Deformities of the spine: Lordosis, Kyphosis, and Scoliosis

ICD-9: 737.20 LORDOSIS

ICD-9: 737.10 KYPHOSIS

ICD-9: 737.30 SCOLIOSIS

Video: How to Correct a Scoliosis With Exercise and Stretching

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.

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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.

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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.

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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.

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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

 

Spine Health. PROCEDURE 4 — EXTENSION IN LYING WITH BELT FIXATION The patient’s position and the exercise are the same as in the third procedure, but now a fixating belt is placed at or just below the segments to be extended. The safety belt is the first simple external aid, used to enhance maximum extension. It does so by preventing the pelvis and lumbar spine lifting from the couch. Other methods of restraint may be used effectively, for example the body weight of a young son or daughter when exercising at home. Fig. Extension in lying with belt fixation. Effects: This procedure creates a greater and more localised passive extension stress than the previous ones. It is particularly suitable for stretching in the case of extension dysfunction, and is more often required in dysfunction than in derangement. In dysfunction some pain will be experienced in the small of the back while exercising, because contracted tissues are being stretched. In derangement the rules pertaining to the centralisation phenomenon must be observed, and the proce...
Spine Health. PROCEDURE 3 — EXTENSION IN LYING The patient, already lying prone, places the hands (palms down) near the shoulders as for the traditional press-up exercise. He now presses the top half of his body up by straightening the arms, while the bottom half, from the pelvis down is allowed to sag with gravity. The top half of the body is then lowered and the exercise is repeated about ten times. The first two or three movements should be carried out with some caution, but once these are found to be safe the remaining extension stresses may become successively stronger until the last movement is made to the maximum possible extension range. If the first series of exercises appears beneficial, then a second series may be indicated. More vigour can be applied and a better effect will be obtained if the last two or three extension stresses are sustained for a few seconds. It is essential to obtain the maximum elevation by the tenth excursion and once obtained the lumbar spine should be permitted to relax into the most extreme ...
Intervertebral discs Figure. The adult vertebral column and typical vertebrae in each region, lateral views. There are at least 24 intervertebral discs interposed between the vertebral bodies: six in the cervical, twelve in the thoracic and five in the lumbar region, with one between the sacrum and coccyx. (Additional discs may be present between fused sacral segments.) The discs account for approximately one-quarter of the total length of the vertebral column, and are primarily responsible for the presence of the various curvatures. On descending the vertebral column, the discs increase in thickness, being thinnest in the upper cervical region and thickest in the lower lumbar. In the upper thoracic region, however, the discs appear to narrow slightly. In the cervical region the disc is about two-fifths the height of the vertebrae, being approx-imately 5 mm thick. In the thoracic region the discs average 7 mm in thickness, so that they are one-quarter of the height of the vertebral bodies. The discs in ...
Spine Health. PROCEDURE 2 — LYING PRONE IN EXTENSION The patient, already lying prone, places the elbows under the shoulders and raises the top half of his body so that he comes to lean on elbows and forearms while pelvis and thighs remain on the couch. In this position the lumbar lordosis is automatically increased. Emphasis must be placed on allowing the low back to sag and the lordosis to increase. Fig. Lying prone in extension. Effects: Procedure 2 is a progression of procedure 1 and merely enhances its effects by increasing extension. Again, in derangement some time must be allowed to affect the contents of the disc and, if possible patients should remain in this position for five to ten minutes. In more acute patients sustained extension may not be well tolerated due to pain, and initially we must rely on the use of intermittent extension.
Physical examination of the shoulder The shoulder girdle is composed of three joints and one “articulation”: the sternoclavicular joint the acromioclavicular joint the glenohumeral joint (the shoulder joint) the scapulothoracic articulation Fig. The shoulder girdle. Fig. The humerus has very minimal osseous support. Notice the shallow glenoid fossa in the shoulder as compared to the deep acetabular socket of the hip. All four work together in a synchronous rhythm to permit universal motion. Unlike the hip, which is a stable joint having deep acetabular socket support, the shoulder is a mobile joint with a shallow glenoid fossa. The humerus is suspended from the scapula by soft tissue, muscles, ligaments, and a joint capsule, and has only minimal osseous support. Examination of the shoulder begins with a careful visual inspection, followed by a detailed palpation of the bony structures and soft tissues comprising the shoulder girdle. Range of motion determination, muscle testing, neurologic assessment...