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Spine Surgery pp 197-202 | Cite as

Diagnosis, Classification and General Treatment Options for Hyperkyphosis

  • Mohammad Arabmotlagh
  • Michael Rauschmann
Chapter

Abstract

The physiological sagittal shape of the spine consists of kyphosis of thoracic spine and lordosis of cervical and lumbar spine. Normal range of thoracic kyphosis and lumbar lordosis are 20–45° and 40–60°, respectively (Bernhardt M, Bridwell K. Spine 14:717–721, 1989). The sum of these curvatures aims to keep the spine in sagittal balance, a condition with lowest energy consumption during standing position. The sagittal balance is characterized by the plump line, which is drawn vertically from the center of the C7 vertebral body down to the sacrum. In normal condition, the plump line bisects the sacral endplate. A variety of conditions may lead to increasing segmental (angular) or regional (arcuar) kyphosis. Compensatory mechanisms exist to counteract the shift of the trunk to the forward as hyperlordosis of cervical and lumbar spine, reclination of pelvis and flexion of knees. Exhaustion of these compensatory mechanism result in the shift of the plump line anterior to the femoral head axis and sagittal imbalance of the spine. Table 26.1 illustrates etiologic conditions that result in kyphotic deformities.

References

  1. 1.
    Bernhardt M, Bridwell K. Segmental analysis of the sagittal plane alignment of the normal thoracic and lumbar spine and thoracolumbar junction. Spine. 1989;14:717–21.CrossRefGoogle Scholar
  2. 2.
    Smith-Petersen MN, Larson CB, Aufranc OE. Osteotomy of the spine for correction of flexion deformity in rheumatoid arthritis. J Bone Joint Surg Am. 1945;27:1–11.Google Scholar
  3. 3.
    Fazl M, Bilbao JM, Hudson AR. Laceration of the aorta complicating spinal fracture in ankylosing spondylitis. Neurosurgery. 1981;8:732–4.CrossRefGoogle Scholar
  4. 4.
    Wilson MJ, Turkel JK. Multiple spinal wedge osteotomy; its use in a case of Marie-Strumpell spondylitis. Am J Surg. 1949;77:777–82.CrossRefGoogle Scholar
  5. 5.
    Ponte A, Vero B, Siccardi G. Surgical treatment of Scheuermann’s hyperkyphosis. In: Winter RB, editor: Progressing Spinal Pathology: Kyphosis. Bologna; Aulo Gaggi. 1984. p. 75–81.Google Scholar
  6. 6.
    Thomasen E. Vertebral osteotomy for correction of kyphosis in ankylosing spondylitis. Clin Orthop Relat Res. 1985;(194):142–52.Google Scholar
  7. 7.
    Alzakri A, Boissiere L, Cawley DT, Bourgli A, Pointillart V, Gille O, Vital JM, Obeid I. L5 pedicle subtraction osteotomy: indication, surgical techniques and specifities. Eur Spine J. 2018;27:644–51.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Mohammad Arabmotlagh
    • 1
  • Michael Rauschmann
    • 2
  1. 1.Spine Department, Academic University Hospital Sana Klinik OffenbachGoethe University FrankfurtOffenbachGermany
  2. 2.Department of Spine SurgerySana Klinikum OffenbachOffenbachGermany

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