Kyphosis of the thoracic spine: what does it mean?

Back pain, shortness of breath, irritability, increased fatigue - all these are signs of certain disorders in the body. And few people realize that the cause of such disorders can be thoracic kyphosis - curvature of the spine, which is externally manifested by a common stoop or hunched posture. What do you need to know about this problem? How to identify it and is it possible to get rid of it?

What does it mean?

When speaking about thoracic kyphosis, medical professionals mean the incorrect position of the corresponding spinal section – namely, the incorrect tilt of its anteroposterior plane.

This section is most susceptible to pathological curvatures, although the disorder itself also occurs in the lumbar region.

The problem often reveals itself not only in the characteristic stoop of a person: the patient develops back pain and neurological disorders.

Normally, the spine is not even and straight: there is a physiological anteroposterior curvature - the so-called physiological thoracic kyphosis, the degree of which should not exceed 30-40´. Otherwise, they talk about pathological kyphosis, which, in turn, can be combined with other disorders - for example, with scoliosis.

Normal thoracic kyphosis

Human health largely depends on the condition of his spine. And in order for the vertebrae to comfortably perform their function, the spinal column has natural curves that provide the necessary degree of cushioning during movements.

In order for these mechanisms to work adequately, each of the vertebral sections has its own normal bending level indicators. Changing these indicators in one direction or another leads to health problems. In this case, problems arise most often in the thoracic section.

The normal values for thoracic kyphosis are oriented towards a value of 30-40´, although there may be fluctuations depending on age (approximately from 23 to 45´).

The kyphosis type of curvature most often forms in the thoracic spine, which acquires an incorrect configuration. This gives the posture a stooped or hunched look.

It is interesting that at first such a violation goes unnoticed. Only with time can a person hear about the shortcomings of his posture from friends or close people.

There are many reasons for the pathology, but they all come down to one: the position of the spine is regulated by the tension of muscles and ligaments. When such a supporting apparatus is weak, a violation occurs in a certain place, the load on the spinal column increases. Over time, pain and stagnation appear, which, in turn, leads to the development of diseases of the internal organs. And when the intervertebral discs are overloaded, the risk of osteochondrosis and the formation of hernias increases. To prevent such a development of events, it is necessary to promptly identify thoracic kyphosis and treat it.

Epidemiology

According to updated statistics, almost 10% of people on the planet have thoracic kyphosis to a lesser or greater degree.

Most often, the problem is detected in childhood and adolescence, with girls suffering to a lesser extent than boys.

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Causes thoracic kyphosis

As we have already noted, there are many reasons for the occurrence of thoracic kyphosis, for example:

• congenital weakness of the paravertebral muscles, congenital cysts, anomalies, etc.;
• unfavorable heredity (for example, Scheuermann-Mau dorsopathy);
• mechanical damage to the spinal column, back;
• paresis and paralysis of the spinal muscles (in cerebral palsy, poliomyelitis);
• postoperative complications (after surgical interventions on the spine);
• a sedentary lifestyle, which leads to a general weakening of the muscles;
• compression injuries of the thoracic vertebrae;
• diseases of non-infectious etiology, which include oncology of the spinal column, spondylitis, ankylosing spondylitis;
• underdevelopment of the muscular frame of the back;
• rickets;
• frequent and prolonged stay in an uncomfortable “hunched” position (for example, at a desk, at a computer);
• degenerative processes (osteochondrosis, osteoporosis).

Often the cause of the formation of thoracic kyphosis in childhood is a psychological factor: for example, some teenagers begin to consciously slouch, trying to hide their tall stature or figure flaws.

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Risk factors

Sometimes, with the same causes, some people develop thoracic kyphosis, while others do not. Why does this happen? The fact is that there are certain risk groups, which include people with an increased predisposition to such pathology.

The risk groups for developing thoracic kyphosis include:

• patients with a family history of severe postural disorders or spinal curvature;
• teenagers who are tall;
• people prone to physical inactivity and leading a sedentary lifestyle;
• physically weakened patients, frequently ill children;
• overweight people;
• patients with back and spine injuries;
• people working on a conveyor belt production line, forced to perform monotonous repetitive movements with an unchanged body position.

Those people who are in several risk groups at the same time are at particular risk – for example, an overweight child who often sits at the computer and does not engage in physical activity.

Pathogenesis

Thoracic kyphosis can manifest itself in both childhood and adulthood, including in the elderly. Moreover, the causes are almost always different, which allows us to divide the disease into several types, depending on the mechanism of development.

• Functional kyphosis is a consequence of incorrect posture and is found in children and young people. Under certain conditions (for example, with regular incorrect sitting at the table), overstretching of the vertebral ligaments occurs, the vertebrae change their shape, and a peculiar forward tilt is formed. At the same time, the load on other parts of the spinal column increases: compensatory increased lordosis is formed.
• The congenital form of kyphosis begins in the 5th to 8th week of intrauterine development, when the spinal column of the future baby is being laid down. Certain disorders in this period (diseases, intoxication in a pregnant woman, taking certain medications) can cause the development of spinal defects in the child and congenital weakness of the paravertebral muscles.
• In post-traumatic kyphosis, the basis for the development of the problem is a violation of the anatomical structure of the spine, which becomes deformed and unstable. As a result, the paravertebral muscles cease to perform their functions properly.
• With degenerative kyphosis, the vertebrae change their configuration, the discs become lower (or hernias form), the muscular frame weakens. As a result, the spine begins to deform under the influence of any load. At the same time, healthy segments of the spinal column take on the main share of the load, quickly wear out, which also affects the spinal stability.
• Senile kyphosis develops under the influence of age-related changes: the vertebrae soften, the discs become thinner, the muscular-ligamentous apparatus loses elasticity. All these processes cause various curvatures of the spine, including the kyphosis type.

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Symptoms thoracic kyphosis

It should not be thought that thoracic kyphosis manifests itself only in stooping and hunching. Pathological changes can also spread to other organs and systems.

• Due to kyphosis curvature, the chest loses volume, which negatively affects the quality of breathing (inhalation becomes shallow and incomplete).
• The diaphragm descends, which begins to put pressure on the abdominal organs, causing disruption in their functioning.
• In addition to the increase in kyphosis pathology according to the compensatory type, the patient develops lumbocervical hyperlordosis.
• The shock-absorbing function of the intervertebral discs changes, and the spine seems to “sag.”
• The spinal nerve roots are pinched, and the innervation of the arms and legs is disrupted.
• The load on the intervertebral discs is distributed unevenly, and osteochondrosis develops.

The first signs of problems caused by kyphosis changes may be:

• increased fatigue of the back muscles;
• back pain (some patients experience pain in the chest, between the shoulder blades, or the entire chest and shoulder girdle);
• tingling in the fingers, numbness, feeling of weakness;
• loss of appetite, digestive problems (many complain of heartburn, intestinal disorders);
• breathing difficulties, frequent respiratory diseases;
• disorders of the cardiovascular system (hypertension, increased heart rate).

Pain in thoracic kyphosis may not manifest itself immediately: it intensifies gradually, in the absence of necessary treatment, which often leads to unfavorable consequences in the future. Many patients experience pain not only at the level of the affected spine: it can “radiate” to other areas of the body - for example, to the sternum, shoulder girdle, upper abdominal cavity.

Thoracic kyphosis in a child

Childhood thoracic kyphosis can be congenital or acquired.

Congenital pathology is a consequence of impaired intrauterine development, and in approximately 25% of cases it is observed in combination with defects in the development of the urinary system.

The causes of congenital kyphosis are certain disorders that occur during the 5-8 week of pregnancy, when the formation of the corresponding organs and ossification of the vertebrae occurs. In combination with kyphosis changes, such children often have neurological symptoms, urinary disorders, etc.

Juvenile thoracic kyphosis develops during the period of pronounced growth of adolescents - between 14 and 16 years. In medicine, this pathology is called Scheuermann-Mau disease. The exact cause of the disease is unknown. Presumably, we are talking about congenital excessive growth of bone tissue, necrosis of hyaline cartilage, early osteoporosis, and a defect in the development of the back muscles. The disease is diagnosed relatively rarely - in about 1% of children.

Stages

Thoracic kyphosis is divided into several degrees, depending on how pronounced the angle of inclination is.

• Thoracic kyphosis of the 1st degree is characterized by a range of tilt angle from 31 to 40´. Externally, stooping is almost not visible, but the back quickly gets tired, and pain may bother.
• Thoracic kyphosis of the 2nd degree is diagnosed at an angle of inclination within 41-50´. The posture disorder is noticeable from the side: the shoulders look lowered and "look" forward, the stomach protrudes somewhat, the back is "rounded". The head may shift forward. The patient often develops respiratory and heart diseases.
• Thoracic kyphosis of the 3rd degree is diagnosed at an angle of inclination within 51-70´. The back looks clearly deformed (S-shaped), the person becomes shorter due to the visual shortening of the spine. Pain bothers both under load and at rest. Muscle tone in the limbs decreases. Neuralgia, shortness of breath, heart problems, and digestive disorders often occur. Unpleasant sensations in the form of numbness and tingling are often noted in the back, arms, and legs.

If the angle is more than 71´, then we speak of a critical fourth degree pathology.

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Forms

If we consider thoracic kyphosis based on the causes of its occurrence, then we can classify the disease into groups or varieties. The corresponding terms can be found in the patient's medical history, in the column of preliminary or main diagnosis.

• Physiological thoracic kyphosis is a normal curvature of the spinal column, which, along with the balancing physiological lordoses, contributes to adequate cushioning of the spine during movements and loads.
• Pathological thoracic kyphosis is an excessive curvature of the thoracic spine with a posterior convexity. Such a curvature can develop with age-related changes or as a result of damage to discs or vertebrae. Pathological kyphosis disorder can be provoked by a number of diseases, including hyperparathyroidism, Cushing's disease, osteoarthritis, Paget's disease, poliomyelitis, tumor and tuberculosis processes. In some cases, the pathology is caused by prolonged corticosteroid therapy, spinal injuries, incorrect back position during work or study.
• Cervicothoracic kyphosis can be congenital or acquired, and it is not always noticeable to the naked eye. Often, the pathology is discovered only after visiting a doctor about discomfort in the neck and back, headaches, hearing and visual impairment, and blood pressure fluctuations. The causes of the pathology are practically the same as for isolated kyphosis-thoracic pathology.
• Osteochondropathy kyphosis of the thoracic spine is a term identical to the diagnosis of juvenile kyphosis, or Scheuermann-Mau disease. The spine changes its shape during the period of intensive development of the musculoskeletal system in a child - approximately at the age of 14-15 years. The exact cause of such kyphosis has not been established. It is assumed that the provoking factor is congenital hypertrophied growth of bone tissue on the vertebrae against the background of necrosis of the hyaline cartilage, with improper blood supply to the spine. Other possible causes include osteoporosis and impaired development of the spinal muscles.
• When the angle of inclination of the corresponding section of the spinal column exceeds 30´, then we speak of increased thoracic kyphosis. In different patients, thoracic kyphosis is increased differently, depending on the degree of pathology - and in all cases we are talking about a deviation from the norm. A consultation with a medical specialist is required if there is a pronounced thoracic kyphosis.
• A normal healthy spine has a physiological S-shaped curvature. If the angle of inclination is determined by a value less than 15´, then they say that such a curvature is smoothed. Not all doctors point to pathology if the thoracic kyphosis is straightened, the smoothness of the thoracic kyphosis is outwardly almost imperceptible and it seems that everything is fine with the patient. However, most specialists still agree that this condition is still related to pathology. Smoothness is most often found in people who, for various reasons, spend a lot of time lying in bed. Other causes include back injuries, myositis, congenital disorders.

Complications and consequences

Thoracic kyphosis itself develops on an increasing schedule for quite a long time: often the problem “emerges” in childhood and adolescence, when the spinal column is still flexible and the tissues are elastic. But with age, various unpleasant consequences and complications begin to appear.

The extent of the problems depends on the degree of the disorder. Sometimes the nerve endings and spinal cord are compressed, but the muscles near the spine can also be subject to spasm. The nerve pathways leading to the brain are damaged, which becomes the impetus for the development of pathologies such as epilepsy. When the spinal cord is deformed, its function at the corresponding level is impaired.

At first, an inflammatory process develops around the compressed tissues. The muscles near the inflammation zone contract to the maximum, compressing the surrounding vessels. Ischemia occurs as a result of a disruption of the flow in the vessels, processes of oxygen and trophic deficiency in the affected tissues are triggered, and the conductivity of nerve fibers is disrupted.

With thoracic kyphosis, osteochondrosis manifests itself especially acutely, causing severe pain and connecting the damaged vertebrae, which further aggravates the problem. Problems begin with the internal organs: the digestive tract, the respiratory system. The heart and liver also suffer, blood pressure increases. To prevent the development of such disorders, it is necessary to promptly diagnose and treat thoracic kyphosis.

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Diagnostics thoracic kyphosis

Orthopedic and vertebrological doctors diagnose thoracic kyphosis. During the consultation, the doctor examines the patient, palpates the spine, sometimes asks to bend the back or stand up straight. Then he clarifies and details the complaints, checks the quality and strength of the muscles, evaluates the sensitivity of the skin, checks for reflexes.

Instrumental diagnostics usually involves X-raying the spine. X-rays are often taken in different projections at once - for example, in the front and side, after which a targeted shot is taken in a non-standard position (to check the functional capacity of the spine).

If pathologies of the muscular corset are suspected, the patient is prescribed an MRI procedure. And the computed tomography method helps to clarify the changes affecting the bone apparatus.

To determine the degree and severity (coefficient) of the disorder, an X-ray examination of the spinal column is performed with a lateral projection and maximum extension. The centers of the vertebral bodies are taken as measuring points - the geometric intersection of their diagonal lines. Straight lines are drawn connecting the centers of the outer vertebral bodies and the vertebra that is located at the upper kyphosis point. As a result, a triangle is obtained: a perpendicular line from the center of the "upper" vertebra is lowered to its base, after which the height and length of the base of the formed triangle are measured. The value of the thoracic kyphosis coefficient is determined as the ratio of the measured length to the height. A pathological value is said to be if this coefficient is less than or equal to 10.

To determine the kyphosis angle, continue to draw lines through the point where the legs intersect in the center of the "upper" vertebra. The kyphosis angle needed for diagnostics is the one that is adjacent to the legs from the outside.

The thoracic kyphosis index is defined as the ratio of the distance from the anterior superior border of the third and inferior anterior border of the twelfth thoracic vertebrae to the maximum distance from the drawn line to the anterior edge of the spine. The index value is estimated in points:

• up to 0.09 – normal variant, or so-called 0 points;
• from 0.09 to 0.129 – 1 point;
• from 0.130 to 0.169 – 2 points;
• 0.170 and above – 3 points.

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Differential diagnosis

Differential diagnosis should be carried out with the following pathologies:

• spinal thoracic nerve damage;
• intercostal nerve damage;
• extramedullary and intramedullary pathologies (tumor processes, abscesses);
• disc herniations, neoplasms, radiculopathy;
• vertebral body injuries, inflammatory processes.

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Treatment thoracic kyphosis

Treatment measures are prescribed primarily based on the symptoms and pathologies that develop as a result of thoracic kyphosis. If possible, preference in treatment is given to a conservative method, supplemented by physiotherapy, exercise therapy, and massage.

Massages help to activate the blood supply to tissues. With the improvement of trophic processes in the muscles, the spine can gradually acquire the necessary configuration, which will lead to a decrease in pressure on the nerve endings and tissues, relieve pain and improve the functioning of organs. In addition, a properly conducted massage course has a relaxing and antispasmodic effect. And vice versa: incorrect massage movements, rough impact can aggravate the situation, disrupting blood and lymph flow.

The benefits of exercise therapy are undeniable, even for healthy people. Specially designed exercises can improve blood circulation, strengthen muscles, and increase tissue tone. For patients with thoracic kyphosis, exercises are selected especially carefully so as not to cause harm or worsen pain.

Strength exercises should be excluded: they contribute to increased load on the back, which significantly worsens well-being. With regular and prolonged force effects, the degree of kyphosis disorder may increase, and the pain syndrome will become more pronounced.

Drug treatment for thoracic kyphosis involves taking glucocorticosteroids, non-steroidal anti-inflammatory drugs, analgesics, muscle relaxants, and blockades.

Blockades are prescribed for severe back pain: medicinal substances that block impulse transmission are injected into a specific area. Novocaine and lidocaine, which are blockers of cellular sodium channels, are most often used. The injection is performed only by a doctor in a hospital setting.

Prevention

Prevention of spinal curvatures is a necessary measure for all people, and it should be started from childhood. Preventive rules must be followed by yourself and teach your children to do the same.

• When working at a table or sitting at a desk, you need to control your posture: your feet should be completely on the floor, your thighs should be parallel to the floor, your back should be kept straight, and your elbows should be on the table.
• Maintaining correct posture while walking is no less important, so the position of the back should always be kept under control.
• To maintain the health of the spine and the entire musculoskeletal system, it is necessary to eat properly and nutritiously, ensuring the intake of all useful substances into the body - first of all, this concerns minerals and vitamins.
• Hypodynamia is the enemy of spinal health. Therefore, you need to keep yourself in good physical shape, strengthen the back muscles. Even ordinary but regular morning exercises will help with this.
• Any problems with the spinal column should be treated promptly, without delaying a visit to the doctor.
• At work, during sports, and in any other circumstances, one must not forget about safety and injury prevention. In addition, it is necessary to control the load on the spine so as not to overload the back and not to damage the structure and functionality of the vertebrae and muscles.

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Forecast

Today, there are many opportunities to detect thoracic kyphosis at early stages of development. This allows for high-quality and safe restoration of the spinal column, in many cases avoiding surgical intervention.

In general, most people with such a diagnosis live a normal, full life, without an increased risk of complications. However, some still periodically experience pain, impaired ability to work, and suffer from life activity. It is safe to say that the quality of the prognosis depends on the degree of curvature and the timeliness of the patient's request for medical help.

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Will people diagnosed with thoracic kyphosis be drafted into the army?

The possibility of serving in the armed forces for a patient with thoracic kyphosis is decided on an individual basis. Why?

The fact is that thoracic kyphosis itself is not a reason for exemption from service. But there are some reservations:

• at the first degree of curvature, no exemptions or deferments from military service are provided;
• in the second degree of pathological disorder, this issue is considered additionally: if a young man indicates a constant pain syndrome not associated with overloading of the spine, then he is recommended to undergo a series of diagnostic examinations, and the outcome of the case is decided on the basis of the results obtained;
• If, against the background of kyphotic curvature, a patient is found to have problems with the functioning of internal organs, and these problems are incompatible with serving in the army, then the young man may be declared unfit for military service;
• The third and fourth degree of thoracic kyphosis, complications of the disease, impossibility or limitation of physical activity are direct reasons for recognizing the patient as unfit for military service.

When going to undergo a military commission, a conscript must remember: the main requirements of doctors are that any malfunction in the body must be diagnosed (proven by diagnostics) and written down in a document. If, apart from verbal complaints, a young man does not present anything documented, then it is unlikely that he will be recognized as unfit for service. It is necessary that the patient's regular requests for an existing pathology be written down in the medical record, all episodes of treatment, medical observations, etc. be recorded. Only if all the relevant records are available can one expect that thoracic kyphosis will become a reason for exemption from military conscription.