The 33 vertebrae in the human spine are uniquely aligned to efficiently support the body. The gentle curves (as seen from the side of the spine) help the muscles support the body with minimal effort. The alignment also provides openings for the nerves originating in the spinal cord to pass out of the spinal column to their destinations. When a vertebra is not in alignment, many problems may occur.
What is kyphosis?
Kyphosis is a deformity of the spine that results in a segment of it curving (flexing) more than is normal. Because the vertebrae are no longer stacked properly, the muscle and nerve functions are disturbed. Symptoms include pain and impaired nerve function, which can develop slowly or rapidly and may get worse over a period of time. When excessive, this abnormal flexing may result in a hunchback.
What causes kyphosis?
Kyphosis is caused by the deformity of the vertebra. Kyphosis that occurs in children is usually due to abnormal development (congenital or during adolescent growth) or poor posture. In adults, kyphosis may be caused by fractures to the spine, injury, tumors, infection or osteoporosis (deterioration of the bone).
Can kyphosis be prevented?
Not all causes of kyphosis can be prevented, but certain actions may reduce the possibility of it developing. These actions include good posture, good nutrition, consistent and sensible exercise, avoiding smoking, proper lifting and accident prevention.
What surgical treatment options exist for kyphosis?
Kyphoplasty for osteoporotic fractures
Kyphoplasty is a surgical procedure that treats kyphosis caused by fractures of the vertebral body, in turn caused by osteoporosis or bone diseases such as multiple myeloma. The surgery is minimally invasive, requiring only a very small incision in the back. A narrow tube is inserted through the incision using fluoroscopy to guide it into the correct position in the damaged vertebrae. Using the tube as a channel, the surgeon guides a special balloon into the vertebral body.
The balloon is then carefully inflated, restoring the vertebrae to a more normal shape. The balloon also creates a cavity in the vertebral body by compacting the soft inner bone material.
The balloon is then deflated and gently removed. Special instruments are then used to fill the cavity with a soft cement-like material which quickly hardens to stabilize the vertebrae. With the vertebrae shape and height restored, the pressure on the nerves is reduced, easing the pain.
Fusion with bone graft
Spinal fusion is a "welding" process by which two or more of the vertebrae that make up the spinal column are fused together with bone grafts and internal devices such as metal rods. The surgery eliminates motion between vertebrae segments. Spinal fusion may be used to treat abnormal curvatures such as scoliosis or kyphosis.
Bone is the most commonly used material to help promote fusion. Generally, small pieces of bone are placed into the space between the vertebrae to be fused. Sometimes larger solid pieces of bone are used to provide immediate structural support. Bone may come from the patient (autogenous bone) or a bank of bone harvested from other individuals (allograft bone). After the fusion procedure has been performed, the adjacent spinal segments are held immobile to allow fusion to progress. Immobilization is achieved through internal fixation devices or external bracing or casting. Both forms of immobilization may be necessary at times.
Fusion with instrumentation
Normally, each vertebrae moves with respect to the one above and below it, allowing the spine to bend and rotate. A fusion means to fuse the two vertebra so that they cannot move on one another. Spinal instrumentation is often used to help provide stability for the spine after vertebrae have been fused together. Common types of instrumentation include:
- anterior cervical plates, which can be applied to the front of the spine.
- posterior cervical plates, which can be placed on the side of the spine.
- posterior cervical wiring, which can be placed around the spinous processes or the facet joints in the posterior cervical spine.
- post-operative cervical braces. Because of their relatively small size, the cervical spine is well suited for postoperative braces.
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