Kyphoscoliosis

What is Kyphoscoliosis?

Kyphoscoliosis is a deformity of the spine in which there is an abnormal curvature of the spine on two planes: the sagittal plane, or back to front, and the coronal plane, or side to side. It is essentially a combination of two spinal conditions called kyphosis and scoliosis. Kyphosis causes an excessive outward spinal curve, giving the back a hunched or rounded appearance, while scoliosis causes an unnatural sideways spinal curve. So kyphoscoliosis is essentially the development of an unnatural forward/backward and sideways spinal curve simultaneously. The impact of these abnormal curvatures on the body depends on the degree, location, spinal axis rotation, and severity of the curvature.

Causes of Kyphoscoliosis

Kyphoscoliosis can occur at any age and may be caused by a variety of different factors. Many cases of kyphoscoliosis are found to be idiopathic, meaning the exact cause of the condition is unknown. Other causative factors associated with kyphoscoliosis include:

• Injuries/fractures of the spine
• Prolonged bad posture
• Degenerative diseases of the spine, such as osteoarthritis or osteoporosis
• Congenital abnormalities such as malformation of the spine before birth
• Neuromuscular conditions such as muscular dystrophy or cerebral palsy
• Connective tissue diseases, such as Marfan syndrome and Ehlers-Danlos syndrome
• Infections such as tuberculosis and osteochondrodysplasia
• Inflammatory diseases
• Repetitive movements or overuse trauma
• Post-surgical changes
• Degenerative changes

Signs and Symptoms of Kyphoscoliosis

Some of the common signs and symptoms of kyphoscoliosis include:

• Hunched back
• Uneven shoulders
• Back pain and stiffness
• Weak back muscles
• Difficulty in breathing
• Weakness of respiratory muscles
• Disfigurement of the body
• Cardiac issues
• Neurological issues
• Loss of appetite
• Generalized weakness

Diagnosis of Kyphoscoliosis

Your physician may diagnose kyphoscoliosis based on physical examination, functional assessment, medical history, and diagnostic imaging scans.

• Physical examination: This involves the assessment of spinal movements, height, alignment, level of flexibility, sensation, reflexes, and muscle strength.
• Functional evaluation: This involves a walking test for 6 minutes or standing up from a sitting position to help evaluate the severity of the disease.
• Medical history: This involves a thorough evaluation of your medical history, including the age of onset of the disease, appearance of changes along with neurological and psychosocial impacts.
• Diagnostic imaging: This may involve obtaining X-rays of the spine to evaluate the level of asymmetry. MRI and bone mineral density scans may be advised if additional examinations are required.

In severe instances, lung function tests such as Forced Vital Capacity (FVC) and Functional Residual Capacity (FRC) are also performed.

Treatment for Kyphoscoliosis

Treatment for kyphoscoliosis may vary depending on:

• Level of the spine curvature
• Age of the patient
• Capacity to maintain a healthy posture
• Impact on activities of daily living
• Other medical conditions

Various treatment modalities may include:

• Observation: In mild cases of kyphoscoliosis, physicians closely monitor patients over time with regular functional evaluation and imaging scans to keep track of disease progression and suggest suitable remedies.
• Pain Management: Kyphoscoliosis or any spinal abnormalities can cause severe pain, discomfort, stiffness, and can affect normal daily routines. Your physician may recommend cortisone injections and medications such as muscle relaxants and Non-Steroid Anti-Inflammatory Drugs (NSAIDs) for pain management along with constant monitoring of associated side effects.
• Physical Therapy: Physical therapy can help with mild to moderate cases of kyphoscoliosis. The main objective of physical therapy is to increase spinal strength and flexibility through exercises to help correct the curvature as much as possible.
• Bracing: Bracing is employed in many mild to moderate cases of scoliosis or kyphoscoliosis and involves the use of a back brace to restrict the progression of the spinal curvature. The brace supports the bones and muscles and encourages the straightening of the spine. However, the bracing required for kyphoscoliosis is still in the developmental stage as they need to restrict the curvature in both the sagittal and coronal planes.
• Surgery: Surgical management is recommended when non-surgical treatment has failed to relieve symptoms of kyphoscoliosis. Surgical management may involve surgical methods such as spinal osteotomies in which a section of the spinal bone is cut and removed to allow for correction of spinal alignment, spinal fusion surgeries in which two or more bones in the spine are permanently joined together to prevent movement, non-fusion surgeries, or placement of screws or rods to stabilize the spine based on various factors such as bone health, age, risk profile, etc.