management of kyphosis in the elderly
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Ma. Celina C. Butalon, MD
Department of Rehabilitation Medicine
Philippine General Hospital
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KYPHOSIS
y Excessive curvature of
the thoracic spine
y Round back deformity
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NORMAL KYPHOSISy Cobbs Angle
y 20-40 degrees
y Measured from T2-T12
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Anterior Wedge Fracture
y Anterior part ofvertebral body is
crushedy Middle column intact
y Anteriorcolumndecreased in
heighty Posterior
columnunchanged
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y Majority of damagelimited to anterior
column
y Fracturestable
y Rarely associated withneurologic compromise
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Increasing kyphosis angle is independently associatedwith worsening mobility. Interventions are needed to
prevent or reduce increasing kyphosis and mobilitydecline.
Katzman W, VittinghoffE, Ensrud K, Black D, Kado D. Increasing kyphosispredicts worsening mobility in older community-dwelling women: aprospective cohort study. Jounal of American Geriatric Society. 2011
Jan;59(1):96-100
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VERTEBRAL COMPRESSION
FRACTURE
y MODIFIABLE RISK FACTORS
y Advanced age
y Female gender
y Caucasian race
y Presence of dementia
y Susceptibility to falling
y History of fractures in adulthood
y History of fractures in a first-degree relative
y Hallmark of osteoporosis
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VERTEBRAL COMPRESSION
FRACTURE
y NON-MODIFIABLE RISK FACTORS
y Being in an abusive situation
y Alcohol and/or tobacco use
y Presence of osteoporosis and/or estrogen deficiency
y E
arly menopause or bilateral ovariectomyy Premenopausal amenorrhea for more than one year
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VERTEBRAL COMPRESSION
FRACTURE
y NON-MODIFIABLE RISK FACTORS
y Frailty
y Impaired eyesight
y Insufficient physical activity
y Low body weight
y Dietary calcium and/or vitamin D deficiency
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Spinal Compression Fracturey Insidious
y Produce modest back pain
y Multiple fractures loss of heighty Shortening of paraspinal musculature
Prolonged active contraction Maintenance of posture
Pain from muscle fatigue
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Thoracic Kyphosisy Develop as vertebral
height is lost
y Rib cage presses down onpelvis
y Reduced thoracic andabdominal space
Impaired
pulmonary
function
Protruberant
abdomen
early satiety
Weight loss
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DIAGNOSIS
RADIOGRAPHIC FINDINGSy
Wedge-shaped vertebral bodyy Narrowing of anterior portion
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COMPRESSION FRACTURE
y Decrease in vertebral
height of >20%
y Decrease of at least 4mm compared with
baseline height
50% decrease
In vertebral
height
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y Common location
y T8-T12
y L1
y L4
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DIAGNOSISy 20-30% are multiple
y May occur at different levels
y One to five consecutive vertebral bodies
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DIAGNOSISy CT Scan
yIdentify fractures notwell visualized in plainfilms
y
Reveal spinal canalnarrowing
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DIAGNOSIS
y MRI
y Spinal cord compression
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DIAGNOSISy Bone density studies y Bone scan
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TREATMENT
y Determine stability of spine
y Stable fracture
y Non operative and conservative
yAvoid inactivity
y Oral or parenteral analgesics
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TREATMENTBraces for Osteoporotic Vertebral Compression Fracture
Jewett Hyperextension Brace
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TRE
ATMEN
TBraces for Osteoporotic Vertebral Compression FractureMolded Jacket or Clam-shell
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TREATMENTBraces for Osteoporotic Vertebral Compression Fracture
Cruciate Anterior Spinal Hyperextension Brace
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TREATMENTBraces for Osteoporotic Vertebral Compression Fracture
Spinomed
Pfeifer, M., Begerow, B., Minne, H.W. (2004). Effects of a new spinal orthosis on posture, trunk strength, and
quality of life in women with postmenopausal osteoporosis: A randomized trial. Am J Phys Med Rehabil. 83:177
186.
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TREATMENTPercutaneous Vertebroplasty
y Injecting acrylic cementinto the collapsed
vertebra
y
Stabilize and strengthenthe fracture and vertebral
body
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TREATMENTKYPHOPLASTY
y cement is injected into a
cavity created by a high-pressure balloon
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y Full recovery at 6 to 12 weeks
y
Return to normal activities after fracture has completelyhealed
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Three Column Spinal Stability by Denis
Anterior 2/3 of vertebral body
Anterior Longitudinal Ligament
Posterior 1/3 of vertebral body Posterior Annulus
Posterior Longitudinal Ligament
Posterior elements
Pedicles, facets, laminaLigamentous complex
facet capsules
Ligamentum flavum
Interspinous ligament
Supraspinous ligament