This document discusses different types of sagittal plane deformities of the thoracic and thoracolumbar spine. It describes mobile kyphosis, which is correctable by muscles, and fixed kyphosis, which is not correctable. Fixed kyphosis includes Scheuermann's disease, ankylosing spondylitis, and senile kyphosis. Angular kyphosis can be congenital, due to tuberculosis, or vertebral body collapse from trauma or infection. Treatment depends on the type and severity of the deformity and may include exercises, bracing, or spinal fusion surgery.

1. Professor of OrthopaedicsProfessor of Orthopaedics
1/15/2011 ١Professor Freih Abu hassan -
University of Jordan

2. Sagittal plane deformity in the thoracic orSagittal plane deformity in the thoracic or
thoracolumbar spine
Thoracic Spine Kyphosis : 25 - 45 degrees
Typesyp
1- Mobile
2 Fixed2- Fixed
3-Angular
1/15/2011 ٢Professor Freih Abu hassan -
University of Jordan

3. 1 Mobile Kyphosis1- Mobile Kyphosis
C t bl b th ti t’ l bCorrectable by the patient’s own muscles or by
the surgeon
A PosturalA- Postural
B- Muscle weaknessB Muscle weakness
C- Compensatory to L. lordosis
1/15/2011 ٣Professor Freih Abu hassan -
University of Jordan

4. Associated withAssociated with
1-Flat feet
2 f i i2-Women after child birth
3- Obesity3 Obes ty
C.P
Painless, Correctable,, ,
Long curve, N. X-ray
1/15/2011 ٤Professor Freih Abu hassan -
University of Jordan

5. T t tTreatment
Posture trainingPosture training
Exercises
Weight reductionWeight reduction
1/15/2011 ٥Professor Freih Abu hassan -
University of Jordan

6. * Muscle dystrophy* Muscle dystrophy
* Polio.
(Lumbar lordosis and
Thoracic kyphosis)Thoracic kyphosis)
1/15/2011 ٦Professor Freih Abu hassan -
University of Jordan

7. * Gross hip deformity e.g hip dislocation ,
fi d fl i hi d ffixed flextion hip def.
lumbar lordosis Thoracic kyphosisyp
1/15/2011 ٧Professor Freih Abu hassan -
University of Jordan

8. Compensatory to L. lordosis
1/15/2011 ٨Professor Freih Abu hassan -
University of Jordan

9. 2- Fixed Kyphosis2- Fixed Kyphosis
Not correctable by the patient’s own muscles orNot correctable by the patient s own muscles or
by the surgeon
Types
1 S h ’ di1- Scheuermann’s disease
2- A. Spondylitisp y
3- Senile kyphosis
4 Bone dysplasia4- Bone dysplasia
5- with Scoliosis
1/15/2011 ٩Professor Freih Abu hassan -
University of Jordan

10. Scheuermann’s dis
Senile kyphosis
1/15/2011 ١٠Professor Freih Abu hassan -
University of Jordan

11. 3-Angular Kyphosis3-Angular Kyphosis
1- Cong.1 Cong.
2- T.B
3 V b l b d ll3- Vertebral body collapse
= Trauma, Tumour,
= infection
C l ’= Calve’s
5- Deficient post bony elementsp y
= post laminectomy, Spina bifida
1/15/2011 ١١Professor Freih Abu hassan -
University of Jordan

12. 1/15/2011 ١٢Professor Freih Abu hassan -
University of Jordan

13. T BT.B
1/15/2011 ١٣Professor Freih Abu hassan -
University of Jordan

14. Progressive
k hkyphus
T.B
Lumbar abscess ١٤
Coin test
1/15/2011 Professor Freih Abu hassan -
University of Jordan

15. Calve’sCalve s
1/15/2011 ١٥Professor Freih Abu hassan -
University of Jordan

16. Kyphoscoliosis
1/15/2011 ١٦Professor Freih Abu hassan -
University of Jordan

17. Age related KyphosisAge related Kyphosis
1- Child Cong1 Child Cong.,
2- Adolescent Postural,,
Scheuermann’s disease
3- Young adult A.S
4 Elderly Senile Path #4- Elderly Senile, Path. #,
Paget’s.Paget s.
5- All age group T.B
1/15/2011 ١٧Professor Freih Abu hassan -
University of Jordan

18. KYPHUS
1/15/2011 ١٨Professor Freih Abu hassan -
University of Jordan

19. Scheuermann’s diseaseScheuermann s disease
Causes
1- Unknown
Causes
1 Unknown
2-Osteochondritis
(irregular ossification of epiphyseal plates)(irregular ossification of epiphyseal plates)
3- Undue strain on the ant.
ti f th t b l b diportion of the vertebral bodies
4-Traumatic infarction of the epi. plates
5-Vertebral osteoporosis and the discs
herniate in the fragile bonee e e g e bo e
1/15/2011 ١٩Professor Freih Abu hassan -
University of Jordan

20. = Starts at puberty= Starts at puberty
= > in females> in females
= Round shoulders
= Back pain + fatigue
1/15/2011 ٢٠Professor Freih Abu hassan -
University of Jordan

21. 1/15/2011 ٢١Professor Freih Abu hassan -
University of Jordan

22. O/E
P= Poor posture
= Smooth kyphosis= Smooth kyphosis
= Lumbar lordosis
= Non correctable
= Full ROM
Ti ht h t i !!!????= Tight hamstrings!!!????
1/15/2011 ٢٢Professor Freih Abu hassan -
University of Jordan

23. X ra sX-rays
* Wedging ant > 5 degree of eachWedging ant. > 5 degree of each
vertebra D6 - D10
* Contain small translucent areas
(Schmorl’s nodes)(Schmorl’s nodes)
* Fragmented ant. epiphyseal platesg p p y p
> 3 Vertebrae
* A 40* Angle > 40
1/15/2011 ٢٣Professor Freih Abu hassan -
University of Jordan

24. 1/15/2011 ٢٤Professor Freih Abu hassan -
University of Jordan

25. D DxD.Dx
1- Postural: Painless, Correctable,, ,
Long curve, N. X-ray
2 T B2-T.B
= Angular kyphosAngular kyphos
= X-ray : = destruction at least two
adjacent vertebrae with
= narrowing of the disc += narrowing of the disc +
= paravertebral abscessp ve eb bscess
1/15/2011 ٢٥Professor Freih Abu hassan -
University of Jordan

26. R/R/
= 40 60 Degree= 40-60 Degree
Postural trainingsg
Strengthening exercises.
= 60 degree in young child60 degree in young child
Corrective cast for 6 m followed by
Milwaukee brace until remodelling of the
vertebrae.vertebrae.
1/15/2011 ٢٦Professor Freih Abu hassan -
University of Jordan

27. R/R/
Older adolescent and adult 60= Older adolescent and adult 60
degreedegree
* If painful , > 60 degree, or impending paresis.
1 ant release and m ltiple disc e cision1- ant. release and multiple disc excision
2- traction for 2 weeks
3- Post fusion
1/15/2011 ٢٧Professor Freih Abu hassan -
University of Jordan

28. 1- Cosmesis
2- Stop progression
3- Alleviate pain
4- Prevent pain in the future
1/15/2011 ٢٨Professor Freih Abu hassan -
University of Jordan

29. Scheuermann’s disease
1/15/2011 ٢٩Professor Freih Abu hassan -
University of Jordan

30. Types
1 F il f f i f b l1- Failure of formation of vertebral
body 20% paralysisbody. 20% paralysis
2-Failure of segmentation
Very slow progression, no risk of
paralysisparalysis
3-Combination
1/15/2011 ٣٠Professor Freih Abu hassan -
University of Jordan

31. 1/15/2011 ٣١Professor Freih Abu hassan -
University of Jordan

32. 1/15/2011 ٣٢Professor Freih Abu hassan -
University of Jordan

33. 1/15/2011 ٣٣Professor Freih Abu hassan -
University of Jordan

34. 1/15/2011 ٣٤Professor Freih Abu hassan -
University of Jordan

35. 1/15/2011 ٣٥Professor Freih Abu hassan -
University of Jordan

36. Type 1
P t f i ith t i t t tiPost fusion without instrumentation
at the age of 3 years.at the age of 3 years.
If seen late ant. strut graft and
after 2-4 weeks post fusion
Type 3 Ant.& Post fusion
1/15/2011 ٣٦Professor Freih Abu hassan -
University of Jordan

37. 1- Senile
2- Senile osteoporosis
3- Paget’s
4- Pathological #
1/15/2011 ٣٧Professor Freih Abu hassan -
University of Jordan

38. S il k h iSenile kyphosis
= More in males= More in males.
= Multiple discs degeneration causing
narrowing followed by slight wedging
= little pain unless development oflittle pain unless development of
Facet O.A.
1/15/2011 ٣٨Professor Freih Abu hassan -
University of Jordan

39. Senile Osteoporosis
U ll i hi f l= Usually in thin females.
= Wide spread osteoporosisWide spread osteoporosis
= Code fish spine
= Pain is common due to fractures
Or due to compensatory lumbarOr due to compensatory lumbar
lordosis or O.A
1/15/2011 ٣٩Professor Freih Abu hassan -
University of Jordan

40. R/
= ANTI OSTEOPOROSIS R/
STICK= STICK
= ANALGESIA= ANALGESIA
1/15/2011 ٤٠Professor Freih Abu hassan -
University of Jordan

41. 1/15/2011 ٤١Professor Freih Abu hassan -
University of Jordan

42. Paget’s kyphosis
= due to bone softening
= associated criteria of paget’s= associated criteria of paget s
(thick bent bones)(thick bent bones)
= large vertebra with coarse
trabeculation
1/15/2011 ٤٢Professor Freih Abu hassan -
University of Jordan

43. Pathological # kyphosis
T= Trauma
= MetastasisMetastasis
R/
*With neurology Surgery*With neurology - Surgery
*No neurology Radio/ +Brace.gy
1/15/2011 ٤٣Professor Freih Abu hassan -
University of Jordan

44. = Cong.g
= Neuromuscular
= Post surgeryg y
1/15/2011 ٤٤Professor Freih Abu hassan -
University of Jordan

45. 1/15/2011 ٤٥Professor Freih Abu hassan -
University of Jordan