows, it will disappear on its own. However, this is a misconception, since with excessive or insufficient load, first-degree kyphosis can progress to the second or even third degree.

Second degree kyphosis

The angle of inclination is slightly greater, so the symptoms are more pronounced.

Causes

• untreated first degree kyphosis
• consequences of injuries or surgical interventions
• inadequate load on the spine during the period of intensive growth, and it can be either excessive or insufficient
• congenital kyphosis

Signs

• The roundness of the back is pronounced, the shoulders are dropped down.
• The curvature becomes especially noticeable if a child or adult sits at a table for a long time: the back takes on a C-shape. This happens because the back muscles get tired quickly. Therefore, the patient tries to find a comfortable position and support, but in vain.
• When lying on your stomach, your back remains arched, even if the body is slightly pressed from above.
• Standing stomach sticks out due to a moderate compensatory increase in the forward curve of the spine in the lumbar region (lordosis), as well as relaxation of the abdominal muscles.
• Cervical lordosis (protrusion forward) becomes more pronounced, therefore, due to a shift in the position of the neck, the patient’s chin is strongly shifted forward.

All these phenomena lead to a decrease in the volume of the chest, and the diaphragm ( respiratory muscle) no longer fully performs its function. As a result, the functioning of the heart and respiratory organs is disrupted. Therefore, such patients often suffer from pneumonia, bronchitis, coronary disease heart and other diseases.

Kyphosis third degree

Severe pathology, which is characterized not only by external changes, but also by severe dysfunction of internal organs.

Causes

• Untreated kyphosis of the first or second degree.
• Congenital anomalies of the spinal column and musculoskeletal system.
• After suffering severe injuries to the spinal column.
• Severe degenerative changes in the spine that arise from various reasons: rapid skeletal growth, rapidly progressing infectious and non-infectious inflammatory diseases of the spine, rickets and others.

Signs

• The line of the spinal column takes on an S-shape. That is, the spine is curved, both in the thoracic and lumbar regions, so the patient’s back is literally bent in half.
• Due to deformation of the torso, height decreases, and the limbs appear longer.
• Muscle tone in the arms and legs is reduced.
• The patient cannot withstand prolonged stress and cannot remain in a sitting or standing position for a long time. In addition, he needs support.
• Worried constant pain in the back, intercostal neuralgia develops (compression or irritation of the intercostal nerves).
• At the slightest load, the functioning of the respiratory and cardiovascular systems is disrupted: shortness of breath appears (sometimes even at rest), interruptions in the functioning of the heart (fading or increased heart rate) and some other symptoms.
• Sometimes, due to pressure on the internal organs, there are signs of disruption in their functioning: fecal and urinary incontinence, belching and others.
• If kyphosis of the second or third degree has developed in a child, then he lags behind his peers in physical development.

Over time, all these changes progress, leading to profound disability of the patient.

Symptoms of kyphosis

Many believe that kyphosis is a deformity of the spine, which is manifested only by stooping or hunchback.

However, invisible changes also occur: the volume of the chest decreases, the diaphragm lowers and puts pressure on the internal organs, disrupting their function. As kyphosis progresses, compensatory hyperlordosis (excessive forward curvature) of the lumbar or cervical spine develops.

In addition, the spine ages quickly, the height of the intervertebral discs decreases, and their shock-absorbing functions are also lost. The roots of the spinal cord may be pinched, which leads to disruption of the functioning of internal organs and innervation of the limbs. As a result, pain occurs, blood circulation is impaired and many other changes develop.

All manifestations of kyphosis and complaints of patients depend on the degree of tilt, as well as the affected segment of the spine.

Kyphosis of the thoracic spine

It occurs most often and is characterized by involvement of the 4th to 10th thoracic vertebrae.

Signs

Patients complain of rapid fatigue of the back muscles, as well as their painful spasms.

When the spinal cord or its roots are pinched, patients report numbness and weakness in the limbs, as well as a feeling of “pins and needles” in them.

As the angle of inclination increases, the disease progresses, so disturbances in the functioning of internal organs are often observed:

• gastrointestinal tract (belching, poor appetite, stool incontinence)
• respiratory system(shortness of breath, frequent bronchitis, pneumonia)
• heart and blood vessels (interruptions in heart function, rapid heartbeat, increased blood pressure)
• urinary system (urinary incontinence)

Cervical kyphosis

IN cervical spine The spine normally has a physiological lordosis - a forward bend. Therefore, when the posterior bend changes, it is not entirely correct to talk about kyphosis. In this case, we are talking about flattening or straightening the lordosis.

Causes

• degenerative (changes in organs and tissues with disruption or loss of their function) processes in the spine resulting from inflammatory diseases infectious (tuberculosis) and non-infectious (ankylosing spondylitis, osteochondrosis) nature
• age-related (senile) changes
• consequences of injuries
• intervertebral disc herniation
• spinal tumors (benign, malignant)

Signs

• stoop appears
• patients complain of numbness in the hands, pain in the back of the head and shoulders, headaches and dizziness
• there are frequent changes blood pressure
• sometimes a hump is formed on the neck due to the protruding spinous processes of the vertebrae

With a long course of the disease and in the absence of adequate treatment, the roots of the spinal cord may be infringed. As a result, the functioning of the respiratory system is often disrupted (shortness of breath appears, sometimes even at rest, frequent illnesses pneumonia, bronchitis) and heart (arrhythmias, increased blood pressure).

Kyphosis of the lumbar spine

We are talking about smoothing the physiological lordosis in the lumbar part of the spinal column. The vertebrae of the lumbar region are affected, as well as secondarily the 11th and 12th thoracic vertebrae.

Causes

• lumbar spine injuries
• herniated discs in the lumbar region
• in young people with well-developed lumbar muscles
• lumbar osteochondrosis
• malignant and benign neoplasms
• consequences of infections (tuberculosis)
• post-mortem rickets

Signs

• pain in the lower back, radiating to the buttocks or lower limbs (along the sciatic nerve)
• decreased sensitivity and numbness in the legs
• changes in blood pressure
• sexual dysfunction
• urinary and fecal incontinence
• secondary formation of a hump above the lumbar spine

Which doctor diagnoses and treats spinal diseases?

The spine is the seat of the spinal cord and parts bone marrow. Therefore, doctors of different specialties are involved in the treatment and diagnosis of spinal diseases: neurologist, vertebro-neurologist, chiropractor, oncologist, traumatologist, rheumatologist and others.

Doctors of such specialties as vertebro-neurologist, traumatologist, neurosurgeon, chiropractor are responsible for the treatment and diagnosis of kyphosis.

Treatment of kyphosis

The choice of direction depends on the stage and cause of kyphosis, as well as complications that have already developed. Of course, you cannot do without medications that alleviate general state, reducing pain, compensating for the lack of vitamins and minerals in the body. However, pills, ointments, gels and injections are not the mainstay of treatment for kyphosis.

A slightly different approach is needed here.

There are two main directions in treatment:

1. Without surgery - conservative treatment (main method)
   • execution of special therapeutic exercises
   • back massage
   • wearing orthopedic corsets
2. With surgery- surgery

Performing special therapeutic exercises

In children and adolescents, therapeutic exercises, depending on the angle of inclination of kyphosis, can lead to complete recovery. Whereas in adults, recovery does not always occur, since the spinal column is already formed, and its shape will not change.

However, this does not mean that this treatment method should be neglected. Since the exercises visually straighten the back, improve local blood circulation and tissue nutrition. Therefore, further destruction of the anatomical structures of the spine and the progression of kyphosis are stopped. In addition, strong muscles form a powerful frame for the spine.

There are many sets of therapeutic exercises. Here are just a few of them that anyone can do at home.

A set of exercises for the treatment of thoracic kyphosis

When starting to perform this set of exercises, stock up on a gymnastic stick in advance.

1. Take the starting position (I.P.): Stand on your feet and spread them shoulder-width apart. Then place the gymnastic stick behind your back and lightly press it with your hands against your shoulder blades (this position helps straighten your shoulder blades). And start squats: while squatting, exhale. Returning to the starting position, inhale.
2. I.P. The same as in the previous exercise. Raise your arms up to your sides while inhaling. Returning to the starting position, exhale.
3. I.P. Stand up straight and spread your legs shoulder-width apart. Then place the gymnastic stick behind your back and hold it in your hands, lightly pressing it against your shoulder blades. Next, raising your arms, at the same time slightly tilt your head back. Inhale while doing this exercise. Returning to the starting position, exhale.
4. Get on all fours, lean on your hands and knees. Next, raise your head, move your elbows to the sides and bend your chest as far down as possible. In this position, take 40-50 steps.
5. I.P. Lie on your back, straighten your arms along your body. Then, leaning on your hands, bend your spine upward, lifting your chest and pelvis. Inhale while doing the exercise. Returning to the starting position, exhale.
6. I.P. Lie on your stomach, place a gymnastic stick on your shoulder blades and hold it with your hands. Next, tilt your head back while arching your spine upward. Hold in this position for 3 to 5 seconds and return to IP. During the exercise, breathing is voluntary.
7. I.P. Stand in a knee-wrist position. Next, bend your elbows and lower your chest toward the floor, moving your whole body forward. Hold in this position for 3 to 5 seconds and return to IP. Breathing is voluntary.
8. I.P. Lie on your back, stretch your arms along your body and relax as much as possible. Then place your hands behind your head and stretch. Hold in this position for 3 to 5 seconds and return to IP. Breathing is voluntary.
9. I.P. Stand on your feet straight, place your hands on the back of your head. Next, rise up onto your toes and at the same time spread your arms to the sides. Inhale while performing the exercise. Returning to the starting position, exhale.

Exercises to treat lumbar kyphosis

1. I.P. Lie on your back, raise your arms up and stretch them out. Then simultaneously stretch your arms up as much as possible and your toes down. Stay in this position for 20-30 seconds. Next, pull your toes towards you, and pull your heels down, alternately with each leg, so as to create the illusion of walking, but without bending your legs at the knee joints. Repeat the movements for 20-30 seconds. This exercise stretches the muscles of the back and lower back.
2. I.P. Remaining in a position on your back, spread your arms to the sides and bend your legs at the knee joints, move your pelvis slightly to the right. Then turn your head to the right, and your bent legs at the knee joints to the left and place them on the surface. Stay in this position for 20-30 seconds. Then repeat the exercise, but in the opposite direction. While performing the exercise, breathe slowly and relax your back muscles as much as possible with each exhalation.
3. I.P. Remaining on your back, lower your arms along your body. Turn your legs bent at the knees in both directions, and your feet towards each other and connect them. Then, while inhaling, leaning on your hands, lift your back and pelvis above the surface, and squeeze your buttocks. Remain in this position for 5-10 seconds, then, as you exhale, slowly return to IP.
4. I.P. In a supine position, bend your knees and pull them towards your chest, holding them in this position with your hands. Next, inhale, and as you exhale, raise your head to your knees. If it’s hard, then pull each leg to your chest in turn, without raising your head.

Exercises to treat neck kyphosis

1. I.P. While sitting, lower your shoulders down and pull the top of your head up. Then close your eyes and focus on stretching your neck. Next, begin smooth movements of your head forward and backward, while tilting your head back only slightly.
2. I.P. as in the previous exercise. Slowly tilt your head to the sides.
3. I.P. While sitting, place your palms on your forehead. Next, take a deep breath and, as you exhale, press your palms on your forehead, and your forehead on your palms. But try not to strain too much, and try to keep your neck vertical when performing the exercise.
4. I.P. While sitting, place your palms on your temples. As you exhale, press your temples with your palms and press your head onto your palms. As you inhale, stop pressing on your temples. First perform the exercise in one direction, and then in the other.

On a note

1. In complexes, repeat each exercise from 3 to 5 times, depending on load tolerance, only then move on to the next one.
2. Perform exercises for all departments, strengthening the entire spine.
3. If it's hard for you, do classes every other day.
4. Perform each exercise depending on your general well-being, gradually increasing their repetition and quantity.
5. Perform all exercises on a hard surface.

Surgery for kyphosis

A measure that is resorted to if other methods have not helped, since there are high risks of complications.

Indications

• the disease is rapidly progressing
• kyphosis with an angle of inclination greater than 60 degrees
• severe pain syndrome, which indicates infringement of the spinal cord roots and is not relieved by medications
• high risk spinal cord compression
• Impaired balance and free movement
• development of complications: urinary and fecal incontinence
• atrophy (reduction in size with impairment or loss of function) of muscles

Contraindications

• elderly age
• presence of severe concomitant pathology: arterial hypertension III degree, diabetes with severe course, arrhythmias and other ailments
• oncological diseases not in remission

Risks of surgical treatment

• introduction of infection
• nerve damage
• graft modification
• difficulty healing surgical wounds
• bleeding

Techniques

Their choice depends on the severity of kyphosis, as well as the cause that caused it.

Methodology	Method of accessing the problem area	Progress of the procedure	Efficiency
Osteotomy (crossing the bone to correct deformity) followed by plastic surgery	In accordance with the characteristics of the curvature, anterior, posterior or combined dissection is performed.	Problematic vertebrae are cut, deformities are corrected, and then they are fixed in the desired position. The resulting cracks are filled with donor bone, artificial grafts, and biological substances. The spine is stabilized with titanium screws, plates, and so on. All these methods fix the vertebrae and keep the spine in balance, ensuring its stability.	The method is quite effective in advanced cases.
Kyphoplasty is a minimally invasive surgery	It is performed through small incisions at the site of injury using endoscopic equipment.	A capsule is inserted into the area of ​​the destroyed vertebra, which has the ability to swell and take on the shape of the defect. Then its cavity is filled with a special solution, which hardens after injection. Thus, maintaining the shape of the vertebra and preventing it from further destruction.	This method is especially effective for minor defects and after recent spinal injuries.

Massage for kyphosis

Plays a supporting role and gives good results when combined with therapeutic exercises.

What should a massage be like?

• Regardless of the type of kyphosis, all movements should be smooth and easy.
• Before and during the massage session, the patient's back muscles should be as relaxed as possible, and he should lie in a comfortable position.
• You should not put pressure on the curved area of ​​the back as if it needs to be straightened right away.
• The area of ​​the spinous processes of the vertebrae should be massaged carefully.
• If there are wounds, bruises or irritation on the skin of the back, it is better to temporarily refrain from massage sessions.

How to massage?

Before the massage, lightly lubricate your back with massage oil. Next, prepare the back muscles for the massage: carry out stroking movements along the entire back with a full palm and on both sides of the spine at the same time.

Then proceed to the massage itself, performing the movements in the following order:

1. First kneading block: grasping, stroking with zigzag and rake-like movements of the fingers, touching in a spiral.
2. Rubbing muscles with full palms, ribs of the palms, fingers.
3. Second kneading block: pulling, sliding, pinching, comb-like kneading.
4. Vibrations by tapping with your fingertips, chopping the edge of your palm, or patting with your palm.

Each of the listed movements is repeated 5-8 times, and the procedure itself lasts about 15-20 minutes.

The massage session ends with gentle stroking.

What is the effect of massage?

Improves blood circulation and lymph flow, nutrition of the muscles and ligaments of the back, as well as the vertebrae. Therefore, the destruction of bones and intervertebral discs is stopped, and the back muscles are strengthened.

Prevention

In the age of computer technology, office workers spend their working day sitting in front of a monitor screen. And schoolchildren are mostly at school, sitting at their desks, and at home doing homework. As a result, various spinal deformities may develop. Therefore, it is necessary to organize the workplace correctly for each employee and schoolchild.

How to choose a corset for stooping?

Corsets are used to fix different parts of the spinal column: lumbar, sacral, thoracic or cervical.

Corset tasks

• formation of correct posture
• maintaining the spine in a physiologically correct position during curvature
• fixation of the spine after surgery or injury, in the presence of a herniated disc and other diseases

Types of corsets
The model and type of corset is recommended by the attending physician individually, depending on what goals need to be achieved and the severity of the disease itself. In addition, the doctor will select the type of corset: thoracic, thoracolumbar, lumbar, lumbosacral or cervical.

Your tasks:

• Choose the correct corset size. To do this, while inhaling, measure your chest circumference and height. Next, refer to the size table, which is included in the description of each model. If your parameters are intermediate, then give preference to the product bigger size.


• Choose a corset made from quality material:
  • The corset fabric itself should be light and elastic, and its inner surface should be made of cotton fabric
  • all metal inserts and corrective parts must not press or rub
  • It’s better to opt for a product that is equipped with Velcro fasteners and wide elastic straps

Rules for wearing a corset

• no more than six hours a day
• must be removed at night
• do not tighten too tightly, as local blood circulation is impaired
• wear if necessary: ​​performing physical work, traveling in public transport, etc.
• wear over underwear so that the corset details do not rub the skin

What exercises to do for stooping?

There are complexes of therapeutic and health-improving physical education that are aimed at strengthening the back muscles. They are quite simple, so anyone can do them at home.

The simplest set of exercises for stooping

1. Take the starting position (IP): Lie on your stomach, raise your hands to your shoulders. Then, as you inhale, lift your chest while resting on your forearms and throwing your head back. As you exhale, lower yourself.
2. I.P. Get on all fours, bend your back down as much as possible and spread your elbows to the sides. In this position, walk 40-50 steps.
3. I.P. Lie on your back and bend your knees. Then lean on your feet and head, then lift your pelvis and back from the surface. Hold this position for 2-3 seconds and return to the starting position.
4. I.P. Sit on the floor, straighten your legs and place your hands on your shoulders. Then perform backward circular movements (counterclockwise). At the same time, straining the muscles of the abductor shoulder blades as much as possible.

How to treat stooped posture in a child?

In children, due to circumstances (staying at a desk for a long time in an incorrect position, and so on), postural or functional kyphosis most often develops. The parents' task is to prevent further development kyphosis and promote full recovery child.

Fortunately, children have the opportunity complete cure, because their spine is not fully formed, and the muscles and ligaments of the back are elastic.

To treat stooped posture in children, the following will be used:

• therapeutic and health-improving gymnastics
• wearing a corset
• back massage
• proper organization of the workplace
• swimming lessons under the guidance of an experienced instructor

How to identify stoop?

Slouch- a physical flaw that is usually clearly visible.

Characteristic appearance person with kyphosis:

• shoulders are lowered and tilted forward and downward because the chest muscles are shortened
• head tilted forward
• the abdomen is protruded due to weakness of the abdominal muscles and hyperlordosis of the lumbar spine (excessive forward curvature)
• legs bent at the knees
• the chest is narrowed

There are two diagnostic methods:

• X-ray of the spine in lateral projection
• magnetic resonance imaging of the spinal column