presentation outline text. It apparently didn’t work. Here’s my
response again, but in a more basic (readable) text format. I hope
this transmits with much less break in formatting!)
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In response to your question, I recently did a literature search and
review on the Orthotic treatment of kyphosis. (This was for our
Academy’s Pediatric Certificate Program, to which my subject was
the management of the pediatric and adolescent spine.) If you don’t
mind the brevity, I thought the easiest way to respond to your
questions would be to simply provide you a copy of the outline
format of my power point slides. I hope you find this helpful, and
please don’t hesitate to contact me if you have any questions
about my post.
Kyphosis
Differential Diagnoses
I. Juvenile Roundback: > 45 degrees without vertebral
wedging.
II. Scheuermann’s Kyphosis: More rigid kyphosis 45
degrees with vertebral wedging; some suggest > 5 degrees in three
or more adjacent vertebrae.
Scheuermann’s Kyphosis
Etiology: Schmorl’s disc herniations into the cartilaginous
end plate. Interruption of endochondral ossification, leading to
anterior wedging and increasing kyphosis.
Typical presentation around age 10.
Marked increase in kyphosis upon forward bending.
Common apex between T7 and T9, but thoracolumbar and
lumbar disease exists.
Often pectoral muscle contractures.
Indications for Treatment
Skeletal immaturity (Risser 0 to 3).
Curves between 50 and 70 degrees, with passive flexibility
of no less than 40%.
Vertebral wedging in fewer than three vertebrae.
Treatment Goals
Correct kyphosis to an acceptable magnitude:
required to have a positive prognostic outcome
throughout adulthood.
Achieved by maintaining correction of curve up to the time
of skeletal maturity.
treatment end to make up for increasing curvature
with follow-up.
Corrective Forces with an Orthosis
Orthotic Treatment
Milwaukee most studied orthosis: Correction is thought to
be partly active in nature, with patient reacting to throatmold.
apices of T9 or below; one report proporting 70
degrees to be a threshold for low-profile
consideration.
reports suggest 8 – 12 months to be sufficient.
Part-time (night wear) until skeletal maturity.
correction imperative.
to 20 degrees.
degrees at maturity should result in an acceptable curve of
around 50 degrees in adulthood.
