Kyphosis of the thoracic spine: what does it mean?

Back pain, shortness of breath, irritability, fatigue - all these are signs of certain disorders in the body. And few people realize that the cause of such violations may be a thoracic kyphosis - a curvature of the spinal column, which is externally manifested by ordinary slouching or stooping. What you need to know about this issue? How to identify it and is it possible to get rid of it?

What does it mean?

Speaking about thoracic kyphosis, medical specialists mean the incorrect position of the corresponding vertebral part - namely, the wrong inclination of its anteroposterior plane.

This department is most susceptible to pathological distortions, although the violation itself also occurs in the lumbar region.

The problem often reveals itself not only the characteristic stoop of a person: the patient has vertebral pain, neurological disorders.

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

Norm of a chest kyphosis

Human health depends on the state of his spine. And so that the vertebrae comfortably perform their function, the spinal column has natural curves, providing the necessary degree of depreciation during movements.

In order for these mechanisms to work adequately, each of the vertebral divisions has its own normal indicators of the level of bending. Changes in these indicators in one direction or another lead to health problems. At the same time in the thoracic problems occur most often.

Indicators of the rate of thoracic kyphosis are based on a value of 30-40´, although there may be variations depending on age (approximately from 23 to 45´).

The kyphosis type curvature is most often formed precisely in the thoracic vertebral part, which acquires the wrong configuration. This gives the posture a stooped or stooping look.

Interestingly, at first, such a violation proceeds unnoticed. Only over time can a person hear about the shortcomings of his posture from friends or close people.

There are many causes of pathology, but they all boil down to one thing: the position of the spine is regulated by the tension of muscles and ligaments. With the weakness of such a supporting apparatus in a certain place there is a violation, the load on the spinal column increases. Over time, pain, stagnation processes occur, which, in turn, leads to the development of diseases of internal organs. And when the intervertebral discs are overloaded, the risk of osteochondrosis and hernia formation increases. In order to prevent such a development of events, it is necessary to promptly detect 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 extent.

Most often, the problem is found in childhood and adolescence, with girls suffering less than boys.

[1], [2], [3]

Causes of the thoracic kyphosis

As we have already noted, there are many causes of breast kyphosis, for example:

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

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

[4], [5], [6]

Risk factors

Sometimes with the same causes, some people develop thoracic kyphosis, while others do not. Why it happens? The fact is that there are certain risk groups that include people who have an increased susceptibility to this pathology.

The risk groups for developing kyphosis include:

• patients in the family who have had cases of pronounced violations of posture or curvature of the spinal column;
• adolescents who are tall;
• people prone to physical inactivity, leading a sedentary lifestyle;
• physically impaired patients, often ill children;
• overweight people;
• patients with back and spinal injuries;
• Persons working in the conveyor production, forced to perform monotonous repetitive movement at a constant body position.

Particularly at risk are those people who belong to several dangerous groups at the same time - for example, it can be an overweight child who often sits at a computer and does not engage in physical activity.

Pathogenesis

Thoracic kyphosis is able to manifest itself in childhood, and in adulthood, including the elderly. Moreover, the reasons are almost always different, which allows you 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 improper planting at the table), the vertebral ligaments over-exacerbation occurs, the vertebrae change their shape, a kind of anterior slope forms. At the same time, the load on other parts of the spinal column is increasing: a compensatory reinforced lordosis is being formed.
• The congenital form of kyphosis starts from the 5th to the 8th week of intrauterine development, when the future baby’s spinal column is laid. Certain disorders in this period (diseases, intoxication in a pregnant woman, taking certain medications) can cause the development of spinal defects in a child and congenital weakness of the paravertebral muscles.
• In post-traumatic kyphosis, a violation of the anatomical structure of the spine, which becomes deformed and unstable, acts as the basis for the development of a malfunction. As a result, the paravertebral muscles cease to perform their functions properly.
• In degenerative kyphosis, the vertebrae change their configuration, the discs become lower (or hernias are formed), the muscular framework weakens. As a result, the spine under the influence of any load begins to deform. At the same time, the healthy segments of the spinal column assume the main share of the load, wear out quickly, which also affects the vertebral stability.
• Senile kyphosis develops under the influence of age-related changes: the vertebrae soften, the discs become thinner, the muscular-ligamentous apparatus loses its elasticity. All these processes cause various spinal curvatures, including the kyphosis type.

[7], [8], [9], [10], [11]

Symptoms of the thoracic kyphosis

It should not be thought that thoracic kyphosis is manifested only by stoop and hunchedness. Pathological changes can spread to other organs and systems.

• The thorax due to kyphosis curvature loses in volume, which negatively affects the quality of breathing (inhalation becomes superficial, inadequate).
• There is a prolapse of the diaphragm, which begins to put pressure on the abdominal organs, causing a disturbance in their work.
• In addition to the increase in kyphosis pathology, the patient develops a lumbar-cervical hyperlordosis according to a compensatory type.
• The depreciation function of the intervertebral discs changes, the spine “sinks” as it were.
• The spinal nerve roots are clamped, the innervation of the arms and legs is disturbed.
• The load on the intervertebral discs is unevenly distributed, osteochondrosis develops.

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

• increased muscle fatigue of the back;
• back pain (some patients have chest pain, 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);
• difficulty breathing, frequent respiratory problems;
• disorders of the cardiovascular system (hypertension, increased heart rate).

The pains in the chest kyphosis can manifest themselves far from immediately: they intensify gradually, in the absence of the necessary treatment, which often leads to adverse consequences in the future. Pain in many patients is present not only at the level of the affected spine: they are able to "give" to other areas of the body - for example, in the region of the sternum, shoulder girdle, upper abdominal cavity.

Thoracic kyphosis in a child

Infantile kyphosis is congenital or acquired.

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

Causes of congenital kyphosis are certain disorders that occurred during the period of 5-8 weeks of gestation when the corresponding organs are laid and vertebrae are ossified. In combination with kyphosis changes, neurological symptoms, urinary impairment, etc. Are often found in such children.

The juvenile kyphosis of the thoracic spine is formed during the pronounced growth of adolescents - in the period from 14 to 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 overgrowth of bone tissue, hyaline cartilage necrosis, early osteoporosis, a defect in the development of the muscles of the back. 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.

• Thoracic kyphosis of the 1 st degree is characterized by the inclination angle range from 31 to 40´. Outwardly, slouching is practically invisible, but the back quickly gets tired, and pain may disturb.
• Chest kyphosis of 2 degrees is diagnosed at an angle of inclination in the range of 41-50´. Disturbance of posture is noticeable from the side: the shoulders look down and “look” forward, the stomach is somewhat protruding, the back is “rounded”. Perhaps the displacement of the head anteriorly. The patient often develops diseases of the respiratory tract, heart.
• Grade 3 thoracic kyphosis is diagnosed at an angle of inclination in the range of 51-70´. The back looks clearly deformed (S-shaped), the person becomes lower due to the visual shortening of the spine. Pains are disturbing, both under load and at rest. In the limbs muscle tone decreases. Often there are neuralgia, shortness of breath, abnormal heart function, digestive disorders. In the back, arms and legs are often marked discomfort in the form of numbness, tingling.

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

[12], [13]

Forms

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

• Physiological thoracic kyphosis is the normal bending of the spinal column, which, along with balancing physiological lordosis, contributes to adequate depreciation of the spine during movements and loads.
• Pathological thoracic kyphosis is the excessive bending of the thoracic spine with a bulge posteriorly. Such a curvature may develop with age-related changes, or as a result of damage to the discs or vertebrae. Pathological kyphosis can be triggered 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 due to prolonged corticosteroid therapy, spinal injuries, incorrect position of the back during work or school.
• The cervicothoracic kyphosis can be congenital and acquired, it can not always be seen with the naked eye. Often they learn about the pathology only after visiting the doctor about the discomfort in the neck and back, headaches, hearing and visual impairment, and blood pressure drops. The causes of pathology are practically the same as for isolated kyphosis and pectoral pathology.
• Osteochondropathic 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 - at about 14-15 years of age. The exact cause of such kyphosis has not been established. It is assumed that congenital hypertrophic bone tissue growth on the vertebrae against the background of hyaline cartilage necrosis, with improper blood supply to the spine, becomes a provoking factor. Other possible causes are osteoporosis and impaired development of the spinal muscles.
• When the angle of inclination of the corresponding section of the spinal column exceeds 30´, it is said that breast kyphosis is enhanced. In different patients, the thoracic kyphosis is strengthened differently, depending on the degree of pathology - and in all cases we are talking about a deviation from the norm. It is imperative that you consult a medical professional if there is a pronounced chest kyphosis.
• Normal healthy spine has a physiological curvature of the S-shape. If the angle of inclination is determined by a value less than 15´, then they say about the smoothness of such a curvature. Not all doctors point to pathology, if the thoracic kyphosis is straightened, the smoothness of the thoracic kyphosis is outwardly imperceptible and it seems that the patient is fine. However, most experts 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

The thoracic kyphosis itself develops on an accruing schedule for a long time: often the problem “originates” in childhood and adolescence, when the vertebral column is still flexible and the tissues are elastic. But with age, various unpleasant consequences and complications begin to be found.

How severe the problems will be depends on the degree of the violation. Sometimes the nerves and the spinal cord are compressed, but muscle spasm near the spine can also be affected. The nerve pathways that go to the brain are damaged, which becomes the impetus for the development of pathologies such as epilepsy. When a spinal cord is deformed, its function is disturbed at an appropriate level.

Initially, an inflammatory process develops around the compressed tissue. The musculature near the zone of inflammation is extremely reduced, squeezing the surrounding vessels. Ischemia occurs as a result of a current disturbance in the vessels, oxygen and trophic deficiency processes are launched in the affected tissues, and the conduction of nerve fibers is disturbed.

In thoracic kyphosis, osteochondrosis is particularly acute, causing severe pain and connecting the broken vertebrae, which further aggravates the problem. Problems begin with the internal organs: the digestive tract, the respiratory system. The heart, the liver also suffers, blood pressure rises. In order to prevent the development of such disorders, it is necessary to promptly diagnose and treat thoracic kyphosis.

[14], [15]

Diagnostics of the thoracic kyphosis

Doctors of orthopedic and vertebrological direction are engaged in the diagnosis of thoracic kyphosis. In the process of consultation, the doctor examines the patient, probes the spine, sometimes asks to bend his back or to become exactly. Then he clarifies and details the complaints, checks the quality and strength of the muscles, assesses the sensitivity of the skin, checks for the presence of reflexes.

Instrumental diagnostics, as a rule, consists in conducting radiography of the spinal column. X-rays are more often made immediately in different projections - for example, in the front and side, and then perform targeted shooting in a non-standard position (to check the functional ability of the spinal column).

If the pathology of the muscular system is suspected, the patient is prescribed an MRI procedure. A computed tomography method helps clarify changes affecting the bone apparatus.

To determine the degree and severity (coefficient) of the violation, a radiographic examination of the spinal column is performed during lateral projection and limiting extension. The centers of vertebral bodies are taken as measuring points — the geometric intersection of their diagonal lines. Straight lines are drawn, connecting the centers of the extreme vertebral bodies and that vertebra, which is located at the upper kyphosis point. The result is a triangle: on its base a perpendicular line is lowered from the center of the “upper” vertebra, after which the height and length of the base of the formed triangle are measured. The value of the coefficient of thoracic kyphosis is defined as the ratio of the measured length to height. A pathological meaning is indicated if this coefficient is less than or equal to 10.

To clarify the kyphosis angle, lines continue to lead through the point at which the legs overlap in the center of the “upper” vertebra. The angle of kyphosis necessary for diagnosis is the one that is adjacent to the outside of the legs.

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

• up to 0.09 - a variant of the norm, or the so-called 0 points;
• from 0.09 to 0.129 - 1 point;
• from 0.130 to 0.169 - 2 points;
• 0.170 and higher - 3 points.

[16], [17], [18]

Differential diagnosis

Differential diagnostics should be carried out with the following pathologies:

• damage to the spinal pectoral nerves;
• intercostal nerve damage;
• extramedullary and intramedullary pathologies (tumor processes, abscesses);
• disc herniation, neoplasm, radiculopathy;
• injuries of vertebral bodies, inflammatory processes.

[19], [20], [21]

Treatment of the thoracic kyphosis

Therapeutic measures are appointed primarily on the basis of the present symptoms and pathologies that develop as a result of thoracic kyphosis. If this is possible, then treatment preference is given to the conservative method, supplemented by physiotherapy, physical therapy, and massage.

Massages help to activate the blood supply to the tissues. With the improvement of trophic processes in the muscles, the spine can gradually acquire the necessary configuration, which will lead to a weakening of pressure on the nerve endings and tissues, relieve pain syndrome and improve the functioning of the organs. In addition, a well-conducted massage course has a relaxing and antispasmodic effect. And vice versa: irregular massage movements, a gross impact can aggravate the situation, breaking blood and lymph circulation.

The use of exercise therapy is indisputable, even if we are talking about healthy people. Specially designed exercises can improve blood circulation, strengthen muscles, improve tissue tone. For patients with thoracic kyphosis, exercises are chosen especially carefully, so as not to harm or aggravate the pain.

Strength training should be excluded: they contribute to increasing the load on the back, which significantly worsens health. With regular and prolonged power effects, the degree of kyphosis of the disorder may increase, and the pain syndrome will become more pronounced.

Drug treatment for breast kyphosis involves taking glucocorticosteroids, nonsteroidal anti-inflammatory drugs, analgesics, muscle relaxants, as well as blockades.

Blockades are prescribed for severe back pain: medicinal substances that block the transmission of impulse are injected into a certain zone. The most commonly used procaine and lidocaine, which are blockers of cellular sodium channels. The injection is performed only by a doctor in the hospital.

Prevention

Prevention of spinal curvatures is a necessary measure for all people, and it is necessary to begin its implementation from childhood. Preventive rules must be followed by yourself and teach your children.

• Working at the table or sitting at the desk you need to control your posture: the feet should be completely on the floor, the hips should be parallel to the floor, the back should be kept straight, and the elbows should be on the table.
• While walking, correct posture is equally 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 correctly and fully, ensuring the supply of all the nutrients into the body - first of all, it concerns minerals and vitamins.
• Hypodynamia is the enemy of spinal health. Therefore, you need to keep yourself in good physical shape, to strengthen the muscles of the back. Even ordinary, but regular morning exercises will help in this.
• Any problems with the spinal column should be treated on time, without delaying the treatment to the doctor.
• In the workplace, while playing sports, and in any other circumstances, one should 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 damage the structure and functionality of the vertebrae and muscles.

[22], [23], [24]

Forecast

To date, there are many opportunities to identify thoracic kyphosis in the early stages of development. This allows for the restoration of the spinal column qualitatively and safely, in many cases avoiding surgical intervention.

In general, most people with a similar diagnosis live a normal full life, without the heightened risk of complications. However, some still occasionally have pain, disability, life activity suffers. It can be said with confidence that the quality of the forecast depends on the degree of curvature and on the timeliness of the patient to seek medical help.

[25], [26], [27]

With a diagnosis of thoracic kyphosis do they take to the army?

The possibility of serving in the armed forces for a patient with thoracic kyphosis is decided individually. Why?

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

• with the first degree of curvature, no exemptions and delays from the army are provided;
• in case of a second degree of pathological violation, this issue is considered additionally: if a young man indicates a constant pain syndrome that is not associated with spinal overload, 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 a patient with a kyphosis curvature reveals violations of the internal organs, and these violations are incompatible with being in the army, the young man may be declared unfit for military service;
• the third and fourth degree of thoracic kyphosis, complications of the disease, the impossibility or limitation of physical activity - these are direct reasons for declaring a patient unfit for military service.

Going to pass the military commission, the recruit must remember: the basic requirements of doctors are that any malfunction in the body must be diagnosed (proven diagnostic) and spelled out in a document. If, apart from verbal complaints, the young man does not make any documentary, then the recognition of his unsuitability for service is unlikely to take place. It is necessary that the patient's regular appeals about the existing pathology be registered in the medical record, all treatment episodes, medical observations, etc. Were recorded. Only with all the relevant records available, one can expect that the thoracic kyphosis will become a reason for being released from the army draft.