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 !!!