Kyphoscoliosis


Kyphoscoliosis describes an abnormal curvature of the spine in both a coronal and sagittal plane. It is a combination of kyphosis and scoliosis. This musculoskeletal disorder often leads to other issues in patients, such as under-ventilation of lungs, pulmonary hypertension, difficulty in performing day-to-day activities, psychological issues emanating from anxiety about acceptance among peers, especially in young patients. It can also be seen in syringomyelia, Friedreich's ataxia, spina bifida, Kyphoscoliotic Ehlers-Danlos Syndrome, and Duchenne muscular dystrophy due to asymmetric weakening of the paraspinal muscles.

Signs and symptoms

The following are clear signs of Kyphoscoliosis:
by itself refers to an excessive convex curvature of spine occurring in the thoracic and sacral regions. A normal thoracic curvature from the 1st to the 12th spine has a naturally occurring convex shape with angles ranging from 20 degrees to 45 degrees. When the curvature goes past 45 degrees, the condition is termed as Kyphosis.
Kyphosis, depending on the extent of curvature can result in many discomforts including breathing and digestion difficulties, cardiovascular issues, and even neurological deformities. The greater the extent of deformity, the more pressing the need becomes for a surgery.
Kyphosis by itself is of several types, including postural kyphosis caused by slouching. Such forms of kyphosis can be reversed to a certain extent by correcting muscular imbalances. The more debilitating version of kyphosis is Scheuermann’s kyphosis, found mostly in teenagers. There are few other causes of Kyphosis as well, such as congenital, nutritional or osteoporosis induced and post-traumatic.
Depending on the type of Kyphosis, the extent of curvature, the age of the patient, various treatment modalities can be suggested including the provision for posture correction, braces, physiotherapy for correcting the muscular imbalance, and finally the surgery. Surgery can be most useful in patients who have an extensive deformity. The rate of post-surgery complications may be higher in elderly patients.

Scoliosis

refers to yet another form of abnormal curvature in which the person’s spine takes an “S” or “C” shape. Scoliosis too has similar forms of treatments available as Kyphosis including bracing, physical therapy and various types of surgeries. Typically, a human spine is straight but in Scoliosis patients; there may be a curve of ten degrees in either direction, left or right.

Cause

Kyphoscoliosis may manifest in an individual at different stages of life and for various causes. When present at a young age ranging from childhood to teenage, Kyphoscoliosis may be present from birth due to congenital abnormalities including Spina bifida.
Certain infections can also lead to the development of Kyphoscoliosis such as vertebral tuberculosis or general tuberculosis. Osteochondrodysplasia, a disorder related to the development of bone and cartilage, can also cause this disease.
In later ages, Kyphoscoliosis can occur in patients suffering from chronic degenerative diseases like osteoporosis and Osteoarthritis. This type of incidence is usually seen in patients above 50+ years of age and is mainly attributed to structural changes in the spine and adjoining tissues. Sometimes, a traumatic injury can also lead to its development.
Further, there are many idiopathic occurrences of Kyphoscoliosis where the exact cause is not very well known but is suspected to be caused by genetic factors.

Diagnosis

Kyphoscoliosis is one of the main criteria in Kyphoscoliotic Ehlers-Danlos Syndrome. It is caused by mutation in the PLOD1 gene and/or gene. The diagnosis is confirmed by molecular testing and suggested when a patient meets criteria 1 and criteria 2: Congenital muscle hypotonia and congenital or early onset kyphoscoliosis, respectively.

Treatments

A study measured outcome from surgery of 49 cases of scoliosis and kyphoscoliosis. Of this sample, 36 patients were monitored for a period of 8 years.
Bad refers to cases where the surgery failed to address the disease and the patient either had to undergo a revision surgery or continues to suffer from a poor quality of life as before surgery.
Typically post-surgery complications range up to 5% involving all major and minor complications when measured within one year of surgery. However, there may be a progressive decline in patient’s condition after a few years.
In another study that evaluated surgical treatment of kyphoscoliosis and scoliosis due to congenital reasons, 91% of surgeries were found to be successful and met their intended objectives for the two-year follow-up period after surgery. The sample consisted of 23 patients of whom 17 were male and 6 were female, with an average age of 27 years, ranging from 13 to 61 years. The most popular type of surgeries for spinal correction includes pedicle subtraction osteotomy and posterior vertebral column resection.
Another study which focused on elderly patients found that the rate of complications was much higher for a sample population of 72 cases with mean age of 60.7 years. The rate of complications was as high as 22% in the entire sample. The study points that in the case of elderly patients, surgery should only be considered when there is no other option left; the disease is in progression stage, and the quality of life has degraded to an extent where conservative treatments can no longer help with pain.
While there are many surgical approaches for spinal deformity correction including anterior only, posterior only, anterior-posterior, the techniques that are most popular nowadays include the posterior only VCR or pVCR. One of the studies which analyze pVCR technique also noted the benefit of using a technique called NMEP monitoring in assisting the surgeon avoid any neurological complications while performing a spine surgery.
In conclusion, the decision to undergo a corrective spine surgery is a complex one but sometimes becomes necessary when the quality of life has degraded to such an extent that potential benefits outweigh the risks. No surgery is devoid of risks but by carefully assessing factors such as the skills and experience of the surgical team, previous record or history of outcomes, and the techniques that are used for spine surgery, a patient along with his or her doctor can certainly help in achieving a successful outcome.
As studies are repeatedly pointing out, the success rates for spinal surgeries have improved so much so that the risks rates can now be comparable to other types of surgeries. These success rates also tend to be higher at a younger age when compared to the elderly age.