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CONDITION/DISORDER SYNONYMS

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  • Scheuermann disease

  • Juvenile disc disease

  • Roundback

  • Hunchback

  • Postural kyphosis

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ICD-9-CM CODES

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  • 737 Curvature of spine

  • 737.0 Adolescent postural kyphosis

  • 737.1 Kyphosis (acquired)

  • 737.10 Kyphosis (acquired) (postural)

  • 737.11 Kyphosis due to radiation

  • 737.12 Kyphosis postlaminectomy

  • 737.19 Other kyphosis acquired

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ICD-10-CM CODES

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  • M40.00 Postural kyphosis, site unspecified

  • M40.209 Unspecified kyphosis, site unspecified

  • M96.2 Postradiation kyphosis

  • M96.3 Postlaminectomy kyphosis

  • M40.299 Other kyphosis, site unspecified

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PREFERRED PRACTICE PATTERNS

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  • 4A: Primary Prevention/Risk Reduction for Skeletal Demineralization1

  • 4B: Impaired Posture2

  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and ROM Associated with Localized Inflammation3

  • 6E: Impaired Ventilation and Respiration/Gas Exchange Associated with Ventilatory Pump Dysfunction or Failure4

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PATIENT PRESENTATION

A 93-year-old woman and her family report she had declined in function throughout the last 1 to 2 months. She has extensive history of postmenopausal osteoporosis for 15 years. Despite the use of bisphosphonates, she has experienced vertebral compression fractures at T8 and T11. She reports chronic back pain, which is severely limiting her activity. She presents with a dowager hump deformity.

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KEY FEATURES

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Description
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  • Excessive posterior curvature of the thoracic spine

  • Adult kyphosis: Scheuermann disease (juvenile disc disease) caused by wedging of several vertebrae5

  • Postural kyphosis: From slouching or poor posture

  • Congenital kyphosis: Under-development of the spinal column6

  • Gibbus deformity: Structural kyphosis from tuberculosis

  • Types of kyphotic deformities

    • Round back

      • Decreased pelvic inclination with thoracolumbar or thoracic kyphosis

      • Caused by tightness in soft tissues from prolonged postural change

      • Compensatory mechanism to maintain body’s center of gravity

    • Hunchback (hump back)

      • Gibbus: Localized, sharp, posterior angulation

      • Structural cause

        • Anterior wedging of one to two thoracic vertebral bodies

        • Wedging may be caused by fracture, tumor, bone disease

      • Pelvic inclination usually normal

    • Flat back

      • Decreased pelvic inclination

      • Thoracic spine remains mobile

      • Kyphosis present

      • Does not have appearance of excessive kyphotic curve

    • Dowager hump

      • Secondary to postmenopausal osteoporosis

      • Anterior-wedge fractures of several upper or middle thoracic vertebrae

      • Contributes to decrease in height

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FIGURE 126-1

The rule of threes. (From Dutton M. Dutton’s Orthopaedic Examination, Evaluation, and Intervention. 3rd ed. http://www.accessphysiotherapy.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

Graphic Jump Location
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Essentials of Diagnosis
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  • Diagnosis usually made by clinical examination

  • Can be an independent diagnosis, not associated with a disease process

  • Cobb angle for measurement of scoliosis5

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General Considerations
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  • Pain and stiffness at rest/sleep

  • Inability to sleep supine

  • Respiratory problems secondary to changes in rib-cage space

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Demographics
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  • Women affected more frequently than men due to postmenopausal alteration

  • Can occur at any age

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CLINICAL FINDINGS

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