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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/09/07 17:07:24」(JST)

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For other uses, see Kyphosis (disambiguation).

"Hunchback" redirects here. For other uses, see Hunchback (disambiguation).

Hyperkyphosis
Classification and external resources
A preoperative image of a 22-year-old man with Scheuermann's disease, a type of structural kyphosis
ICD-10	M40.0-M40.2, M42.0, E64.3,Q76.4, M84.0, M96.2, M96.3
ICD-9	732.0, 737.0, 737.1, 756.19
DiseasesDB	21885
MedlinePlus	001240
Patient UK	Kyphosis
MeSH	D007738

Kyphosis (from Greek κυφός kyphos, a hump), refers to the normal convex curvature of the spine as it occurs in the thoracic and sacral regions. Inward concave curving of the cervical and lumbar regions of the spine is called lordosis. The term kyphosis can also be used to describe excessive kyphosis or overcurvature when it is also known as hyperkyphosis. Kyphosis can be called roundback or Kelso's hunchback. It can result from degenerative diseases such as arthritis; developmental problems, most commonly Scheuermann's disease; osteoporosis with compression fractures of the vertebrae, or trauma. A normal thoracic spine extends from the 1st to the 12th vertebra and should have a slight kyphosis ranging from 20° to 45°. When the "roundness" of the upper spine increases past 45° it is called "hyperkyphosis". Scheuermann's kyphosis is the most classic form of hyperkyphosis and is the result of wedged vertebrae that develop during adolescence. The cause is not currently known and the condition appears to be multifactorial and is seen more frequently in males than females.

In the sense of a deformity, it is the pathological curving of the spine, where parts of the spinal column lose some or all of their lordotic profile. This causes a bowing of the back, seen as a slouching posture.

While most cases of kyphosis are mild and only require routine monitoring, serious cases can be debilitating. High degrees of kyphosis can cause severe pain and discomfort, breathing and digestion difficulties, cardiovascular irregularities, neurological compromise and, in the more severe cases, significantly shortened life spans. These types of high-end curves typically do not respond well to conservative treatment and almost always warrant spinal fusion surgery, which can successfully restore the body's natural degree of curvature. The Cobb angle is the preferred method of measuring kyphosis.

Classification

There are several kinds of kyphosis (ICD-10 codes are provided):

• Postural kyphosis (M40.0), the most common type, normally attributed to slouching, can occur in both the old and the young. In the young, it can be called 'slouching' and is reversible by correcting muscular imbalances. In the old, it may be a case of hyperkyphosis and called 'dowager’s hump'. About one third of the most severe hyperkyphosis cases in older people have vertebral fractures. Otherwise, the aging body does tend towards a loss of musculoskeletal integrity, and hyperkyphosis can develop due to aging alone.
• Scheuermann's kyphosis (M42.0) is significantly worse cosmetically and can cause varying degrees of pain, and can also affect different areas of the spine (the most common being the midthoracic area). Scheuermann's kyphosis is considered a form of juvenile osteochondrosis of the spine, and is more commonly called Scheuermann's disease. It is found mostly in teenagers and presents a significantly worse deformity than postural kyphosis. A patient suffering from Scheuermann’s kyphosis cannot consciously correct posture. The apex of the curve, located in the thoracic vertebrae, is quite rigid. The patient may feel pain at this apex, which can be aggravated by physical activity and by long periods of standing or sitting. This can have a significantly detrimental effect on their lives, as their level of activity is curbed by their condition; they may feel isolated or uneasy amongst peers if they are children, depending on the level of deformity. Whereas in postural kyphosis, the vertebrae and disks appear normal, in Scheuermann’s kyphosis, they are irregular, often herniated, and wedge-shaped over at least three adjacent levels. Fatigue is a very common symptom, most likely because of the intense muscle work that has to be put into standing and/or sitting properly. The condition appears to run in families. Most patients who undergo surgery to correct their kyphosis have Scheuermann's disease.
• Congenital kyphosis (Q76.4) can result in infants whose spinal column has not developed correctly in the womb. Vertebrae may be malformed or fused together and can cause further progressive kyphosis as the child develops. Surgical treatment may be necessary at a very early stage and can help maintain a normal curve in coordination with consistent follow-ups to monitor changes. However, the decision to carry out the procedure can be very difficult due to the potential risks to the child. A congenital kyphosis can also suddenly appear in teenage years, more commonly in children with cerebral palsy and other neurological disorders.
• Nutritional kyphosis can result from nutritional deficiencies, especially during childhood, such as vitamin D deficiency (producing rickets), which softens bones and results in curving of the spine and limbs under the child's body weight.
• Gibbus deformity is a form of structural kyphosis, often a sequela to tuberculosis.
• Post-traumatic kyphosis (M84.0) can arise from untreated or ineffectively treated vertebral fractures.

Treatments

A diagnosis of kyphosis is generally made through observation and measurement. Idiopathic causes, such as vertebral wedging or other abnormalities, can be confirmed through X-ray. Osteoporosis, a potential cause of kyphosis, can be confirmed with a bone density scan. Postural thoracic kyphosis can often be treated with posture reeducation and focused strengthening exercises.Idiopathic thoracic kyphosis due to vertebral wedging,fractures, or vertebral abnormalities is more difficult to manage, since assuming a correct posture may not be possible with structural changes in the vertebrae.Children who have not completed their growth may show long-lasting improvements with bracing. Exercises may be prescribed to alleviate discomfort associated with overstretched back muscles. A variety of gravity-assisted positions or gentle traction can minimize pain associated with nerve root impingement. Surgery may be recommended for severe idiopathic kyphosis.

Orthosis (brace)

Modern brace for the treatment of a thoracic kyphosis. The brace is constructed using a CAD/CAM device.

Body braces showed benefit in a randomised controlled trial.

The Milwaukee brace is one particular body brace that is often used to treat kyphosis in the US. Modern CAD/CAM braces are used in Europe to treat different types of kyphosis. These are much easier to wear and have better in-brace corrections than reported for the Milwaukee brace. Since there are different curve patterns (thoracic, thoracolumbar and lumbar), different types of brace are in use, with different advantages and disadvantages.

Modern brace for the treatment of a lumbar or thoracolumbar kyphosis. The brace is constructed using a CAD/CAM device. Restoration of the lumbar lordosis is the main aim.

Specialised physical therapy

In Germany, a standard treatment for both Scheuermann's disease and lumbar kyphosis is the Schroth method, a system of physical therapy for scoliosis and related spinal deformities. It involves lying supine, placing a pillow under the scapular region and posteriorly stretching the cervical spine.

Surgery

Surgical treatment can be used in severe cases. In patients with progressive kyphotic deformity due to vertebral collapse, a procedure called a kyphoplasty may arrest the deformity and relieve the pain. Kyphoplasty is a minimally invasive procedure, requiring only a small opening in the skin. The main goal is to return the damaged vertebra as close as possible to its original height.

Complications

The risk of serious complications from spinal fusion surgery for kyphosis is estimated to be 5%, similar to the risks of surgery for scoliosis. Possible complications may be inflammation of the soft tissue or deep inflammatory processes, breathing impairments, bleeding, and nerve injuries. According to the latest evidence, the actual rate of complications may be substantially higher. Even among those who do not suffer serious complications, 5% of patients require re-operation within five years of the procedure, and in general it is not yet clear what to expect from spine surgery in the long-term. Taking into account that signs and symptoms of spinal deformity cannot be changed by surgical intervention, surgery remains to be a cosmetic indication. Unfortunately, the cosmetic effects of surgery are not necessarily stable.

People

• Pepin the Hunchback
• Godfrey IV, Duke of Lower Lorraine
• Margaret of Bavaria (1442–1479)
• The Hunchback of Notre Dame

• Søren Kierkegaard
• Charles Proteus Steinmetz
• Şehzade Cihangir
• Category:Fictional hunchbacks

See also

• Ehlers–Danlos syndrome
• Lordosis
• Pott's disease
• Scoliosis

References

External links

• AAOS.org, Kyphosis (Curvature of the spine)

English Journal

• Deficiency of metallothionein-1 and -2 genes shortens the lifespan of the 129/Sv mouse strain.

• Kadota Y1, Aki Y2, Toriuchi Y2, Mizuno Y2, Kawakami T2, Sato M2, Suzuki S2.
• Experimental gerontology.Exp Gerontol.2015 Jun;66:21-4. doi: 10.1016/j.exger.2015.04.007. Epub 2015 Apr 11.
• Metallothionein (MT) family proteins are small molecular weight and cysteine-rich proteins that regulate zinc homeostasis and have potential protective effects against oxidative stress and toxic metals. To investigate whether MTs play a role in longevity determination in mammals, we measured the lif
• PMID 25871729

• Brittle bones, pain and fractures--lay constructions of osteoporosis among Norwegian women attending the Nord-Trøndelag Health Study (HUNT).

• Skolbekken JA1, Østerlie W, Forsmo S.
• Social science & medicine (1982).Soc Sci Med.2008 Jun;66(12):2562-72. doi: 10.1016/j.socscimed.2008.02.022. Epub 2008 Apr 1.
• Osteoporosis has been labelled the disease of the 21st century. Over the past couple of centuries there have been various notions of this disease in medicine. In the present medical discourse, the emphasis is on prevention rather than treatment, making osteoporosis into a major risk factor for bone
• PMID 18384922

• [Medical, social and economics aspects in the sulphur mines in Sicily(1791 - 1964)].

• Malta R1, Maira G, Salerno A.
• Medicina nei secoli.Med Secoli.2007;19(2):609-26.
• In Sicily the sulphur extraction represented an occasion of economic growth and a development for the dignity of the workers. The "carusi", young boys from 6 to 14 years old, were given up by their parents in return of a hardly payed of loan; it was the so called "soccorso morto" (dead aid). They we
• PMID 18450038

Japanese Journal

• 症例報告 腹腔鏡下直腸脱根治術後に発生したポート孔ヘルニアの一例

• 清家 純一,沖津 宏,吉田 卓弘 [他]
• 四国医学雑誌 62(3・4), 148-151, 2006-08-25
• … The patient was an 80-year-old hunchbacked woman. …
• NAID 40015157302

• 鏡の中の怪物 : マイユーと7月王政期の諷刺

• 野村 正人
• 東京農工大学人間と社会 13, 3-20, 2002-09-10
• … He appeared in many lithographic prints, theatrical plays, pamphlets, journals etc : hunchbacked dwarf with a ape-like face, he was placed in various professions. …
• NAID 110004672442

Related Links

• hunchbacked - The Free Dictionary

An individual whose back is hunched due to abnormal convex curvature of the upper spine. Also called humpback. 2. An abnormally curved or hunched back. 3. Kyphosis. hunch backed adj. hump•backed (ˈhʌmpˌbækt) adj. having a hump ...

• Kyphosis - Wikipedia, the free encyclopedia

Kyphosis (from Greek – kyphos, a hump), also called roundback or Kelso's hunchback, is a condition of over-curvature of the thoracic vertebrae (upper back) . It can be either the result of degenerative diseases (such as arthritis), developmental ...

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