Kyphoscoliosis is the abnormal curvature of the spine in two planes: The sagittal plane which is the backward to forward angle and the coronal plane which is the side to side angle. It may also be associated with spinal axis rotation. Sideways deviation of the spine curvature is known as Scoliosis and abnormal forward to backward rounding of the back is known as Kyphosis. The impact of these abnormal curvatures on the body depend upon the location, degree of curvature, spinal axis rotation and severity.
Causes and risk factors of Kyphoscoliosis
There a number of varying causative factors associated with Kyphoscoliosis. They include:
- Idiopathic: Majority of the Kyphoscoliosis cases are associated with idiopathic etiology which means the causes are unclear.
- Congenital abnormalities such as malformation of the spine before birth.
- Degenerative changes
- Fractures/injuries of the spine
- Inflammatory diseases
- Neuromuscular conditions like cerebral palsy, spinal muscular dystrophy, etc.
- Connective tissue conditions like Marfan syndrome, Scheuermann disease (Juvenile Kyphosis), etc.
Other risk factors include:
- Post-surgical changes
- Repetitive movements or overuse trauma.
Signs and symptoms of Kyphoscoliosis
Some of the common symptoms of kyphoscoliosis includes:
- Back pain and stiffness
- Uneven shoulders
- Hunched back
- Weak back muscles
Severe Kyphoscoliosis can lead to complicated symptoms such as:
- Generalised weakness
- Disfigurement of the body
- Weakness of respiratory muscles
- Difficulty in breathing
- Neurological complications
- Cardiac complications
- Loss of appetite
Diagnosis of Kyphoscoliosis
Kyphoscoliosis can be diagnosed based on medical history, physical examination, functional assessment and diagnostic imaging scans.
Medical history: A thorough medical history of age of onset of the disease, appearance of changes along with neurological and psychosocial impacts are noted.
Physical examination: It involves evaluation of spinal alignment, height, movements, degree of flexibility, reflexes, sensations and muscle strength.
Functional assessment: A walking test for 6 minutes or standing up from a sitting position helps in assessing the severity of the disease.
Diagnostic imaging: X-rays may be taken to assess the degree of asymmetry and MRI and bone mineral density scans may be recommended if additional investigations are required.
In severe cases, lung function tests such as Functional Residual Capacity (FRC) and Forced Vital Capacity (FVC) are carried out.
Treatment of Kyphoscoliosis
Non-surgical methods for management of Kyphoscoliosis may include:
Observation: In mild cases of Kyphoscoliosis, doctors closely monitor patients over time with regular imaging scans and functional evaluation to keep a note of the progression of the disease over time.
Medications: Medicines such Non-Steroid Anti-Inflammatory Drugs (NSAIDs) and muscle relaxants are used for pain management along with constant monitoring of associated side-effects.
Physical therapy: Bracing, spinal cord stimulation, stretching and strengthening exercise, yoga can help in supporting weakened muscles, improvement of curvature and alleviation of pain.
Management of respiratory symptoms: Non-Invasive Intermittent Positive Pressure Ventilation (NIPPV) is opted in patients with severe Kyphoscoliosis presenting with chronic respiratory failure. Other methods such as chest physiotherapy and medications can be used to manage respiratory symptoms.
Surgical management of Kyphoscoliosis is indicated in patients showing poor response to non-surgical methods, uncontrollable pain and signs of neurological changes. Different surgical methods such as fusion surgeries, non-fusion surgeries, osteotomies or placement of rods or screws based on various factors including age, risk profile, bone health etc.
