Kyphosis is a posterior convex angulation of the spine. Kyphosis is normal for the thoracic spine with normal range from about 20°–50°.
Postural round-back This is a normal variation. The major problem is cosmetic. It is flexible, as the posture can be improved by asking the child to straighten up, and it does not cause a permanent deformity.
Congenital kyphosis Congenital kyphosis may be due to a failure of formation, segmentation, or mixed types. The apex of the curve is most common between T10 and L1. Deformities secondary to a failure of formation are usually progressive and may lead to paraplegia. Assess the apex with high-quality radiographs and a CT study if necessary. Classify the type of deformity. For progressive deformities under about 55°–60°, fuse posteriorly. More severe deformities may require anterior and posterior fusions.
Scheuermann Kyphosis in Children
This disease often causes both pain and deformity. The deformity may present with back pain, as discussed on page 205, or as a deformity.
Deformity Management of the deformity is controversial, as long-term disability is mild and effective treatment is difficult.
Moderate curves <60° Manage with observation and encourage physical activity. Curves >60° in skeletally immature children (Risser sign <3) may be improved by brace treatment. Consider applying a preliminary hyperextension plaster cast to improve flexibility. For curves above T7, use a Milwaukee brace. For lower curves, use an underarm brace. Brace initially for 20 hours daily. Once the curve is controlled, taper the brace to nighttime use. Curves >80° uncontrolled by bracing may require operative correction with posterior instrumentation and fusion.
Natural history of this condition is usually benign, except in individuals with kyphosis that was upper thoracic and >100° who were likely to have restrictive lung disease.
This serious deformity is common following laminectomy in children for conditions such as tumors or trauma. This deformity is best prevented by decompression or exposures that save posterior elements or early posterior fusion in wide excisions in growing children.
Normal lordosis Lordosis is the anterior convex angulation of the lumbar spine in children. The normal range of lordosis is from about 30° to 50°.
Developmental lordosis This developmental variation is common in the prepubescent child. Parents are concerned. The deformity is flexible, and the screening examination is normal. Radiographs are not necessary. Resolution occurs with growth.
Functional hyperlordosis This deformity is functional, a compensation for a fixed deformity above or below the lumbosacral level.
Hyperkyphosis is the primary deformity, and the hyperlordosis is compensatory. This compensatory deformity remains flexible, and this flexibility is demonstrated by correction of the lordosis on forward bending.
Hip flexion contracture causes a functional increase in lordosis, usually >60°. This deformity is very common in cerebral palsy. Assess with the prone extension test. Lordosis is also common in children with bilateral developmental hip dislocations or coxa vara.