Cyphoses pathologiques

Abstract

Kyphosis could be defined as an anterior spinal curvature. In physiological conditions, spinal sagittal plane is a succession of harmonious sagittal curves of opposite direction: lumbar lordosis, thoracic kyphosis, cervical lordosis. These curves are constituted during the growth and their amplitudes vary from one individual to another. For each individual, the spinal sagittal balance is a compensated combination resulting in an "economic" physiological standing posture. Many different physiological standing postures are present in the population to lead to this sagittal balance and multiple factors interfere for each person. It is necessary to take into account this great variability in spinal sagittal balance before qualifying a spinal curvature as "pathological". Pathological kyphoses are divided into two great groups. Regular kyphoses are localized in a harmonious way on a wide part of the spine. Their "pathological" character rests on the importance of the curve, its stiffness, its evolutivity, or its localization on a usually lordotic spinal segment. Angular kyphoses are localized only on a small number of vertebrae. They are often significant and stiff deformations whose "pathological" character is undeniable. Multiple causes, congenital or acquired, are responsible for the development of a pathological spinal kyphosis. Analysis of the deformation and knowledge of the natural course constitute an essential prerequisite for any therapeutic project. The principal diagnostic and therapeutic stages for each of the most frequent causes of pathological spinal kyphosis are summarized and analyzed in a didactic way.