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Transcript of kyphosis
DORSAL KYPHOSIS
Dr. Laxmikant Dagdia
SPINE ANATOMY
• 4 CURVES Cervical Thoracic ( 20 to 50 degrees kyphosis ) Lumbar ( 31 to 79 degrees lordosis ) Sacral
SPINE ANATOMYSagittal balance and plump line
What is KYPHOSIS ??
• Greek word : ‘ bowed or bent ‘
• Clinically Increased curvature, causing angulation with
posterior convexity and anterior concavity.
What causes KYPHOSIS ??
• 2 ways it can develop 1) Shortening of anterior column of spine 2) Weakening or lengthening of posterior
column.
Etiology of KYPHOSIS
• Postural • Infectious• Traumatic• Inflammatory disorders• Degenerative • Neoplastic• Congenital
• Scheuermann’s kyphosis
• Skeletal dysplasia• Neuromuscular
Diagnostic evaluation
Plain radiographs Standing AP and Lateral films of entire spine. Dynamic films : Flexibility of deformity
CT, CT Myelogram, MRI To further evaluate bony and soft tissue
anatomy comprising deformity.
Diagnostic evaluationcobb’s angle measurement
Dorsal KYPHOSIS
• Postural thoracic kyphosis• Post-infectious kyphosis • Scheuermann’s kyphosis• Osteoporotic fractures• Inflammatory disorders like ankylosing spondylitis• Neoplastic • Congenital • Dysplastic
Postural KYPHOSIS
• Smooth, flexible curve not more than 60 degrees.
• In adolscents and young adults.• Improvements of posture and extension
exercises.
Scheuermann’s KYPHOSIS
• Common cause worldwide.• 2 types 1. Typical : more common, thoracic curve.2. Atypical : unusual, thoraco-lumbar junction
curve, more often seen in athelets and labourers.
Scheuermann’s KYPHOSIS
• Sorenson’s criteria for diagnosis :1. > 5 degrees of anterior wedging in 3 or more
vertebrae at apex of curve.2. Cobb angle > 45 degrees3. Irregular vertebral end plates and disc space
narrowing in kyphotic zone.
Scheuermann’s KYPHOSIS Rx.
• Bracing: in skeletally immature patients.• Surgery :1. Skeletally immature : > 75 degrees kyphosis
even after brace treatment.2. Skeletally mature : back pain, >75 degrees
kyphosis, unacceptable cosmesis.
Scheuermann’s KYPHOSIS: Surgery
Ponte osteotomy : 1.Done in flexible, regional kyphotic deformity. 2.At level of of osteotomy : superior articulating
facet of lower vertebra and inferior of upper vertebra removed and osteotomy is closed posteriorly with pedicle screw fixation.
3.C/I : Rigid deformity, acute angular deformity as in TB.
Ponte osteotomy
Post-infectious KYPHOSIS
• Post tubercular : most common cause in our country.
• Paradiscal lesions of TB : Destruction of 1. intervertebral disc. and 2. Adjacent vertebral bodies Cause shortening of anterior column of spine
leading to KYPHOSIS.
KYPHOSIS in Potts spine
• Without neurological deficit in active disease: Unless deformity is progressive while on ATT
conservative treatment continued.
KYPHOSIS in Potts spine
With neurological deficit Improving with ATT Not improving or worsening
Continue conservative Rx. Decompression and/or fusion Long term follow up.
KYPHOSIS in Potts spine in children
• Indications for fusion in children with healed or active disease.
Rajasekaran (2007) : radiographic signs to assess ‘spine at RISK ’
1. Separation of facet joints2. Posterior retropulsion of diseased vertebrae3. Toppling sign4. Lateral transalation of vertebaral column.
1. Separation of facet joints.2. Retropulsion of diseased vertebrae
3.Lateral translation of vertebral column 4. Toppling sign
.
Post-tubercular kyphosis with spine at RISK signs
Intraoperative heartshell application.
Post tubercular kyphosis in healed disease
SURGERY INDICATION
Posterior spinal fusion Symptomatic mechanical instability in a healed disease.
Anterior transposition of cord
Neural complications due to severe kyphosis
Panvertebral fusion Prevention of severe kyphosis in children with extensive dorsal lesions.
Debridement and/or decompression and/or fusion
Recurrence of disease or neural complication.
Closing-opening wedge osteotomy
Severe deformity >70 degrees in healed disease.
Closing opening wedge osteotomy
Closing opening wedge osteotomy
A: Indications : rigid kyphotic deformity, > 70 degrees as in
1. Potts spine 2. Congenital kyphosis 3. Post laminectomy kyphosis.B: C/I : 1. Deformity >120 degrees 2. With neurological deficit.
Osteoporotic fractures
• Each standard deviation decrease in BMD = Twofold increase in spine fractures.
• Conservative management : Analgesics, bed rest and medical treatment
of underlying cause.
Osteoporotic fractures
• Indications for aggressive line of treatment: Continued progressive deformity Neurologic deterioration Pain Open fracture repair difficult : 1. Poor bone quality 2. Compromised medical status of patient.
Minimally invasive surgeries for Osteoporotic fractures
• Vertebroplasty : Percutaneous injection of polymethylmethacrylate( PMMA ) into a fractured vertebral body.
• Kyphoplasty : insertion of balloon that is inflated in vertebral body before injection of PMMA.
Vertebroplasty placement of trocar and injection of PMMA
Kyphoplasty: balloon inflation before injection of PMMA
Congenital kyphosis
• Type 1 : Failure of vertebral body formation
1. Posterolateral quadrant vertebrae
2. Butterfly ( sagittal cleft ) vertebrae
Congenital kyphosis
3. Posterior hemivertebrae
4. Anterior wedged vertebrae
Congenital kyphosis
• Type 2 : Failure of segmentation
Congenital kyphosis
• Type 3 : Combination of 1 and 2.
Ankylosing spondylitis
• Seronegative autoimmune disorder
Sometimes causes rigid kyphotic deformity by involving multiple consetive vertebrae.
Ankylosing spondylitislumbar osteotomy
THANK YOU ALL !!!