Kyphoscoliosis refers to an abnormal curvature of the spine in both the front-to-back and side-to-side directions. The forward bending of the upper spine is termed kyphosis, while the sideways bending is known as scoliosis. Kyphoscoliosis happens when both irregular curvatures occur together.
This abnormal twisting of the spinal column can range from mild to severe deforming. In mild cases, daily life is still possible with few limitations. On the other hand, severe progressive cases can eventually impact breathing, cause debilitating leg and back pain, greatly reduce mobility, and lead to self-image issues.
While not directly life-threatening in most people, managing the symptoms and progression of kyphoscoliosis is critical for maintaining comfort and quality of life as the condition advances. By understanding the causes, treatments, and self-care strategies for kyphoscoliosis, those affected can minimise the impact it has on their lives.
In this detailed guide, we will explore what kyphoscoliosis is, what causes abnormal spinal curvatures, how it is diagnosed, the range of treatment options available, and tips for living well with the condition.
Kyphoscoliosis refers to an abnormal curvature of the spine in both the frontal (coronal) plane and the sagittal (front-to-back) plane.
The spine naturally has some mild forward curves in the upper back (thoracic region) and front-to-back curves in the neck and lower back. It also has subtle side-to-side curves. With kyphoscoliosis, however, these natural curves are severely accentuated and distorted.
Kyphosis refers specifically to the exaggerated rounding or “hunchback” appearance of the thoracic spine. This occurs when the thoracic vertebrae become wedge-shaped, compressed, and rotated causing the back to curve forward abnormally. Scoliosis refers to the abnormal side-to-side curvature of the spine. This produces a sideways “C” or “S” shaped curve to the spine. The vertebrae twist and rotate instead of stacking vertically. In kyphoscoliosis, both the front-to-back kyphosis and sideways scoliosis curvatures are present together, distorting the shape of the spine in three dimensions.
Kyphoscoliosis can develop in infants, children, adolescents, and adults. The specific underlying cause often depends on the age of the patient. The condition also varies drastically in severity from mild curves to extremely deforming curves exceeding 100 degrees.
Understanding what leads to kyphoscoliosis, monitoring curve progression, and seeking timely treatment provide the best chance of managing symptoms and avoiding disability. Let’s look closer at what causes these abnormal spinal curvatures to develop.
Causes and Risk Factors for Kyphoscoliosis
Kyphoscoliosis has a wide range of possible underlying causes and predisposing factors depending on a patient’s age.
Causes in Infants and Children:
- Congenital spinal abnormalities present at birth – Malformed or missing vertebrae can lead to asymmetric growth.
- Neuromuscular disorders – Conditions like cerebral palsy or muscular dystrophy that affect coordination, muscle tone and control, impairing proper spinal alignment and support.
- Connective tissue disorders – Laxity of ligaments as seen in Marfan syndrome reduces spinal stability.
- Osteochondrodysplasias – Conditions like osteogenesis imperfecta (brittle bone disease) cause abnormal bone formation and strength.
- Infections – Rare cases can be caused by tuberculosis or other spinal infections.
- Neurofibromatosis – Growths along the spine disrupt the structure.
- Other syndromes – Prader Willi, Noonan syndrome, and others are associated with spinal deformities.
Causes in Adolescents and Adults:
- Idiopathic – Most scoliosis cases have no known cause, so are termed idiopathic (of unknown origin). This describes causes in otherwise healthy adolescents.
- Degenerative – Spinal degeneration from ageing, arthritis, injuries, or disc problems leads to asymmetric collapse and curves.
- Secondary – In adults, scoliosis is often secondary to other present neurological, muscular, or skeletal disorders.
- Scheuermann’s kyphosis – A developmental disorder of the thoracic spine causing rigid wedging of vertebrae and abnormal kyphosis.
- Intersegmental instability – Laxity of spinal ligaments leads to excessive motion between vertebrae.
In both children and adults, any condition that impacts the integrity of the spine’s structural support potentially increases risk. Genetic and hormonal factors that influence bone and soft tissue development also play a role. Identifying any underlying diagnoses guides appropriate customised treatment.
Symptoms and Effects of Kyphoscoliosis
The symptoms and functional effects of kyphoscoliosis vary tremendously based on multiple factors, such as the following:
- Age of onset – Congenital or early onset is more likely to be severe and progressive.
- Cause – Any neurological deficits impact symptoms. Connective tissue disorders worsen laxity.
- Spinal location – Thoracic curves affect ribcage expansion more than lumbar curves.
- Curve direction – Curving left versus right produces asymmetry.
- Speed of progression – Faster progression escalates symptoms quicker.
- Curve severity – Larger curves above 50 degrees cause more problems.
Mild to moderate kyphoscoliosis may cause minor or intermittent discomfort. Severe untreated curves, however, can eventually produce:
- Back pain and muscle fatigue from strain
- Limited endurance in activities
- Leg pain, numbness or weakness from nerve root compression
- Headaches and nausea due to brainstem compression
- Shortness of breath
- Heart complications from reduced lung capacity and restrictive chest wall movement
- Postural changes like uneven shoulders, head leaning forward, protruding back
- Height loss from spine collapsing
- Protruding abdomen and ribs
- Gait abnormalities and difficulty walking far distances due to imbalance.
- Body image issues and associated anxiety, depression, and social isolation.
Seeking treatment before the curve progresses helps prevent the most debilitating symptoms. Monitoring change over time is crucial.
Doctors use a combination of diagnostic tests such as X-Rays, MRIs and CT scans to evaluate kyphoscoliosis:
- Medical history – Questions about family history of scoliosis and any other conditions or injuries possibly related.
- Physical exam – Postural assessment, range of motion, balance, coordination, neurological function tests. Checks for leg length differences or other asymmetry.
- X-rays – Used to locate and measure the degree of spinal curvatures. X-rays are essential.
- CT and MRI scans – If needed to visualise underlying congenital defects, tumours, infections, or neurological causes.
- Pulmonary function tests – Measures lung capacity since breathing can be impaired with severe deformity. Checks for sleep apnea.
- EKG – Screens for cardiac changes if heart function seems compromised.
Doctors characterise the curvature severity using the Cobb angle method to measure the curve on X-rays.
- Mild curves measure 10-30 degrees
- Moderate 30-60 degrees
- Severe curves exceed 60+ degrees
Regular X-rays are needed to monitor curve progression over time, especially during adolescent growth spurts when rapid worsening can occur. Early detection of increasing curves is key.
Non-Surgical Treatments for Kyphoscoliosis
For mild to moderate spinal curvature in kyphoscoliosis, non-surgical treatments aim to:
- Halt or slow progression in growing children and adolescents.
- Provide pain relief and maintain flexibility.
- Improve posture, strength, and mobility.
- Enable patients to stay active and independent.
Common non-surgical interventions include:
- Rigid bracing – Custom plastic braces are worn to mechanically straighten and derogate the spine to prevent further progression of curves during child and adolescent growth. Bracing is proven effective, especially if worn full-time as directed until bone maturity.
- Physical therapy – Specific exercises can improve back strength and flexibility to support better posture and alignment. Stretching such as yoga and pilates, core strengthening exercises, lumbar stabilisation exercises, and gentle mobilisation techniques may provide pain relief.
- Chiropractic care – Gentle spinal manipulation and mobilisation done by a specialist such as a chiropractor or orthopaedic doctor may help alleviate pain and improve mobility if applied appropriately.
- Pain management – Over-the-counter anti-inflammatories and pain relievers, ice or heat therapy, massage, and improving muscle strength can help reduce painful symptoms.
- Assistive devices – Walkers, canes, standing frames or wheelchairs may improve safety and conserve energy in severe cases.
The goal of non-surgical management is to stop the curvature progression in youth and improve spinal stability and strength over a lifetime. By avoiding progression, surgery may be unnecessary. Supportive therapies enable patients to continue daily activities comfortably.
When to Consider Surgical Treatment
For progressive kyphoscoliosis producing intractable pain, breathing difficulties, or neurological deficits, orthopaedic surgery may become necessary to correct the structural deformity. The goals of surgery include:
- Stopping further progression of abnormal spinal curves
- Partially correcting and straightening the abnormal curvature and rotation to the extent safely possible. For severe rigid curves, only 50% correction may be achievable
- Decompressing impacted nerves if needed to improve muscle strength and neurological function. This helps resolve pain, weakness, and coordination problems.
- Permanently stabilising and supporting the spine to achieve better posture, balance, and functionality.
Surgery may be worthwhile if:
- Spinal curvatures exceed 40-50 degrees in growing children. Bracing above this threshold is less likely to prevent further progression.
- Chronic pain or neurological deficits arise from spinal cord or nerve root compression.
- Pulmonary function becomes significantly impaired due to reduced lung capacity and restrictive chest wall movement.
- Progressive deformity leads to intractable pain, loss of function, and major disability.
Various surgical techniques can straighten and stabilise the alignment and structural integrity of the spine. Rods, screws, wires, and fused bone grafting are used to reinforce the spinal column in the correct position. Rehabilitation after surgery is crucial to regaining optimal strength, function, and outcomes.
Surgical Treatments for Kyphoscoliosis
For those with severe, progressive kyphoscoliosis producing intractable pain, loss of function, or life-threatening complications, surgery may become the only option to stop further worsening. The goals of surgery include:
- Stopping the progression of abnormal spinal curvature to prevent additional deformity.
- Partially correcting and straightening existing curves and rotation as much as safely possible.
- Decompressing impacted nerves and the spinal cord if needed to resolve or prevent pain, loss of coordination, paralysis, or bowel/bladder dysfunction. This improves neurological function.
- Permanently stabilising and reinforcing the structural integrity of the spine after correction to achieve better posture, balance, and functionality long-term.
There are many complex surgical techniques orthopaedic spinal surgeons may utilise, depending on the case, such as:
- Anterior approach – The surgeon operates from the front of the chest to access the spine for discectomy, bone grafting, and instrumentation. A combined anterior-posterior approach directly corrects the deformity.
- Posterior approach – Surgeon operates from the back to place rods, screws, wires and bone grafts to reinforce the straightened spine. This technique is more common.
- Osteotomies – Sections of bone may be removed to help correct rigid, severe curves that are otherwise unresponsive to correction forces.
- Spinal fusion – Vertebrae are fused with bone grafts to create a rigid column once corrective positioning is achieved.
- Spinal instrumentation – Rods, screws, and wires provide internal bracing to maintain the correct spine position while fusion occurs.
- Hemivertebra excision – Removing wedge-shaped hemivertebrae can allow for correction.
- Halo gravity traction – For rigid curves, this preoperative technique uses skull traction to gradually straighten the spine.
Rehabilitation after surgery is crucial to rebuild the strength, flexibility, balance, and stamina needed for regular activity. While risks are involved with surgery, the reduced pain and improved function following correction of severe deformity are often life-changing.
Learning to Live Well with Kyphoscoliosis
While kyphoscoliosis poses physical challenges, those affected can still live full, active lives through proper conservative management. Developing adaptive strategies and accommodations is key. Some tips for living well with kyphoscoliosis include:
- Engage in a regular, gentle exercise program to build back, core, and leg muscle strength, flexibility, stamina, and balance. This helps keep the spine supported and the muscles surrounding it strong. Low-impact activities like swimming, walking, light strength training, yoga and pilates are ideal.
- Use proper posture, body mechanics, and ergonomics during daily activities. Avoid slouching, bending repeatedly, rounding the shoulders, and lifting heavy objects which increase strain.
- Try supportive back braces, shoe inserts, lumbar rolls, or seat cushions if needed for extra stability, posture, and pain relief. Use assistive devices if necessary for safety.
- Listen to your body. Rest when tired. Stop an activity if it causes pain. Pace activities over the day and week to avoid overexertion. When you are outdoors, also try to stay under shades as much as possible to avoid heat injuries.
- Manage and reduce emotional stress since anxiety and muscle tension can exacerbate pain and fatigue. Try counselling, support groups, relaxation techniques, pursuing hobbies, allowing extra time for tasks, and saying “no” when needed.
- Maintain a healthy diet and weight to avoid placing excess strain on the spine.
- Optimise bone health through the intake of calcium, vitamin D, and other nutrients.
- Stay hydrated.
- Make home modifications for accessibility if needed like railings, raised chairs, reachable shelves, and shower grips. Eliminate tripping hazards.
- Access social support. Spend time with supportive friends and family. Participate in support groups to connect with others who understand the daily challenges. A positive mindset, humour, and seeking accommodations can lighten the burden.
Remaining flexible physically and mentally is key to successfully managing life with kyphoscoliosis. With thoughtful adaptation, the use of tools to aid daily activities, patient self-care, and support from others, living well with kyphoscoliosis is very possible.
Treating Kyphoscoliosis in Singapore
Kyphoscoliosis is an abnormal side-to-side and front-to-back curvature of the spine requiring careful monitoring and treatment. While mild cases may have minimal impact, severe progressive kyphoscoliosis can substantially impair posture, mobility, breathing, neurological function, and quality of life if left unaddressed.
Through regular radiographic exams to monitor progression, bracing to halt worsening, physical therapy and exercise tailored to individual capability, medication and therapy for pain relief, supportive equipment as needed, and surgery in advanced cases, kyphoscoliosis can be well-managed. Although the abnormal spinal curvature cannot be fully reversed in most patients, leading a fulfilling and active life is absolutely achievable with proper conservative care or surgical correction of deformity.
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About the Author
Dr James Tan is a highly skilled orthopaedic surgeon who has more than 10 years of experience in sports surgery and exercise medicine. He is a member of the elite Asian Shoulder and Elbow Group and a founding member of the Singapore Shoulder and Elbow Surgery Society.
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