Kyphosis, lordosis, scoliosis

The evolutionary process has made its own adjustments to the structure of the human spine. During the transition to upright posture, the spine formed curves, thanks to which it became easier for it to perform the most important musculoskeletal function.

In accordance with the norm, the human spinal column has 3 bends: in the cervical region, the bend is directed forward (cervical lordosis), as well as in the lumbar region, it is directed forward (lumbar lordosis), but in the thoracic region, the bend is directed backward (thoracic kyphosis).

The formation of bends occurs in childhood and only by the age of 6 they become clearly expressed. In the process of human growth, a curvature of the spine is not so rare: if it occurs to the sides, then scoliosis is diagnosed , with a strong protrusion forward, a diagnosis of lordosis is made, on the contrary, a strong protrusion back leads to the development of kyphosis .

Lordosis is a very rare disease that in the vast majority of cases causes hip dislocation.

Rickets leads to the development of kyphosis in young children, poor posture during reading in anemic girls, and in old people it occurs due to degenerative processes in the body. But not a single curvature can be compared in frequency of occurrence with scoliosis.

With the development of lordosis, there is an increase in lumbar concavity. The gait of patients becomes jerky, they cannot bend forward so that their knees are straight.

Secondary lordosis occurs as a compensation for kyphosis of the thoracic spine, due to hip dislocation or ankylosis (immobility) of the hip joint. This is a kind of adaptation of the body in order to maintain the balance of the body. If you treat the underlying disease, then the secondary lordosis will pass by itself. But if it arose in childhood and remained unattended for a long time, then it will remain fixed to the end.

Kyphosis is when the spine curves backwards

An example of kyphosis is stoop and hunchback.

With the curvature of the thoracic spine, a round back is formed, when the shoulders begin to bulge in front and sag to the bottom, there is a narrowing of the chest during exhalation, and protrusion of the abdomen. The shift of the center of gravity behind compensates for the tilt of the upper body forward, while the shoulder blades begin to take on a pterygoid shape. Narrowing in the chest area contributes to a deterioration in the mobility of the ribs, a decrease in the vital capacity of the lungs and, as a result, to a violation of respiratory and cardiac activity.

As compensation for kyphosis, lordosis or simply counter -curvature may develop , which eventually becomes stable.

Sometimes, when deformed, the shoulders do not change their position and remain above the pelvis. In this case, it is considered that the kyphosis is compensated. When the whole body is involved in the process of curvature, when the shoulders are located behind, while the pelvic bones are pushed forward, an uncompensated form of kyphosis occurs.

By the nature of kyphosis can be congenital and acquired

In addition, kyphosis is classified by age and form. Depending on the shape, kyphosis can be angular and arcuate. The development of angular kyphosis leads to the formation of a hump. With the development of arcuate kyphosis, the surface of the chest from behind, when tilted forward, looks like a coffin lid.

Also, depending on the location of kyphosis, there are thoracic and lumbar-thoracic forms. If the pathological process affects the thoracic vertebrae from IV to X, then the form of thoracic kyphosis. If the lesion affects the thoracic vertebrae from the XI-XII, as well as the I-II lumbar, then the kyphosis is lumbar-thoracic.

During the examination of the patient, a special instrument is used, which is called a kyphometer . It allows you to determine the level of curvature of the spinal column in the usual posture position for a person, and in three more positions: a straightened posture, a maximum bent and a maximum unbent position. It must be remembered that kyphosis is not a disease, but appears as a result of the influence of adverse causes.

Congenital kyphosis causes underdevelopment of the intervertebral discs, impaired formation of the vertebrae. Acquired kyphosis occurs as a result of trauma to the vertebral bodies, with the development of oncology or inflammation, during postoperative intervention, the development of rickets, osteoporosis, spondylosis, osteochondropathy of the vertebrae. Among the causes of kyphosis are childhood leukemia, pathologies that are classified as systemic diseases of the skeleton and muscle tissue in the form of myatonia , muscular dystrophy, myasthenia gravis.

At different ages, kyphosis has its own characteristics, so there is a classification of pathology by age. Kyphosis can be infantile, childish, adolescent, youthful, typical for adults, presenile, senile (occurring in old age).

Rickets contributes to the development of infantile kyphosis, so you can often hear its second name “rachitic kyphosis”. It is an arc at the level of I-III lumbar vertebrae. As for the form of childhood kyphosis, it can be bone or muscle. The bone form is caused by diseases (tuberculosis) or damage to the vertebral bodies.

Muscle weakness causes the development of a muscular form of pathology. It arises on the basis of a serious illness suffered by a child, or his weak physical development. Visually, it looks like an incorrect posture during the period of growth of the child.

Juvenile kyphosis is recognized by the back, which has a fixed, rounded shape.

The development of kyphosis in adults leads to Bechterew’s disease (progressive spondylitis) or ankylosing spondylitis. Men are almost 10 times more likely to suffer from this disease. Pathology begins to develop at the age of 20-30. At the last stage, the patient’s back is a solid arc, starting from the base of the skull, ending with the sacrum, the abdomen is swollen in the lower part, the knees do not leave the bent position, the arms are folded back relative to the body. In old age, spondylosis and kyphosis develop together (this is facilitated by the involution of the spine).

Among the reasons that lead to the development of pathology, the primary bone form of youthful kyphosis in a neglected state, the destruction of the intervertebral discs. As for presynile kyphosis, its development is most often observed in women at the age of 50-55, when the menstrual cycle stops, the hormonal system is rebuilt, which contributes to the development of osteoporosis.

Presenile kyphosis appears at an earlier age and proceeds in a painful form. In this it differs from senile kyphosis, which affects the upper and middle parts of the thoracic part of the spinal column. In the process of degenerative changes, the intervertebral discs flatten, kyphosis develops downward and is natural in the aging process. It manifests itself in the form of a hunched “senile back” in the upper part.

Scoliosis is a pathology characterized by a lateral deviation of the spine from the axis of the body.

Scoliosis differs from thoracic kyphosis and lumbar lordosis in that the lateral displacement itself is a pathology. It can be congenital or acquired. The formation of congenital scoliosis occurs during fetal development of the fetus, when disorders cause problems associated with the formation of the skeleton.

Among the reasons that lead to intrauterine disorders are bad habits and malnutrition of women during the period of gestation, neglect of physical activity and exercise therapy. Scoliosis of an acquired nature can be caused by diseases (poliomyelitis, rickets, tuberculosis), trauma (fracture of the spinal column), impaired posture, etc. Scoliosis can be an occupational disease of adults when they are forced to stay in one position for a long time in their field of activity (office employees shoemakers, dentists, musicians).

There are 4 main groups of acquired scoliosis:

  • the first group is rheumatic, which is characterized by a sudden onset of scoliosis due to a strong contraction of muscle tissue in a healthy area during inflammatory muscle diseases or the development of pathologies associated with the intervertebral joints (spondyloarthritis, myositis);
  • the second group is rachitic, where scoliosis develops due to muscle weakness, long-term carrying of the child in her arms, sitting at school;
  • the third group is paralytic, here scoliosis is associated with cerebral palsy and other nervous disorders;
  • the fourth group is habitual, where poor posture is a determining factor in the development of scoliosis.

There is another classification of scoliosis according to anatomical features, according to which scoliosis can be non-structural (simple) or structural (complex). Based on the name, non-structural scoliosis does not cause anatomical or structural deformation of the vertebrae with the spine and is presented as a simple lateral deviation of the line of the spinal column from the axis of the body.

A distinctive feature of non-structural scoliosis from structural scoliosis is the absence of fixed rotation, which consists in the rotation of the vertebrae relative to the longitudinal axis of the spinal column. Non- structural scoliosis is characterized by division into the following types: reflex, postural , inflammatory, compensatory, hysterical.

The formation of postural scoliosis occurs by the age of 8-11 due to a violation of posture. In this case, the lateral curvature in the form of an arc is directed to the left. In the prone position and the applied effort, the curvature completely disappears.

Shortening of one of the legs leads to the development of compensatory scoliosis. The curvature occurs towards the short leg. At the same time, the pelvis tilts, which leads to compensation in the difference in leg length. With the development of compensatory scoliosis, they fight with the help of orthopedic shoes.

Reflex is not true scoliosis, since its more correct name is “sparing posture”, which the patient tries to take in order to reduce the irritation of nerve endings that occurs during disc herniation.

Inflammatory scoliosis can cause an abscess of the perirenal tissue, and if it is opened, the curvature will disappear.

Hysterical scoliosis is characterized by the fact that it appears and disappears for no reason. Structural scoliosis appears in childhood. It is characterized by a complex curvature of the spinal column and a fixed rotation of the vertebrae.

The displacement of the ribs back in the form of a costal hump is observed on the convex side of the curvature. On the concave side, the ribs, on the contrary, are compressed and bulge forward. Structural changes in the vertebrae during adolescence cause a violation of bone formation.

Structural scoliosis is characterized by one primary curvature.

To balance the position of the head relative to the pelvis, the spine tends to form two compensatory curvatures at once. One will be located under the primary curvature, the other above it. As a result, the spine takes on an S-shape. It is worth noting that the cause of structural scoliosis remains unknown in 50-70% of cases.

Depending on the causes that led to the development of pathology, scoliosis is conventionally divided into: myopathic , neuropathic, metabolic, osteopathic , fibropathic , thoracogenic and scoliosis caused by external factors.


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