126: KYPHOSIS

CONDITION/DISORDER SYNONYMS

• Scheuermann disease

• Juvenile disc disease

• Roundback

• Hunchback

• Postural kyphosis

ICD-9-CM CODES

• 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

ICD-10-CM CODES

• 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

PREFERRED PRACTICE PATTERNS

• 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

KEY FEATURES

Description

• 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

Essentials of Diagnosis

• Diagnosis usually made by clinical examination

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

• Cobb angle for measurement of scoliosis⁵

General Considerations

• Pain and stiffness at rest/sleep

• Inability to sleep supine

• Respiratory problems secondary to changes in rib-cage space

Demographics

• Women affected more frequently than men due to postmenopausal alteration

• Can occur at any age

CLINICAL ...