Kyphotic Index Research Articles

A comparative study to assess thoracic kyphotic index in adults with and without mechanical neck pain.

To assess thoracic kyphotic index in adults, and to find out the correlation between Neck Disability Index and Thoracic Kyphotic Index. The analytical cross-sectional study was conducted from October 2020 to January 2021 at the Shifa Tameer-e-Millat University, Islamabad, Pakistan, and comprised adults aged 18-35 years. Those with neck pain formed group A, while those without neck pain formed group B. The Numeric Pain Rating Scale and the Neck Disability Index were used to measure mechanical neck pain, while the Thoracic Kyphotic Index value was measured using a flexicurve ruler. Data was analyzed using SPSS 24. Of the 74 subjects, 37(50%) were in each of the two groups. There were 19 (51.40%) females and 18(48.60%) males in group A, while in group B there were 18(48.60%) females and 19(51.40%) males. The overall mean age of the sample was 23.35±3.31 years. Group A showed higher Thoracic Kyphotic Index value than group B (p=0.0001). The Neck Disability Index showed negative weak (r=-0.18, p=0.28) correlation with Thoracic Kyphotic Index in group B and moderate positive correlation (r=0.33, p=0.04) in group A. Higher Thoracic Kyphotic Index value was found among adults with mechanical neck pain compared to healthy adults.

Feasibility of a 4-Week Manual Therapy and Exercise Intervention on Posture and Function in Community-Dwelling Older Adults: A Pilot Study.

Thoracic hyperkyphosis is a common condition that progresses with aging and has been associated with impaired functional performance, increased risk of falls, and even mortality. Previous studies to improve posture primarily used exercise for durations of 3 months or longer. The purpose of this pilot study was to examine the feasibility of a manual therapy intervention in community-dwelling older adults over a 4-week time frame that is comparable to the typical clinical setting, to test the appropriateness and procedures for the measurement of posture and function in the older population with hyperkyphosis, and to collect preliminary data to describe change in posture and function measures. Twenty-four participants with hyperkyphosis or forward head posture were recruited, and 22 participants completed this pilot study. Feasibility was measured based on attendance, tolerance, safety, and retention. Issues with measurement procedures were recorded. The intervention included manual therapy and exercise 3 times a week for 4 weeks to target spinal and peripheral joint stiffness, muscle lengthening, and muscle activation. Outcomes included height, kyphotic index (KI), Block Test, Acromion to Table (ATT), Timed Up and Go (TUG), 5 times sit-to-stand (5XSTS), Functional Reach (FR), 2-minute walk test (2MWT), and Patient-Specific Functional Scale (PSFS). Data collected at visits 1, 6, and 12 were analyzed using 1-way repeated-measures multivariate analysis of variance. Measurement and intervention protocols were found to be feasible. A significant effect for the aggregate dependent variables change over time was found. Univariate analysis of each dependent variable showed significance except for FR. All postural measures (height, KI, Block Test, and ATT) significantly improved statistically. The KI and ATT exceed the minimal detectable change for clinical significance. Function showed statistical improvements in the TUG, 5XSTS, 2MWT, and PSFS. Clinical significance was reached with the PSFS. Seven of 9 measures showed a statistically significant change in just 2 weeks. This pilot study suggests that manual therapy and exercise applied to older adults shows promise for improvement in measures of posture and functional performance in a clinically feasible 4-week time frame.

Effect of lumbar stabilization exercises and thoracic mobilization with strengthening exercises on pain level, thoracic kyphosis, and functional disability in chronic low back pain.

The purpose of this study was to compare the effect of lumbar stabilization exercise and thoracic mobilization with strengthening exercise on pain level, thoracic kyphosis, and functional disability in patients with Chronic Low Back Pain (CLBP). Thirty patients with CLBP were recruited based on inclusion and exclusion criteria. They were randomly allocated into two groups i.e., Group A (n=15) and B (n=15). Group A has received lumbar stabilization exercise and thoracic mobilization with strengthening exercises and Group B received only lumbar stabilization exercises, three sessions per week for 4weeks both the groups. The conventional moist hot pack and interferential therapy was given to both the groups before the administration of exercise. Pre- and post-treatment pain level, Thoracic kyphosis, and functional disability were taken and statistical analysis was done. The result of this study showed significant improvement from pre-intervention to post-intervention on pain level, thoracic kyphosis, and functional disability for both the groups i.e., Group A and group B but Group A showed greater changes in Numerical pain rating scale (NPRS), Kyphotic index, and Oswestry disability index (ODI), than Group B. The 4week of therapeutic intervention including lumbar stabilization exercise with thoracic mobilization and strengthening exercise showed significantly reduction of the thoracic kyphosis, pain level and functional disability in patients with Chronic Low Back Pain.

Effect of treatment on back pain and back extensor strength with a spinal orthosis in older women with osteoporosis: a randomized controlled trial

SummaryThe treatment effect of an activating spinal orthosis on back pain and back extensor strength was compared to a training group and to a control group. Between the groups, there was no significant difference in back pain, back extensor strength, or kyphosis index after the 6 months of treatment.PurposeThe aim of this study was to study the effect of treatment with an activating spinal orthosis on back pain, back extensor strength, and kyphotic index. Our hypothesis was that an activating spinal orthosis may be an alternative treatment to decrease back pain and increase back extensor strength.MethodsA total of 113 women aged ≥ 60 years with back pain and osteoporosis, with or without vertebral fractures, were randomized to three groups: a spinal orthosis group, an equipment training group, and a control group. All three groups were examined at baseline and followed up after 3 and 6 months. Statistical analyses were performed with a mixed model for repeated measures according to intention to treat (ITT) and per protocol (PP).ResultsA total of 96 women completed the study. Between the groups, there was no significant difference in baseline characteristics. Comparison between groups showed no significant difference in back pain, back extensor strength, or kyphosis index at the follow-up after 6 months according to ITT and PP analyses. Analysis in each group showed that the back extensor strength had increased by 26.9% in the spinal orthosis group, by 22.1% in the exercise training group and by 9.9% in the control group.ConclusionsSix months’ treatment by an activating spinal orthosis showed no significant difference in back pain, back extensor strength, or kyphosis index between the three groups. In the spinal orthosis group, present back pain decreased slightly and back extensor strength increased by 26.9% which indicates that the spinal orthosis may become an alternative training method.Clinicaltrials.com ID: NCT03263585

Kyphosis and incident falls among community-dwelling older adults.

To determine the association between four measures of kyphosis and incident and injurious falls in older persons. Community-dwelling adults aged 65 and older (n=72) residing in southern California were invited to participate in a prospective cohort study. Participants had kyphosis assessed four ways. Two standing measures included a flexicurve ruler placed against the back to derive a kyphotic index and the Debrunner kyphometer, a protractor used to measure the kyphotic angle in degrees. Two lying measures included the blocks method (number of 1.7cm blocks needed to achieve a neutral head position while lying supine) and traditional Cobb angle calculation derived from DXA based lateral vertebral assessment. Baseline demographic, clinical, and other health information (including a timed up and go (TUG) test) were assessed at a clinic visit. Participants were followed monthly through email or postcard for 1year, with falls outcomes confirmed through telephone interview. Mean age was 77.8 (±7.1) among the 52 women and 20 men. Over 12months, 64% of participants experienced at least one incident fall and 35% experienced an injurious fall. Each standard deviation increase in kyphosis resulted in more than doubling the adjusted odds of an incident fall, even after adjusting for TUG. Odds of injurious falls were less consistent across measures; after adjusting for TUG, only the blocks method was associated with injurious falls. Each kyphosis measure was independently associated with incident falls. Findings were inconsistent for injurious falls; the blocks measure suggested the strongest association. If these findings are replicated, the blocks measure could be incorporated into office visits as a quick and efficient tool to identify patients at increased fall risk.

Chronic Paraspinal Muscle Injury Model in Rat.

ObjectiveThe objective of this study is to establish an animal model of chronic paraspinal muscle injury in rat.MethodsFifty four Sprague-Dawley male rats were divided into experimental group (n=30), sham (n=15), and normal group (n=9). Incision was done from T7 to L2 and paraspinal muscles were detached from spine and tied at each level. The paraspinal muscles were exposed and untied at 2 weeks after surgery. Sham operation was done by paraspinal muscles dissection at the same levels and wound closure was done without tying. Kyphotic index and thoracolumbar Cobb's angle were measured at preoperative, 2, 4, 8, and 12 weeks after the first surgery for all groups. The rats were sacrificed at 4, 8, and 12 weeks after the first surgery, and performed histological examinations.Results At 4 weeks after surgery, the kyphotic index decreased, but, Cobb's angle increased significantly in the experimental group (p<0.05), and then that were maintained until the end of the experiment. However, there were no significant differences of the kyphotic index and Cobb's angle between sham and normal groups. In histological examinations, necrosis and fibrosis were observed definitely and persisted until 12 weeks after surgery. There were also presences of regenerated muscle cells which nucleus is at the center of cytoplasm, centronucleated myofibers.ConclusionOur chronic injury model of paraspinal muscles in rats shows necrosis and fibrosis in the muscles for 12 weeks after surgery, which might be useful to study the pathophysiology of the degenerative thoracolumbar kyphosis or degeneration of paraspinal muscles.

Analysis of Results of Kyphotic Deformity Reduction Using Puncture Vertebroplasty and Stenoplasty in Patients with Traumatic Compression Fractures of Thoraco-Lumbar Localization

Correction of posttraumatic deformity and stabilization of injured segment play an important role in treatment and complication prevention after traumatic compression vertebral body fractures. Possibilities of deformity reduction using vertebroplasty and a combination of distractive titanium cage with insertion of bone cement into vertebral body (stenoplasty) are not well studied. Retrospective comparative analysis of clinical efficacy and degree of kyphotic deformity reduction using puncture vertebroplasty (1 st group, n=15) and stenoplasty (2 nd group, n=15) in patients with traumatic A1 compression fractures of thoraco-lumbar vertebral bodies was performed. Severity of pain syndrome (VAS) and degree of injured segment deformity (kyphotic angle and wedge-shaping index) were assessed. In both groups surgical intervention resulted in marked pain reduction but in long-term period it was less significant for 2 nd group (p=0.0035). Postoperatively kyphotic angle median and wedge-shaping index changed statistically significant in 2 nd group from 12.60 (10.50; 13.40) to 2.50 (1.90; 3.20) (p=0.0015) and from 25.3% (22.8; 26.7) to 9.3% (8.9; 11.4) (p=0.0022), respectively and not significantly in 1 st group from 13.10 (11.40; 14.30) to 12.90 (11.20; 14.00) (p= 0.93) and from 26.5% (24.0; 28.8) to 25.9% (23.8; 28.4) (p=0.86), respectively. Progression of posttraumatic kyphosis in late postoperative period was noted in 1 st group (P M Ü=0.042) but not in 2nd group (P =0.58). In traumatic A1 compression fractures stenoplasty enabled to perform kyphotic deformity correction in the early period of spinal injury, to achieve significantly greater reduction of kyphotic angle and to preserve the result in remote postoperative period as compared to puncture vertebroplasty

Postural correction for kyphosis improves the dyspnea index and pulmonary functions in patients with chronic obstructive pulmonary disease: A randomized trial over 12 weeks

Background: Patients with chronic obstructive pulmonary disease (COPD) tend to attain forward shoulder posture and kyphosis and this affects their respiratory functions. Correcting this posture leads to straightening of the spine leading to improvement in the lung functions. The present study was carried out to evaluate the additional effect of correction of kyphosis in COPD patients. Objectives: The objective of the following study is to evaluate the effect of postural correction with respiratory muscle training in patients with COPD. Settings and Study Design: A randomized controlled prospective study in a tertiary care hospital in out-patients for 12 weeks. Materials and Methods: Confirmed cases of COPD were randomly divided into two groups by computer generated randomization: Study and control group. Study group patients received combination of respiratory muscle training and postural correction by a brace, whereas the control group received only respiratory muscle training exercises. The outcome measures evaluated were maximal inspiratory pressure, spirometry values, dyspnea scores and 6-min walk distance (MWD). Statistical Analysis: Statistical analysis was performed using Statistical Package for the Social Sciences version 16. Descriptive statistics are reported as means and standard deviation. Results: A total of 120 patients were included in the study with 60 in each group. Both groups showed a significant improvement in the inspiratory muscle strength, lung functions, dyspnea index and functional capacity at 8 weeks and 12 weeks of intervention. However, the interscapular distance, percentage of kyphotic index (KI) and grades of a plumb line (PL) measurement reduced significantly in the study group when compared to the control group (P < 0.01). There was also significant improvement in the 6-MWD and reduction of Borg scale of dyspnea when compared to the control group (P < 0.01). The pulmonary functions improvement was better in the study group after 12 weeks of therapy. Similarly, there was a significant reduction in KI % and PL grades in the study group as compared to the control group. Conclusions: The postural correction is a meaningful addition to pulmonary rehabilitation programs directed toward COPD patients in improving the overall quality-of-life.

The Effects of Glucocorticoids and Voluntary Running on Spinal Curvature Deformation in Mdx Mice

In a previous experiment we found voluntary running exercise accelerated the progression of thoracolumbar kyphosis in mdx mice, the model for human Duchenne muscular dystrophy. In the present study, we test the hypothesis that glucocorticoid treatment concurrent with voluntary running exercise slows the progression of spinal deformation in mdx mice. Both glucocorticoid treatment and exercise have been shown to prolong muscle function in this animal model, although neither treatment has been thoroughly investigated in regard to spinal curvature deformation. In this experiment, mice were treated with twice weekly injections of the glucocorticoid methylprednisolone (MP, 5 mg/kg) or treated with voluntary exercise combined with MP for four weeks. We found no difference in kyphotic index between treatment groups or with controls from our previous study (P &gt; 0.05). Histological morphometric analyses revealed no difference in paravertebral muscle fibrosis or vertebral bone area between groups (P &gt; 0.05). Our findings suggest glucocorticoid treatment mitigates the acceleratory effects of voluntary running activity on pathological kyphosis we previously identified in dystrophic mice.

The Effects of Glucocorticoid and Voluntary Exercise Treatment on the Development of Thoracolumbar Kyphosis in Dystrophin-Deficient Mice

The development of spinal curvature deformities is a hallmark of muscular dystrophy. While glucocorticoid treatment has been shown to prolong muscle function in dystrophic mice, its effects on the development of dystrophinopathic spinal deformation are poorly understood. In this study, we test the effects of glucocorticoid treatment on the onset of thoracolumbar kyphosis in the dystrophin-deficient mdx mouse using voluntary running exercise to exacerbate muscle fibrosis. We measure the kyphotic index, erector spinae muscle fibrosis, and vertebral bone histomorphometry in 4-month-old mdx mice in four groups: sedentary control, exercise-treated (continuous voluntary access to an activity wheel), glucocorticoid-treated, and glucocorticoid + exercise-treated. Exercise treated mice were found to have significantly lower kyphotic index (i.e., greater kyphosis) and greater muscle fibrosis relative to controls (p < 0.05). However, the deleterious effect of exercise on KI and muscle fibrosis was prevented by glucocorticoid treatment. Some differences in bone histological parameters were observed between treatment groups, suggesting there is a complex relationship between dystrophic muscular changes and vertebral bone mass. Our findings indicate glucocorticoid treatment delays the onset of thoracodorsal spinal deformation in mdx mice.

Reliability of Radiographic Parameters in Neuromuscular Scoliosis

Retrospective review of radiographic data. This study sought to define interobserver and intraobserver variability to further delineate reliable means by which radiographs of patients with neuromuscular scoliosis can be examined. Previous studies analyzed the use of Cobb angles in the measurement of idiopathic and congenital scoliosis, but no study until now describes a critical analysis of measurement in evaluating neuromuscular scoliosis. Forty-eight patients with neuromuscular scoliosis radiographs were reviewed. These were evaluated for Cobb angle, end vertebrae selection, Ferguson angle, apex of the curve, C7 balance, pelvic obliquity, Risser sign, status of the triradiate cartilage, kyphosis Cobb angle, endplate selection for kyphosis, and kyphotic index. Interclass and intraclass variability was examined with statistical analysis. Cobb angle had an intraobserver variability was 5.7 degrees and the interobserver variability was 14.8 degrees . The intraobserver and interobserver variability for Ferguson angle was 6.8 degrees and 20.6 degrees, respectively. The kyphotic Cobb angle intraobserver variability was found to be 17.4 degrees, and the interobserver variability was 24.01 degrees . Neuromuscular scoliosis radiographs can be reliably analyzed with the use of Cobb angle. Other forms of analysis, such as Ferguson angle, are not as reliable. Pelvic obliquity should be measured from the horizontal, as other methods are not as reliable. Kyphosis is best evaluated with the use of the kyphotic Cobb angle. Finally, it is felt that a separate anteroposterior pelvis radiograph should be used to assess skeletal maturity, as scoliosis films often truncate the vital anatomy necessary to determine skeletal maturity.

Quantitation of sleep and spinal curvature in an unusually longevous owl monkey (Aotus azarae)

A table summarizing the primary literature on 19 species of longevous non-human primates, other than owl monkey, is presented. We prospectively quantitated the sleep of a longevous female owl monkey (Aotus azarae), aged >30 years, longitudinally for 2 years and also evaluated the senility-induced change in spinal curvature. The mean daily total sleep time (TST) of this monkey ranged between 790 and 1106 minutes, and was markedly higher in comparison with its female progeny (aged 16 years and used as a control) whose daily TST during the same experimental period ranged between 612 and 822 minutes. The calculated kyphotic index (KI) of 2.27 for this monkey, compared with the KIs 4.83 and 5.42, for its progeny and female grandprogeny (aged 1 year) respectively, confirmed the prominent spinal curvature.

Progression of kyphosis in mdx mice.

Spinal deformity in the form of kyphosis or kyphoscoliosis occurs in most patients with Duchenne muscular dystrophy (DMD), a fatal X-linked disorder caused by an absence of the subsarcolemmal protein dystrophin. Mdx mice, which also lack dystrophin, show thoracolumbar kyphosis that progresses with age. We hypothesize that paraspinal and respiratory muscle weakness and fibrosis are associated with the progression of spinal deformity in this mouse model, and similar to DMD patients there is evidence of altered thoracic conformation and area. We measured kyphosis in mdx and age-matched control mice by monthly radiographs and the application of a novel radiographic index, the kyphotic index, similar to that used in boys with DMD. Kyphotic index became significantly less in mdx at 9 mo of age (3.58 +/- 0.12 compared with 4.27 +/- 0.04 in the control strain; P < or = 0.01), indicating more severe kyphosis, and remained less from 10 to 17 mo of age. Thoracic area in 17-mo-old mdx was reduced by 14% compared with control mice (P < or = 0.05). Peak tetanic tension was significantly lower in mdx and fell 47% in old mdx latissimus dorsi muscles, 44% in intercostal strips, and 73% in diaphragm strips (P < or = 0.05). Fibrosis of these muscles and the longissimus dorsi, measured by hydroxyproline analysis and histological grading of picrosirius red-stained sections, was greater in mdx (P < 0.05). We conclude that kyphotic index is a useful measure in mdx and other kyphotic mouse strains, and assessment of paralumbar and accessory respiratory muscles enhance understanding of spinal deformity in muscular dystrophy.

The progression of untreated lumbar kyphosis and the compensatory thoracic lordosis in myelomeningocele

Radiographs of 37 patients with untreated lumbar kyphosis without congenital vertebral anomalies associated with myelomeningocele were analyzed. With an average interval between radiographs of 6.2 years, the kyphosis was noted to increase at a mean rate of 4.3 degrees per year without correlation to its initial magnitude. The compensatory lordosis was more variable and progressed at a mean of 2.5 degrees per year. Children under the age of 2 years were more likely to increase the Cobb angle and the height of their kyphosis. There was an inverse relationship between the height of the kyphus and the lumbar spine height and the resultant growth of each. A modified kyphotic index less than 4 correlated with an increase in the curve and height of the kyphosis and the subsequent desire for surgery. Wide variability in radiographic parameters make predictions for an individual patient difficult.

Scoliosis associated with Duchenne muscular dystrophy.

The pathoanatomy and natural history of scoliosis associated with Duchenne muscular dystrophy were established by a review of 105 patients. Scoliosis developed in 95% of these patients after the loss of ambulation. The direction of the curve was determined by asymmetrical contracture of the iliotibial band. Functional classification using the radiographic sitting kyphotic index proved a reliable guide to the age at loss of ambulation and life expectancy, as well as the rate of progression and eventual severity of spinal deformities. Spinal orthoses failed to control curve progression in 94% of patients (30 of 32). Fourteen patients underwent spinal fusion with excellent long-term results.