Kyphosis Clinical Presentation

Updated: May 04, 2020
  • Author: R Carter Cassidy, MD; Chief Editor: Jeffrey A Goldstein, MD  more...
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Presentation

History

Patients being evaluated for spine deformity should have a thorough history performed. Patients presenting with kyphosis may have as much concern about the cosmesis of the deformity as about the pain. Typically, though, the more significant the deformity is, the greater the pain that will be experienced with ambulation and the eprformance of activities of daily living (ADL). [25]  The presence of numbness or tingling sensations in the lower extremities, more frequent falls, and balance issues should prompt evaluation of the spinal cord and neural elements, which can be compressed with significant deformity.

A 10- to 42-year natural-history study of Scheuermann disease revealed that patients, as compared with control subjects, tended to have increased back pain. [22]  However, they were not more likely to take pain medication, to have sedentary jobs, or to lose motion of the spine. The investigators found no differences between the patient group and the control group with respect to educational level, absenteeism, self-consciousness, or reports of numbness in the legs. Of interest, restrictive lung disease was observed in patients with a curve greater than 100°.

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Physical Examination

Evaluation of a patient should begin with inspection of the coronal and sagittal balance while standing. Specific attention should be directed at the magnitude of trunk shift in the frontal plane, which would indicate a coronal plane deformity, or scoliosis. Inspection of the patient from the side allows evaluation of where the head is positioned in relation to the pelvis.

The patient should also be asked to walk. Significant hip and knee flexion during ambulation indicates that the patient is compensating for the kyphosis by altering the hip and knee position. Whereas such compensation is effective at allowing better forward gait during ambulation, it carries a significantly higher energy cost, negatively correlates with quality-of-life measures, and may increase the risk of falling. [26]

A thorough neurologic examination is also critical in evaluation. A wide-based gait pattern could indicate cervical or thoracic spinal stenosis.  Increased hip and knee flexion during the swing phase of gait could indicate impairment of the ankle dorsiflexion muscles as a consequence of lumbar nerve compression.

Muscle testing should be done systematically and bilaterally so as not to miss any subtle weakness. Hyperactive reflexes or pathologic reflexes, such as clonus or upgoing Babinski, would indicate upper-motor-neuron dysfunction and signify a problem at the level of the cervical or thoracic spine. Alternatively, diminished or absent reflexes could indicate a lower-motor-neuron issue—specifically, at the level of the lumbar spine or more peripherally.

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