From the Research
The management of adolescent kyphosis should prioritize a combination of observation, physical therapy, bracing, and rarely surgery, with the most recent and highest quality study suggesting that Chiropractic BioPhysics® methods can be effective in reducing thoraco-lumbar junctional kyphosis and improving related biomechanical parameters 1.
Key Considerations
- The severity of the condition is a crucial factor in determining the management approach, with mild cases (kyphosis less than 50 degrees) typically involving observation and physical therapy, and moderate cases (50-70 degrees) requiring bracing with a thoracolumbosacral orthosis (TLSO) or Milwaukee brace 2.
- For severe cases (greater than 70-75 degrees) or those with significant pain unresponsive to conservative measures, surgical correction through posterior spinal fusion may be necessary, with the goal of preventing progression during growth, reducing pain, and improving cosmetic appearance 3.
- Patient education about maintaining good posture during daily activities and avoiding prolonged sitting is essential, as well as pain management with NSAIDs like ibuprofen (400-600mg three times daily) as needed 2.
Treatment Options
- Observation with regular follow-up and physical therapy focusing on core strengthening, hamstring stretching, and postural exercises for mild cases
- Bracing with a thoracolumbosacral orthosis (TLSO) or Milwaukee brace worn 16-23 hours daily for 12-24 months during skeletal growth for moderate cases
- Surgical correction through posterior spinal fusion for severe cases or those with significant pain unresponsive to conservative measures
- Chiropractic BioPhysics® methods, including mirror image®, anterior thoracic translation, and thoracolumbar hyperextension traction, as a potential alternative or adjunct to traditional treatment approaches 1
Important Considerations
- The rationale for treatment is to prevent progression during growth, reduce pain, improve cosmetic appearance, and avoid potential cardiopulmonary complications from severe kyphosis in adulthood 2.
- A detailed preoperative assessment is essential in order to establish the correct diagnosis and choose the proper treatment, especially in cases of congenital deformities 3.