- An increase in natural kyphosis of thoracic spine, aka "Dowager's
hump" or "gibbus deformity"
- Can lead to height loss, mobility limitations, decreased lung
capacity, and increased risk for falls
- Incidence increases with age, more common in women than men
- Cause:: Vertebral compression fractures due to Osteoporosis, but can also be due to weakening
of thoracic extensor musculature, ligament
calcification,or degenerative disk disease
- Lateral thoracic spine radiographs with measurement of "Cobb's
angle" is gold standard (angle between lines drawn perpendicular to
upper border of vertebra that starts the thoracic curve and lower
border of vertebra that ends the curve; normal = 20-40'; > 40'
- Can also be measured using a "kyphometer" or "flexicurve ruler"
- Can be confused with "buffalo hump" (fat deposition over upper
thoracic spine in glucocorticoid excess)
- Consider screening for osteoporosis, PT to assess and improve
thoracic paraspinal muscle strength, and if respiratory symptoms are
present, pulmonary function testing to assess vital capacity
- If severe (Cobb's angle > 60') bracing can improve the angle
and relieve some symptoms
- Kyphoplasty (insertion of a balloon into vertebral body to
re-expand a fractured vertebra then injection of bone cement) may
improve pain and function with acute vertebral compression fracture but
utility with old fractures is unproven as of 2012.
(Sources include Core Content Review of Family Medicine, 2012)