From the Guidelines
Treatment options for hyperkyphosis are limited and often reserved for severe cases, with a focus on improving physical functioning, cardiopulmonary functioning, and psychological well-being.
Treatment Options
- Physical therapy: recommended as a first-line treatment to improve mobility and reduce disability 1
- Unsupervised back exercises: conditionally recommended to improve flexibility and strength 1
- Fall evaluation and counseling: conditionally recommended to prevent falls and related injuries 1
- Formal group or individual self-management education: conditionally recommended to educate patients on managing their condition 1
- Elective spinal osteotomy: may be considered in selected patients with severe kyphosis and significant physical and psychological impairments, but is generally conditionally recommended against due to high procedure-associated risks 1
- Spinal surgery: may be considered for patients with disabling kyphosis, loss of horizontal vision, painful spinal pseudarthrosis, or other indications, with a focus on restoring balance and horizontal vision 1
Important Considerations
- Surgical risks: elective spinal osteotomy carries significant risks, including perioperative mortality and permanent neurologic sequelae, and should only be considered in specialized centers by experienced surgeons 1
- Individualized treatment: treatment decisions should be made on a case-by-case basis, taking into account the patient's specific needs, preferences, and risks 1
From the Research
Treatment Options for Hyperkyphosis
The treatment options for hyperkyphosis include:
- Surgical treatment: A surgical treatment algorithm was developed to aid in the choice of the appropriate corrective technique for thoracic and lumbar hyperkyphosis in pediatric population 2.
- Bracing: Brace treatment is an effective treatment approach for patients with Scheuermann's disease, with an average in-brace correction of > 15 degrees predicting a favourable outcome 3.
- Physiotherapy: Physiotherapy is a first-line treatment for Scheuermann's hyperkyphosis, along with bracing 3, 4.
- Orthotic treatment: Orthotic treatment with Milwaukee brace can correct idiopathic hyperkyphosis, especially if the in-brace correction is saved in part-time duration 5.
Surgical Treatment
Surgical treatment for severe fixed hyperkyphosis is technically demanding but can be successfully achieved if all surgical challenges and comorbidities are adequately addressed 6. The surgical treatment algorithm for thoracic and lumbar hyperkyphosis in pediatric population takes into account the classification of Rajasekaran et al., preoperative analysis of the angularity and flexibility of the curve, global sagittal balance, and neurological status of the patient 2.
Bracing and Orthotic Treatment
Bracing and orthotic treatment are effective for patients with hyperkyphosis, with an average in-brace correction of > 15 degrees predicting a favourable outcome 3, 5. The kyphologic brace leads to in-brace corrections comparable to those of the Milwaukee brace, which has previously been shown to provide beneficial outcomes in the long-term 3.
Considerations
The indication for surgical treatment should be thoroughly considered and chosen individually, especially in cases with severe fixed hyperkyphosis due to ankylosing spondylitis 6. The treatment should be initiated before the curvature angle exceeds 50-55 degrees in a growing adolescent 3.