SPINAL DEFORMITIES (Lordosis,Swayback,Kyphosis,Scoliosis)


SPINAL DEFORMITIES (Lordosis,Swayback,Kyphosis,Scoliosis)


Lordosis is an excessive anterior curvature of the spine .3-7 Pathologically, it is an exaggeration of the normal curves found in the cervical and lumbar spines. Causes of increased lordosis include (1) postural deformity; (2) lax muscles, especially the abdominal muscles in combination with tight muscles, especially hip flexors or lumbar extensors; (3) a heavy abdomen, resulting from excess weight or pregnancy' (4) compensatory mechanisms that result from another deformity, such as kyphosis, (5) hip flexion contracture; (6) spondylolisthesis; (7) congenital problems, such as bilateral congenital dislocation of the hip; (8) failure of segmentation of the neural arch of a facet joint segment; or (9) fashion (e.g., wearing high-heeled shoes). There are two types of exaggerated lordosis, pathological lordosis and swayback deformity.


Swayback Deformity.:-


With a swayback deformity, there is increased pelvic inclination to approximately 40°, and the thoracolumbar spine exhibits a kyphosis. A swayback deformity results in the spine's bending back rather sharply at the lumbosacral angle. With this postural deformity, the entire pelvis shifts anteriorly, causing the hips to move into extension. To maintain the center of gravity in its normal position, the thoracic spine flexes on the lumbar spine. The result is an increase in the lumbar and thoracic curves. Such a deformity may be associated with tightness of the hip extensors, lower lumbar extensors, and upper abdominals, along with weakness of the hip flexors, lower abdominals, and lower thoracic extensors




Kyphosis is excessive posterior curvature of the spine  Pathologically, it is an exaggeration of the normal curve found in the thoracic

spine. There are several causes of kyphosis, including tuberculosis, vertebral compression fractures, Scheuermann's disease, ankylosing spondylitis, senile osteoporosis, tumors, compensation in conjunction with lordosis, and congenital anomalies.9 The congenital anomalies include a partial segmental defect, as seen in osseous metaplasia, or centrum hypoplasia and aplasia.  In addition, paralysis may lead to a kyphosis because of the loss of muscle action needed to maintain the correct posture combined with the forces of gravity. Pathological conditions such as Scheuermann's vertebral osteochondritis may also result in a structural kyphosis . In this condition, inflammation of the bone and cartilage occurs around the ring epiphysis of the vertebral body. The condition often leads to an anterior wedging of the vertebra. It is a growth disorder that affects approximately 10% of the population, and in most cases several vertebrae are affected. The most common area for the disease to occur is between T10 and L2.


There are four types of kyphosis.Round Back.:-


The patient with a round back has a long, rounded curve with decreased pelvic inclination «30°) and thoracolumbar kyphosis. The patient often presents with the trunk flexed forward and a decreased lumbar curve. On examination, there are tight hip extensors and trunk flexors with weak hip flexors and lumbar extensors.


Humpback or Gibbus.:-

With humpback, there is a localized, sharp posterior angulation in the thoracic spine.


Flat Back.:-


A patient with flat back has decreased pelvic inclination to 20° and a mobile lumbar spine.


Dowager's Hump:-


 This is often seen in older patients, especially women. The deformity commonly is caused by osteoporosis, in which the thoracic vertebral bodies begin to degenerate and wedge in an anterior direction, resulting in a kyphosis




Scoliosis is a lateral curvature of the spine.9,1l,16-22 This type of deformity is often the most visible spinal deformity, especially in its severe forms. The most famous example of scoliosis is the "hunchback of Notre Dame." In the cervical spine, a scoliosis is called a torticollis. There are several types of scoliosis, some of sternocleidomastoid muscle), in conjunction with malocclusion of the temporomandibular joints or with ear problems (referred to the cervical spine). With structural scoliosis, the patient lacks normal flexibility, and side bending becomes asymmetric. This type of scoliosis may be progressive, and the curve does not disappear on forward flexion. With nonstructural scoliosis, there is no bony deformity; this type of scoliosis is not progressive. The spine shows segmental limitation, and side bending is usually symmetric. The nonstructural scoliotic curve disappears on forward flexion. This type of scoliosis is usually found in the cervical, lumbar, or thoracolumbar area.


Idiopathic scoliosis:-

 accounts for 75% to 85% of all cases of structural scoliosis. The vertebral bodies rotate into the convexity of the curve, with the spinous processes going toward the concavity of the curve. There is a fixed rotational prominence on the convex side which is best seen on forward flexion from the skyline view. This prominence is sometimes called a "razorback spine." The disc spaces are narrowed on the concave side and widened on the convex side. There i distortion of the vertebral body, and vital capacity i considerably lowered if the lateral curvature exceed 60°; compression and malposition of the organs within the rib cage also occur. Examples of scoliotic curve.


SPINAL DEFORMITIES (Lordosis,Swayback,Kyphosis,Scoliosis)


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