Management of Kyphosis in the Elderly

8/7/2019 Management of Kyphosis in the Elderly

1/31

Ma. Celina C. Butalon, MD

Department of Rehabilitation Medicine

Philippine General Hospital


2/31

KYPHOSIS

y Excessive curvature of

the thoracic spine

y Round back deformity


3/31

NORMAL KYPHOSISy Cobbs Angle

y 20-40 degrees

y Measured from T2-T12


4/31


5/31

Anterior Wedge Fracture

y Anterior part ofvertebral body is

crushedy Middle column intact

y Anteriorcolumndecreased in

heighty Posterior

columnunchanged


6/31

y Majority of damagelimited to anterior

column

y Fracturestable

y Rarely associated withneurologic compromise


7/31

Increasing kyphosis angle is independently associatedwith worsening mobility. Interventions are needed to

prevent or reduce increasing kyphosis and mobilitydecline.

Katzman W, VittinghoffE, Ensrud K, Black D, Kado D. Increasing kyphosispredicts worsening mobility in older community-dwelling women: aprospective cohort study. Jounal of American Geriatric Society. 2011

Jan;59(1):96-100


8/31

VERTEBRAL COMPRESSION

FRACTURE

y MODIFIABLE RISK FACTORS

y Advanced age

y Female gender

y Caucasian race

y Presence of dementia

y Susceptibility to falling

y History of fractures in adulthood

y History of fractures in a first-degree relative

y Hallmark of osteoporosis


9/31


FRACTURE

y NON-MODIFIABLE RISK FACTORS

y Being in an abusive situation

y Alcohol and/or tobacco use

y Presence of osteoporosis and/or estrogen deficiency

y E

arly menopause or bilateral ovariectomyy Premenopausal amenorrhea for more than one year


10/31


FRACTURE

y NON-MODIFIABLE RISK FACTORS

y Frailty

y Impaired eyesight

y Insufficient physical activity

y Low body weight

y Dietary calcium and/or vitamin D deficiency


11/31

Spinal Compression Fracturey Insidious

y Produce modest back pain

y Multiple fractures loss of heighty Shortening of paraspinal musculature

Prolonged active contraction Maintenance of posture

Pain from muscle fatigue


12/31

Thoracic Kyphosisy Develop as vertebral

height is lost

y Rib cage presses down onpelvis

y Reduced thoracic andabdominal space

Impaired

pulmonary

function

Protruberant

abdomen

early satiety

Weight loss


13/31

DIAGNOSIS

RADIOGRAPHIC FINDINGSy

Wedge-shaped vertebral bodyy Narrowing of anterior portion


14/31

COMPRESSION FRACTURE

y Decrease in vertebral

height of >20%

y Decrease of at least 4mm compared with

baseline height

50% decrease

In vertebral

height


15/31

y Common location

y T8-T12

y L1

y L4


16/31

DIAGNOSISy 20-30% are multiple

y May occur at different levels

y One to five consecutive vertebral bodies


17/31

DIAGNOSISy CT Scan

yIdentify fractures notwell visualized in plainfilms

y

Reveal spinal canalnarrowing


18/31

DIAGNOSIS

y MRI

y Spinal cord compression


19/31

DIAGNOSISy Bone density studies y Bone scan


20/31

TREATMENT

y Determine stability of spine

y Stable fracture

y Non operative and conservative

yAvoid inactivity

y Oral or parenteral analgesics


21/31


22/31

TREATMENTBraces for Osteoporotic Vertebral Compression Fracture

Jewett Hyperextension Brace


23/31

TRE

ATMEN

TBraces for Osteoporotic Vertebral Compression FractureMolded Jacket or Clam-shell


24/31


Cruciate Anterior Spinal Hyperextension Brace


25/31


26/31


Spinomed

Pfeifer, M., Begerow, B., Minne, H.W. (2004). Effects of a new spinal orthosis on posture, trunk strength, and

quality of life in women with postmenopausal osteoporosis: A randomized trial. Am J Phys Med Rehabil. 83:177

186.


27/31

TREATMENTPercutaneous Vertebroplasty

y Injecting acrylic cementinto the collapsed

vertebra

y

Stabilize and strengthenthe fracture and vertebral

body


28/31

TREATMENTKYPHOPLASTY

y cement is injected into a

cavity created by a high-pressure balloon


29/31

y Full recovery at 6 to 12 weeks

y

Return to normal activities after fracture has completelyhealed


30/31


31/31

Three Column Spinal Stability by Denis

Anterior 2/3 of vertebral body

Anterior Longitudinal Ligament

Posterior 1/3 of vertebral body Posterior Annulus

Posterior Longitudinal Ligament

Posterior elements

Pedicles, facets, laminaLigamentous complex

facet capsules

Ligamentum flavum

Interspinous ligament

Supraspinous ligament

Management of Kyphosis in the Elderly

Documents

Transcript of Management of Kyphosis in the Elderly