Re: Kyphosis

Re: Kyphosis

Donald E. Katz, C.O.

4/5/1999

<FontFamily><param>Times New Roman</param><bigger>In response to your question, I recently did a literature search
and review on the Orthotic treatment of kyphosis. (This was for
our Academy's Pediatric Certificate Program, to which my
subject was the management of the pediatric and adolescent
spine). If you don't mind the brevity, I thought the easiest way
to respond to your questions would be to simply provide you a
copy of the outline format of my powerpoint slides. I hope you
find this helpful, and please don't hesitate to contact me should if
you have any questions about my post.

Sincerely,

Don Katz, C.O.

Texas Scottish Rite Hospital for Children

Dallas, Texas


......From the powerpoint outline:

<flushboth><smaller>Kyphosis<bigger><bigger><bigger><bigger><bigger><bigger></flushboth>

<flushboth><smaller><smaller><smaller><smaller><smaller><smaller>Differential Diagnoses</flushboth>

<paraindent><param>out</param><flushboth>Juvenile Roundback: >45E without vertebral wedging.</paraindent></flushboth>

<paraindent><param>out</param><flushboth>Scheuermann�s Kyphosis:</paraindent></flushboth>

<paraindent><param>out</param><flushboth>More rigid kyphosis 45E with vertebral wedging; some suggest
>5E in three or more adjacent vertebrae.</paraindent></flushboth>


<flushboth>Scheuermann�s Kyphosis</flushboth>

<paraindent><param>out</param><flushboth>Etiology:</paraindent></flushboth>

<paraindent><param>out</param><flushboth>Schmorl�s disc herniations into the cartilaginous end plate.</paraindent></flushboth>

<paraindent><param>out</param><flushboth>Interruption of endochondral ossification, leading to anterior
wedging and kyphosis.</paraindent></flushboth>

<paraindent><param>out</param><flushboth>Typical presentation around age 10.</paraindent></flushboth>

<paraindent><param>out</param><flushboth>Marked increase in kyphosis upon forward bending can be
diagnostic.</paraindent></flushboth>

<paraindent><param>out</param><flushboth>Common apex between T7 and T9, but thoracolumbar and lumbar
disease exists.</paraindent></flushboth>

<paraindent><param>out</param><flushboth>Often pectoral muscle contractures.</paraindent></flushboth>


<flushboth>Treatment Goals</flushboth>

<paraindent><param>out</param><flushboth>Correct kyphosis to an acceptable magnitude</paraindent></flushboth>

<paraindent><param>out</param><flushboth>One report maintains no more than 60 degrees required to have a
positive prognostic outcome throughout adulthood.</paraindent></flushboth>

<paraindent><param>out</param><flushboth>Achieved by maintaining correction of curve up to the time of skeletal
maturity.</paraindent></flushboth>

<paraindent><param>out</param><flushboth>40-50% correction of initial deformity by treatment end to make up
for increasing curvature with follow-up.</paraindent></flushboth>


<flushboth>Orthotic Treatment</flushboth>

<paraindent><param>out</param><flushboth>Milwaukee most studied orthosis</paraindent></flushboth>

<paraindent><param>out</param><flushboth>Correction is thought to be partly active in nature, with patient
reacting to throat-mold.</paraindent></flushboth>

<paraindent><param>out</param><flushboth>Some reports suggest TLSO is as successful for apices of T9 or
below; one report proporting no more than 70 degrees to be a
threshold for low-profile consideration.</paraindent></flushboth>

<paraindent><param>out</param><flushboth>First 12-18 months full-time wear (22 hrs./day); some reports suggest
8-12 months to be sufficient.</paraindent></flushboth>

<paraindent><param>out</param><flushboth>Part-time (night wear) until skeletal maturity.</paraindent></flushboth>

<flushboth>Brace Discontinuation</flushboth>

<paraindent><param>out</param><flushboth>Decreased vertebral wedging and kyphosis correction imperative.</paraindent></flushboth>

<paraindent><param>out</param><flushboth>Follow-up studies show loss of correction from 15 to 20 degrees.</paraindent></flushboth>

<paraindent><param>out</param><flushboth>Therefore, an out of brace kyphosis of around 30 to 35 degrees at
maturity should result in an acceptable curve of around 50 degrees in
adulthood.<bigger><bigger><bigger></paraindent></flushboth>



<smaller><smaller>Date sent: <color><param>0000,0000,8000</param><smaller>Sat, 3 Apr 1999 14:07:59 -0500

</color><bigger>Send reply to: <color><param>0000,0000,8000</param><smaller>john burger << <Email Address Redacted> >

</color><bigger>From: <color><param>0000,0000,8000</param><smaller>john burger << <Email Address Redacted> >

</color><bigger>Subject: <color><param>0000,0000,8000</param><smaller>Kyphosis

</color><bigger>To: <color><param>0000,0000,8000</param><smaller> <Email Address Redacted>


</color><bigger>I would like to know if the in brace correction of a kyphotic curve is the

same as that for scoliosis? That is, 50% correction? Also, can a 55 degree

curve be effectively managed with the apex at T9 with a low profile brace,

having the second pressure point at T9 and the counter forces at the

abdomin and 1.5cm below the sternal notch?

Finally, is the weaning process from the orthosis basically the same for

scoliosis? Thank you in advance for your responses. I will post them after

I receive all the responses.

John Burger C.P.O.

Efes Protez/Ortez Rehabilitasyon Merkezi

1432 Sokak 5/2

Kahramanlar, Izmir, Turkey


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