- Postural spinal balance is maintained by a complex interplay of the disc complex, ligaments, and muscles surrounding the vertebra
- Normal thoracic kyphosis is considered to be 20˚-40˚ as measured from T2-T12
- Postural kyphosis will present with a more gradual, rounded deformity than Scheuermann’s kyphosis
- The deformity is completely correctable on an exam or with improved posture
- Education of the patient and family is the most effective treatment
- Posture is the relationship of the body to a vertical line passing through the body’s center of gravity
- Spinal stability and maintenance of an upright posture against gravity are maintained by a number of structures:
- The disc complex: nucleus pulposus and annulus
- Ligaments: anterior and posterior longitudinal ligaments, ligamentum flavum, interspinous ligament, apophyseal joint ligaments
- Muscles: long spinal muscles, short intrinsic spinal muscles, abdominal muscles (Harrison, 1999)
- The spine will be in a relatively flexed position until the child begins walking upright
- To counteract the head’s anterior position to the body’s vertical axis, cervical lordosis develops and centers the head over the pelvis
- In order to match the flexed position of the hips and pelvis, the lumbar spine becomes lordotic
- Unchanged from its infantile position, the thoracic spine will remain kyphotic (Johnston, 2014)
- Normal thoracic kyphosis is considered to be 20˚-40˚ measured from T2-T12 (Fon, 1976)
- The most common causes of hyperkyphosis in the adolescent are postural round-back deformity or Scheuermann’s kyphosis (Roussouly, 1999)
- Postural kyphosis is a condition seen not infrequently in adolescents. Its specific incidence is not defined in the literature
- The condition is most common in children who are taller than their peers and in young, adolescent girls with early breast development who are self-conscious about their bodies (Warner, 2014)
- Parental concerns over the deformity, more so than patient concern, are typically what brings the child to the attention of an orthopedist.
- A gentle rounding of the spine in the thoracic region will be seen on a forward bend test.
- The kyphosis in postural kyphosis is not as sharp or angular as that seen in congenital or Scheuermann’s kyphosis (Warner, 2014).
- The deformity should be completely correctable on an exam or with changes in posture.
- The erector spinae muscles can contract to correct the thoracic kyphosis while contraction of the abdominal musculature will flatten the concomitant lumbar lordosis (Johnston, 2014).
- Radiographs should show no osseous abnormalities in true postural kyphosis.
- Thoracic kyphosis can be assessed on a standard lateral radiograph with a Cobb angle measurement extending from the superior end plate of T2 to the inferior end plate of T12.
- The apex of normal thoracic kyphosis is the T6-7 disc space.
- The thoracolumbar junction should be without kyphosis or lordosis.
- No medical treatment is required for this condition owing to its benign natural history.
- A hyperextension brace is not indicated (Warner, 2014).
- Core strengthening exercises may provide some benefit and improve the adolescent’s posture, though compliance with any exercise program is difficult to achieve in an adolescent patient.
- Education of both the parents and the patient may be the best treatment option (Johnston, 2014).
- Surgery is not indicated in this condition.
- Postural kyphosis is a self-limiting condition that has no long-term sequelae.
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References:1. Fon, GT., Pitt, MJ., and Thies, Jr., AC. Thoracic kyphosis: range in normal subjects. Am J Roentgenol. 1976;134(5):979-83.
2. Harrison, DD., et. al. Sitting biomechanics part 1: review of the literature. J Manipulative Physiol Ther. 1999;9:594-609.
3. Johnston, CE. Kyphosis. In: Tachdjian’s Pediatric Orthopaedics. 5th ed. Philadelphia, PA: Elsevier;2014:308-27.
4. Roussouly, P. and Nnadi, C. Sagittal plane deformity: an overview of interpretation and management. Eur Spine J. 2010;19:1824-36.
5. Warner, Jr., WC. and Sawyer, JR. Kyphosis. In: Lovell and Winter’s Pediatric Orthopaedics. 7th ed. Philadelphia, PA; Lippincott, Williams, & Wilkins;2014:739-90.