OVERVIEW

What is hunchback?

In modern medicine, the professional term for hunchback is: kyphosis. It is a condition caused by various factors that result in abnormal backward curvature of the spine, leading to anatomical changes in the spine itself and its supporting tissues.

The incidence of this disease is not low, and the resulting disability is significant, which can severely affect the patient's health, life, and ability to work. Therefore, treating this condition is not only about improving appearance but, more importantly, restoring the body's physiological functions and working capacity.

What are the types of hunchback?

Hunchback (i.e., kyphosis) is classified according to Winter's classification criteria:

• Type I: Defective formation of the anterior vertebral body, often occurring in the thoracic or thoracolumbar region.
• Type II: Segmentation failure leading to poor differentiation.
• Type III: Mixed type, combining both abnormalities.

Additionally, it is divided into fixed deformities and non-fixed deformities:

• Non-fixed deformities, such as postural kyphosis, are often caused by weak muscles leading to kyphosis or compensatory thoracic kyphosis due to lumbar lordosis.

• Fixed deformities are mostly caused by other diseases, which are further divided into:

• Arcuate kyphosis: Including congenital kyphosis, paralytic kyphosis, age-related kyphosis, rickets kyphosis, ankylosing spondylitis, multiple epiphyseal dysplasia, primary osteoporosis, secondary epiphyseal osteochondrosis, fluorosis, and hyperparathyroid osteodystrophy. Among these, ankylosing spondylitis is the most common clinically.

• Angular kyphosis: Including congenital hemivertebrae, spinal tuberculosis destroying vertebral bodies, vertebral compression fractures and dislocations that fail to reset, vertebral tumors, Paget's disease of bone, and traumatic kyphosis.

SYMPTOMS

What are the manifestations of hunchback?

Depending on the specific etiological classification of kyphosis (hunchback), the clinical symptoms vary:

• The signs of kyphosis are relatively typical, with patients often appearing stooped and unable to stand upright.

• Due to cervical spine involvement, patients cannot lift their heads or lean backward and are unable to look straight ahead in a kyphotic state.

• Kyphosis disrupts the original balance of gravity, making patients prone to falls. They are often short in stature, with occasional joint swelling, mostly in the thoracic and lumbar regions.

• Patients tend to be thin and short, with a reduced distance between the chest and abdominal walls. In severe cases, the thorax may come into contact with the pelvis.

• Thoracic deformity and a narrowed chest cavity compress the heart and lungs, leading to symptoms such as shortness of breath, palpitations, chest tightness, and possible chest pain or a squeezing sensation.

• The spine exhibits angular or arched kyphosis with a prominent ridge-like bony crest.

How does hunchback generally develop?

Kyphosis (hunchback) usually develops gradually and can be caused by congenital or acquired factors.

In congenital cases, symptoms are generally not obvious during childhood but worsen progressively during adolescence, leading to symptoms such as increasing difficulty breathing, rapid shallow breathing, increased heart rate, and hunchback deformity.

Acquired cases are often related to age, trauma, or disease.

What diseases can hunchback cause?

Kyphosis (hunchback) not only affects appearance but may also lead to other health issues, such as:

• Some patients experience abnormal cardiopulmonary function due to thoracic deformity, a narrowed chest cavity, and compression of the heart and lungs, resulting in increased respiratory and heart rates.

• In severe cases, some patients may develop paralysis.

CAUSES

What causes kyphosis?

The causes of this condition are numerous and mainly include:

• Congenital developmental abnormalities.

• Neurological disorders: such as poliomyelitis, central nervous system paralysis, neurofibromatosis, etc.

• Myogenic disorders: such as myasthenia gravis, progressive muscular dystrophy, hereditary ataxia.

• Bone disease sequelae: such as bone tuberculosis, rickets, bone tumors, ankylosing spondylitis, thoracoplasty, etc.

• Traumatic causes: such as vertebral fractures, late traumatic kyphotic deformities of the spine.

• Idiopathic: unknown causes.

DIAGNOSIS

How is hunchback diagnosed?

Early diagnosis and treatment are crucial. Doctors can generally diagnose it based on characteristic manifestations, signs, and related auxiliary examinations.

What tests do hunchback patients need?

The diagnosis of hunchback, or kyphosis, mainly relies on characteristic clinical symptoms, signs, and related auxiliary examinations. The purpose of these tests is to determine the cause, severity, and rule out other conditions.

• Medical history: Detailed inquiries about the patient's health status, past medical history, surgical history, and trauma history. For children with spinal deformities, the mother's health during pregnancy, medication use in the first trimester, and complications during childbirth should be investigated.
  Family history should note any spinal deformities in relatives. In neuromuscular scoliosis, family history is particularly important.

• Physical examination: Professional angle measurement equipment, such as a goniometer, is usually required to measure the kyphosis angle and compare the ratio of height to the kyphosis angle.

• X-ray examination: Anteroposterior and lateral spinal X-rays are taken to measure the kyphosis angle and assess the degree of spinal kyphosis and osteoporosis.

• 3D CT: Determines whether the deformity is purely kyphosis or three-dimensional, and identifies any bone lesions, such as tumors or tuberculosis.

• Magnetic resonance imaging (MRI): Evaluates spinal cord condition, spinal canal stenosis, spinal cord compression, and intraspinal lesions.

• Cardiopulmonary function tests: If the patient experiences symptoms like shortness of breath, palpitations, or chest tightness due to cardiopulmonary compression, heart and electrocardiogram tests are needed to assess the extent of compression.

• Neurological examination: Tests superficial and deep sensations, checking for sensory dissociation or impairment. Evaluates muscle strength, sphincter function, physiological and pathological reflexes, and identifies any reflex reduction, absence, or pathological reflex elicitation.
  Evoked potential tests may be performed if necessary to determine spinal nerve damage.

• Others: Routine blood tests, coagulation profile, erythrocyte sedimentation rate (ESR), and tuberculosis antibody tests to identify infections or tuberculosis-related deformities.

What conditions should hunchback be distinguished from?

Hunchback, or kyphosis, should be differentiated from the following conditions:

• Scoliosis: Partial spinal spinous processes deviate from the midline, including left or right scoliosis, S-shaped, or C-shaped curves.

• Saddleback: Refers to a sudden backward protrusion of a vertebra due to local vertebral destruction.

• Round back: The entire spine curves backward like a bow.

• Pectus deformity: Two types—one where the sternum protrudes outward and another where it is sunken inward.

• Rotational (twisted) deformity: Caused by uneven lumbar transverse processes or sternal twisting, it is the most complex and difficult to treat.

TREATMENT

Which department should I visit for kyphosis?

Children should visit pediatric surgery, while other patients generally visit orthopedics.

Does kyphosis require hospitalization?

• Patients with only deformity, no cardiopulmonary compression, no significant impact on daily life, and low aesthetic requirements do not require hospitalization.

• Hospitalization is recommended for children in the growth period, pregnant women, patients with significant life impact or cardiopulmonary compression symptoms, those with high aesthetic demands, or those with unclear causes. Surgical treatment may be considered.

How should kyphosis be treated?

Treatment for kyphosis (spinal kyphosis) includes the following aspects:

• Primary disease treatment: For children and adolescents with clear causes, focus on treating the primary disease to reduce thoracic deformity. Treatments include anti-tuberculosis therapy, anti-rickets therapy, and active treatment of primary pleural diseases to reduce pleural adhesions.

• Conservative treatment:

  • General supportive therapy: such as improving nutrition;

  • Etiological treatment: For active ankylosing spondylitis, drug therapy is required; for spinal tuberculosis, anti-tuberculosis drugs are needed;

  • Local therapy: Prevent the progression of kyphosis. For example, patients with ankylosing spondylitis or spinal tuberculosis should lie on their back or stomach during bed rest, avoid high pillows, and wear braces or plaster jackets for correction after getting up.

• Surgical treatment: Severe cases may require spinal correction and fusion surgery.

Under what circumstances does kyphosis require surgery?

Surgery is recommended for patients with kyphosis (spinal kyphosis) if any of the following symptoms are present:

• Progressive worsening of spinal cord damage over time;

• Severe pain, kyphosis deformity (Cobb angle, a measure of spinal curvature assessed by doctors) > 50°, and no improvement after long-term conservative treatment;

• Progressive worsening of kyphosis deformity;

• High aesthetic demands.

• Congenital kyphosis: Caused by congenital vertebral developmental disorders, preventing the spine from maintaining physiological support.
  For patients under 5 years old, posterior bone graft fusion may be performed, but this method is unsuitable for severe kyphosis. For patients over 5 years old with significant kyphosis, combined anterior-posterior surgery is used.

• Senile spinal kyphosis: Mainly treated with anterior-posterior surgery. For osteoporosis patients, multi-row fixation is used to prevent fractures. For patients with neurological symptoms, anterior surgery is needed to relieve spinal stenosis.

• Traumatic kyphosis: Cause-specific treatment, such as anterior decompression and support bone grafting. Posterior surgery with decompression and internal fixation may also be performed.

• Tuberculous kyphosis: Primarily treated with anterior lesion removal, bone grafting, and plate fixation. If anterior lesions are minimal, direct anterior bone grafting and fixation are performed, ensuring complete removal of tuberculosis lesions, followed by anti-tuberculosis therapy.

• Ankylosing spondylitis kyphosis: Due to vertebral hardening, only osteotomy correction can restore alignment.

Under what conditions is surgery contraindicated for kyphosis?

Surgery is prohibited if the patient has any of the following conditions:

• Cardiac, pulmonary, hepatic, or renal insufficiency;

• Active primary disease uncontrolled by medication;

• Poor overall health.

What complications may occur after kyphosis surgery?

Postoperative complications:

• Nerve damage and paralysis: Correction surgery near the spinal canal carries a high risk of nerve injury.

• Spinal cord compression: Extensive surgical trauma may cause postoperative edema, compressing spinal cord tissue and leading to neurological symptoms.

• Other unexpected outcomes: Unsatisfactory surgical results.

• If tuberculosis bacteria are not fully removed or a sinus tract forms, a second surgery may be needed.

DIET & LIFESTYLE

What should patients with kyphosis pay attention to in their diet?

No special dietary requirements.

Does kyphosis require follow-up examinations?

Yes. Typically, outpatient X-ray follow-ups are needed to monitor disease progression. If secondary to conditions like tumors or tuberculosis, relevant hematological tests should be repeated.

Postoperative patients should undergo regular outpatient CT or MRI follow-ups.

PREVENTION

How to Prevent Hunchback?

Hunchback, or kyphosis, can be prevented.

The rehabilitation exercises "Back Lift" and "Pectoral Muscle Stretching" can help prevent and improve kyphosis (hunchback) and rounded shoulders:

Additionally, it's important to note that secondary kyphoscoliosis caused by other diseases requires attention to the prevention of the primary condition. The key to preventing kyphosis is staying active. People in sedentary occupations should pay extra attention to regular physical exercise and avoid prolonged sitting.

• Strengthen back and core muscles: Sports like swimming and aerobics can help exercise the back muscles. If possible, swimming regularly is the best way to strengthen the lumbar spine and prevent kyphosis, as it provides a high-intensity workout without excessive fatigue and also relieves mental stress.

• Improve work posture and balance work with rest: Avoid repetitive, monotonous movements and prevent overexertion. Adjust chair and desk heights to maintain proper sitting posture, and take regular breaks to stretch. It is generally recommended to stand and move for 15 minutes after every 45 minutes of seated work to allow fatigued muscles to recover.

• Maintain a regular lifestyle and balanced diet: Reduce staying up late and avoid working or gaming at the computer overnight. Eat three regular meals a day, consume high-protein and high-vitamin foods, and increase intake of fruits and vegetables.

• Manage psychological stress and maintain a positive mindset in work and life.