On Friday I saw one of my patients from Oklahoma back for follow-up. He is about 40 years old, and has suffered with an accentuated thoracic kyphosis for many years. The curve has not progressed over past 4-6 years, with a thoracic curve around 59 degrees, which is certainly above normal, but has not progressed recently. He works in the financial sector, and travels a lot. He has noticed increasing problems with lower back and neck pain over the years.
Why would the neck and low back hurt, if the deformity is in the thoracic spine?
Well, the answer is that some patients with increased thoracic kyphosis have no pain, and some have pain over the thoracic deformity, while others have pain in the neck or low back area or both. The reason for the neck and/or low back pain is that these areas have to “compansate” for the thoracic increased kyphosis by curving backward more into what we call “Lordosis” (the opposite of kyphosis). This accentuated lordosis can cause increased pressure on the posterior elements including the facet joints. As people get a little older, these facet joints get a bit arthritic, and can be painful if the neck or low back are forced to stay in a “hyperextended” position due to the necessary compensation for the structural thoracic curve.
We are going to try a round of conservative treatment for our friend from Oklahoma.
However, if his curve progresses, or his pain continues to increasingly affect his quality of life, then we may have to consider fixing his thoracic kyphosis.
In the past blogs and podcasts, I have shared some interviews with one of my patients from Chicago IL who had a 90 degree thoracic kyphsos with severe neck pain, who had complete relief of her neck pain and a totally changed posture and self-image after her thoracic kyphosis was corrected. Her podcast interview can be found through iTunes by searching for Dr. Hey’s Podcasts, or through my old Blod and Video Podcast site at http://web.mac.com/drhey. For some reason this hot link to this archived web.mac account does not work, but if you copy or type in URL, you will have no trouble.
17 yo girl who had her kyphosis fixed can be found recently on this blog.
Lloyd A Hey, MD MS
http://www.heyclinic.com
Hey Clinic for Scoliosis and Spine Surgery
Raleigh, NC USA
No comments:
Post a Comment