DEFORMITIES OF THE SPINE: LORDOSIS, KYPHOSIS, AND SCOLIOSIS

   Spinal curvatures

ICD-9: 737.20 LORDOSIS

ICD-9: 737.10 KYPHOSIS

ICD-9: 737.30 SCOLIOSIS

Description

Lordosis is an abnormal inward curvature of the lumbar or lower spine. This condition is commonly called “swayback.” Kyphosis is an abnormal outward curvature of the upper thoracic vertebrae. Commonly, this curvature is known as “humpback” or “round back.” Scoliosis is an abnormal sideward curvature of the spine to either the left or right. Some rotation of a portion of the vertebral column also may occur. Scoliosis often occurs in combination with kyphosis and lordosis. These three spinal deformities may affect children as well as adults.

Spinal curvatures

FIGURE. Spinal curvatures

Etiology

Lordosis, kyphosis, and scoliosis may be caused by a variety of problems, including congenital spinal defects, poor posture, a discrepancy in leg lengths (especially in scoliosis), and growth retardation or a vascular disturbance in the epiphysis of the thoracic vertebrae during periods of rapid growth. Kyphosis may be the result of collapsed vertebrae from degenerative arthritis, or it may occur following a history of excessive sport activity. Obesity and osteoporosis can be contributing factors for lordosis. These three spinal deformities also may result from tumors, trauma, infection, osteoarthritis, tuberculosis, endocrine disorders such as Cushing disease, prolonged steroid therapy, and degeneration of the spine associated with aging. Lordosis, kyphosis, and scoliosis also may be idiopathic.

Signs and Symptoms

The onset of lordosis, kyphosis, and scoliosis frequently is insidious. Signs and symptoms may eventually include chronic fatigue and backache. Scoliosis is often detected by individuals when they notice that their clothing seems longer on one side than on the other. Or they may notice when looking in a mirror that the height of their hips and shoulders appears uneven.

Diagnostic Procedures

Physical examination and anterior, posterior, and lateral x-rays of the spine are the most commonly used procedures to detect these spinal deformities.

Treatment

Treatment varies according to the nature and severity of the spinal curvature, the age of onset, and the underlying cause of the disorder. The goal is to slow the progression of the disease. Physical therapy, exercise, and back braces may all play a role in the treatment of these conditions. Spinal bracing, if closely watched and properly constructed and fitted, may be able to halt the progression of the curve in scoliosis. Surgery may be necessary, however, in cases of adolescent scoliosis if the curvature seriously interferes with mobility or breathing. Spinal fusion, using bone grafts and metal rods, is sometimes performed to straighten the spine in this situation. Surgery is rarely necessary for correction of kyphosis. Analgesics may be prescribed to alleviate the pain that frequently accompanies these disorders.

Complementary Therapy

Kyphosis may respond well to massage. Physical therapy and exercises to strengthen abdominal muscles can decrease lumbar lordosis. Hamstring stretch can reduce muscle contractures, or a permanent shortening of muscle. Stress proper posture. In scoliosis, it is helpful for individuals to turn their whole body, rather than just their head, when looking to the side; yoga is helpful to some.

CLIENT COMMUNICATION

Emotional support is essential. Instruct clients on the use of any brace and to avoid vigorous sports. Meticulous skin care is important to prevent irritation and skin breakdown due to the brace rubbing against the skin.

Prognosis

The prognosis of an individual with lordosis, kyphosis, or scoliosis depends on the underlying cause of the particular disease, how early it is detected, and whether it responds to treatment. In some cases, a spinal deformity may be arrested but not corrected. Pulmonary insufficiency, degenerative arthritis of the spine, and sciatica may arise as complications of spinal deformities.

Prevention

Prevention of lordosis, kyphosis, and scoliosis includes correction of any underlying cause and maintaining good posture. Weight loss can reduce the risk of lordosis. Scoliosis screening in public schools is mandated by law in some states.

Lordosis