Friday, November 8, 2024

Re: Kyphosis

Donald E. Katz, C.O.

Times New RomanIn 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 powerpoint slides. I hope you

find this helpful, and please don’t hesitate to contact me should if

you have any questions about my post.

Sincerely,

Don Katz, C.O.

Texas Scottish Rite Hospital for Children

Dallas, Texas

……From the powerpoint outline:

Kyphosis

Differential Diagnoses

outJuvenile Roundback: >45E without vertebral wedging.

outScheuermann’s Kyphosis:

outMore rigid kyphosis 45E with vertebral wedging; some suggest

>5E in three or more adjacent vertebrae.

Scheuermann’s Kyphosis

outEtiology:

outSchmorl’s disc herniations into the cartilaginous end plate.

outInterruption of endochondral ossification, leading to anterior

wedging and kyphosis.

outTypical presentation around age 10.

outMarked increase in kyphosis upon forward bending can be

diagnostic.

outCommon apex between T7 and T9, but thoracolumbar and lumbar

disease exists.

outOften pectoral muscle contractures.

Treatment Goals

outCorrect kyphosis to an acceptable magnitude

outOne report maintains no more than 60 degrees required to have a

positive prognostic outcome throughout adulthood.

outAchieved by maintaining correction of curve up to the time of skeletal

maturity.

out40-50% correction of initial deformity by treatment end to make up

for increasing curvature with follow-up.

Orthotic Treatment

outMilwaukee most studied orthosis

outCorrection is thought to be partly active in nature, with patient

reacting to throat-mold.

outSome reports suggest TLSO is as successful for apices of T9 or

below; one report proporting no more than 70 degrees to be a

threshold for low-profile consideration.

outFirst 12-18 months full-time wear (22 hrs./day); some reports suggest

8-12 months to be sufficient.

outPart-time (night wear) until skeletal maturity.

Brace Discontinuation

outDecreased vertebral wedging and kyphosis correction imperative.

outFollow-up studies show loss of correction from 15 to 20 degrees.

outTherefore, an out of brace kyphosis of around 30 to 35 degrees at

maturity should result in an acceptable curve of around 50 degrees in

adulthood.

Date sent: 0000,0000,8000Sat, 3 Apr 1999 14:07:59 -0500

Send reply to: 0000,0000,8000john burger <<[email protected]>

From: 0000,0000,8000john burger <<[email protected]>

Subject: 0000,0000,8000Kyphosis

To: 0000,0000,8000[email protected]

I would like to know if the in brace correction of a kyphotic curve is the

same as that for scoliosis? That is, 50% correction? Also, can a 55 degree

curve be effectively managed with the apex at T9 with a low profile brace,

having the second pressure point at T9 and the counter forces at the

abdomin and 1.5cm below the sternal notch?

Finally, is the weaning process from the orthosis basically the same for

scoliosis? Thank you in advance for your responses. I will post them after

I receive all the responses.

John Burger C.P.O.

Efes Protez/Ortez Rehabilitasyon Merkezi

1432 Sokak 5/2

Kahramanlar, Izmir, Turkey

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