Progressive Spinal Kyphosis in the Aging Population. (October 2015)

• Record Type: Journal Article
• Authors: Ailon, Tamir; Shaffrey, Christopher I.; Lenke, Lawrence G.; Harrop, James S.; Smith, Justin S.
• Other Names: Fehlings Michael G. section editor.; Mroz Thomas section editor.; Choma Theodore J. section editor.; Harrop James S. section editor.
• Is Part Of: Neurosurgery. Volume 77:(2015)Supplement 1
• Publication Date: 2015-10
• Subjects: Adult spinal deformity -- Dowager's hump -- Proximal junctional kyphosis -- Senile kyphosis -- Thoracic hyperkyphosis; Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1227/NEU.0000000000000944
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract : Thoracic kyphosis tends to increase with age. Hyperkyphosis is defined as excessive curvature of the thoracic spine and may be associated with adverse health effects. Hyperkyphosis in isolation or as a component of degenerative kyphoscoliosis has important implications for the surgical management of adult spinal deformity. Our objective was to review the literature on the epidemiology, etiology, natural history, management, and outcomes of thoracic hyperkyphosis. We performed a narrative review of literature on thoracic hyperkyphosis and its implications for adult spinal deformity surgery. Hyperkyphosis has a prevalence of 20% to 40% and is more common in the geriatric population. The cause is multifactorial and involves an interaction between degenerative changes, vertebral compression fractures, muscular weakness, and altered biomechanics. It may be associated with adverse health consequences including impaired physical function, pain and disability, impaired pulmonary function, and increased mortality. Nonoperative management may slow the progression of kyphosis and improve function. Surgery is rarely performed for isolated hyperkyphosis in the elderly due to the associated risk, but is an option when kyphosis occurs in the context of significant deformity. In this scenario, increased thoracic kyphosis influences selection of fusion levels and overall surgical planning. Kyphosis is common in older individuals and is associated with adverse health effects and increased mortality. Current evidence suggests a role for nonoperative therapies in reducing kyphosis and delaying its progression. Isolated hyperkyphosis in the elderly is rarely treated surgically; however, increased thoracic kyphosis as a component of global spinal deformity has important implications for patient selection and operative planning. ABBREVIATIONS: ASD, adult spinal deformity BMD, bone mineral density DDD, degenerative disc disease LL, lumbar lordosis OR, odds ratio PI, pelvic incidence PJK, proximal junctional kyphosis PT, pelvic tilt SSV, sagittal stable vertebra TK, thoracic kyphosis UIV, upper-most instrumented vertebra