LORDOSIS/ HYPERLORDOSIS - is an increased curving of the spine - commonly referred to as swayback or saddle back Causes: Atypical and possibly

symptomatic lordotic curves can be caused by several factors: Kyphosis in the thoracic spine can create lordotic exaggeration, especially in the neck. Obesity can put uneven pressure on the spine, causing abnormal lumbar curvature. This usually occurs when the person demonstrates a large mass of fatty tissue around the midsection. Achondroplasia is a bone growth disorder and a form of dwarfism. Unusually spinal curvatures are often seen in these patients. Congenital spinal issues may lead to the development of lordotic irregularities. There is no such thing as a congenital lordotic abnormality, since the lordosis of the cervical and lumbar areas are not yet formed in a fetus or newborn. Osteoporosis can compromise the integrity of the spinal column, causing abnormal and often degenerative curvature in the elderly. Bad posture can cause or contribute to excessive lordotic curvature in the neck or low back. Spondylolithesis can directly cause abnormal lumbar curvature. Symptoms Each child may experience symptoms differently. The major clinical feature of lordosis is a prominence of the buttocks. Symptoms will vary depending if lordosis occurs with other defects, such as muscular dystrophy, developmental dysplasia of the hip, or neuromuscular disorders. Back pain, pain down the legs, and changes in bowel and bladder habits are not commonly associated with lordosis. A child experiencing these types of symptoms requires further medical evaluation by a physician. The symptoms of lordosis may resemble other spinal conditions or deformities, or may be a result of an injury or infection. Always consult your child's physician for a diagnosis. Diagnosis The physician makes the diagnosis of lordosis with a complete medical history of the child, physical examination, and diagnostic tests. Your child's physician obtains a complete prenatal and birth history of the child and asks if other family members are known to have lordosis.

Diagnostic procedures may include the following: X-rays - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film. This test is used to measure and evaluate the curve. With the use of a full-spine x-ray, the physician or radiologist measures the angle of the spinal curve. A determination for treatment can often be made based on this measurement. Bone scans - a nuclear imaging method to evaluate any degenerative and/or arthritic changes in the joints; to detect bone diseases and tumors; to determine the cause of bone pain or inflammation. This test is to rule out any infection or fractures. magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body. This test is done to rule out any associated abnormalities of the spinal cord and nerves. computed tomography scan (Also called a CT or CAT scan.) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays. Blood tests Early detection of lordosis is important for successful treatment. Pediatricians or family physicians, and even some school programs, routinely look for signs that lordosis may be present. Treatment of lordosis: Specific treatment for lordosis will be determined by your child's physician based on: your child's age, overall health, and medical history the extent of the condition your child's tolerance for specific medications, procedures, or therapies expectations for the course of the condition your opinion or preference The goal of treatment is to stop the progression of the curve and prevent deformity. Management of lordosis will depend upon the cause of the lordosis. Simple exercises may be sufficient if lordosis is associated with poor posture. However, lordosis occurring as a result of a hip problem may be treated as a part of the hip problem. Long-term outlook for a child with lordosis:

The management of lordosis is individualized for each child depending on his/her age, amount of curvature, and amount of skeletal growth remaining. Lordosis will require frequent examinations by your child's physician to monitor the curve as your child grows and develops. Early detection is important. Lordosis Treatment Options Most atypical lordotic curves do not cause any discomfort or problematic health concerns. Therefore, most do not require any special treatment. Sometimes, the lordotic curvature is severe and may require conservative or drastic therapy. In these circumstances, the patient might experience nerve compression, also called a pinched nerve, limited range of motion, spinal stenosis or the overall loss of spinal integrity. If the curvature is obviously symptomatic or places the patient at risk for dire health effects, then treatment is prescribed. Nonsurgical treatment is great when it is effective, but will almost never resolve any spinal issues which may be causing the lordosis to exist. However, these methods might provide relief from muscular spasms which may be the true underlying source of the increase curvature. Some of the more commonly utilized conservative treatments include: Pain management drugs: Pharmaceutical products for back pain management come in 2 varieties. There are over the counter drugs (OTC) and prescription drugs. Many types of drugs are available to treat all types of back ache and related neurological and muscular symptoms. Back pain pills are an easy treatment for both doctors and patients and are sometimes handed out like candy. This is an extremely risky practice which has led to horrible mental and physical health issues in some patients, including dependency, sickness and even death. However, with huge financial incentives offered by the big pharmaceutical companies, doctors can literally get rich by doing nothing more than simply writing scripts and handing out pills all day long. It sickens me to the core, especially when patients are NOT adequately informed of the very real dangers involved in taking these chemical compounds. Most back pain drugs fall into 2 categories, pain/inflammation relief and muscle relaxants. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most widely used for pain relief. Please read more detailed information about back pain medicine. Physical therapy: for back pain is a very common conservative treatment option for a variety of painful dorsalgia conditions. Physical therapy is used for many purposes including pain relief, muscular conditioning, post injury rehabilitation and back surgery recuperation. Physical therapy is an important facet of a recovery program for many patients and a qualified physical therapist can play an vital role in allowing a patient to move past their pain and lead a symptom-free life in the future. Back brace: Back braces can be rigid or flexible and most are designed to provide support for the

back muscles and spinal structures. Other types of braces are utilized to treat scoliosis or other abnormal spinal curvature issues. Back supports are fitted around the body in the affected area and are intended to help limit the motion of the protected region. A brace is a useful tool to assist in supporting a fractured vertebrae or to aid in the healing after back surgery. Some specialty braces are especially useful at creating limited motion in the vertebral column after spinal fusion surgery, in order to create a more solid fusion of the newly operated spinal bones. Lordosis Treatment / Surgery Severe lordotic curves can cause serious health problems. Usually, the greater the lordotic curve, the more symptoms the patient will experience, although this is surely not an absolute. In extreme cases, surgery might be necessary to correct the abnormal curvature. There are several procedures used, with the determination made mostly by the causative condition enacting the exaggerated lordotic curve. Spinal fusion is the most common form of corrective surgery indicated for extreme lordosis. Recommendation for Lordosis Treatment Many mild and moderate lordotic curves are not symptomatic. They should always be be monitored by a doctor, just to be sure they do not progress to a dangerous degree. Many people have an abnormal lordotic curve and do not even know it. Unfortunately, some are diagnosed with this condition and then proceed to suffer symptoms. This is a classic example of the nocebo effect of the medical diagnosis. Patients who have been diagnosed with lordosis should always learn the facts of the condition and completely understand the extent of their irregular curvature. All cases are not the same. Talk to your doctor about the severity of the curvature, as well as their recommendations for professional care. Once you know the facts, then you can make an informed decision on the best way to proceed forward with any lordosis treatment you may require.

KYPHOSIS Kyphosis refers to the normal apical-dorsal sagittal contour of the thoracic and sacral spine. As a pathologic entity, kyphosis is an accentuation of this normal curvature. Kyphosis can occur as a deformity solely in the sagittal plane, or it can occur in association with an abnormality in the coronal plane, resulting in kyphoscoliosis. Types Postural kyphosis most common type of kyphosis. This is more common in girls than in boys and is typically first noticed during adolescence.

 Scheuermanns kyphosis also first noticed during adolescence. It is more common to develop scoliosis (kyphoscoliosis) with Scheuermanns kyphosis than with the other types of kyphosis. Congenital kyphosis least common type of kyphosis. This is caused by an abnormal development of the vertebrae during development prior to birth. This can lead to several of the vertebrae growing together ( fusing) in kyphosis. Causes Many potential causes of kyphosis have been described. Scheuermann disease and postural round back are often identified in adolescents. Congenital abnormalities, such as failure of formation or failure of segmentation of the spinal elements, can cause a pathologic kyphosis. Autoimmune arthropathy, such as ankylosing spondylitis, can cause rigid kyphosis to develop as the spinal elements coalesce. Kyphosis can also develop as a result of trauma, a spinal tumor, or an infection. Iatrogenic causes of kyphosis include the effects of laminectomy and irradiation, which lead to incompetence of the anterior or posterior column. Finally, metabolic disorders and dwarfing conditions can lead to kyphosis. Pathophysiology The pathophysiology of kyphosis depends on the etiologic factor. The exact cause of Scheuermann disease is still imprecisely defined. Scheuermann postulated that the condition resulted from avascular necrosis of the apophyseal ring. Other theories include histologic abnormalities at the endplate, osteoporosis, and mechanical factors that affect spinal growth. A Danish study demonstrated an important genetic component to the entity. Postural kyphosis is present when accentuated kyphosis is observed without the characteristic 5 of wedging over 3 consecutive vertebral segments that defines Scheuermann kyphosis. This is felt to be due to muscular imbalance leading to the round-back appearance of these individuals. When focal kyphosis occurs after a fracture, more height is lost in the anterior aspect than in the posterior aspect; this is the typical fracture pattern. The angulation can increase as the fracture heals, placing pressure on the spinal cord. Patients with fractures have historically been treated with laminectomy alone, especially in the thoracic spine, and they often had progressive kyphosis at the fracture site. Postinfectious kyphosis occurs in a manner similar to that just described. Mechanical integrity of the anterior column is lost due to the infectious process. Bending forces then accentuate the normal sagittal contour. Symptoms The most common symptoms for patients with an abnormal kyphosis are the appearance of poor posture with a hump appearance of the back or "hunchback," back pain, muscle fatigue, and stiffness in the back. Most often, these symptoms remain fairly constant and do not become progressively worse with time. In more severe situations, the patient may notice their symptoms worsening with time. The

kyphosis can progress, causing a more exaggerated hunchback. In rare cases, this can lead to compression of the spinal cord with neurologic symptoms including weakness, loss of sensation, or loss of bowel and bladder control. Severe cases of thoracic kyphosis can also limit the amount of space in the chest and cause cardiac and pulmonary problems leading to chest pain and shortness of breath. Diagnosis Your doctor will likely begin by obtaining your medical history, including when you first noticed your symptoms, any history of family members with similar problems, and other history of back or neck problems. A physical examination will then be performed. This will assess the curve of your spine both standing upright and while bending forward. Your strength, sensation, reflexes, and flexibility in your arms and legs will also be tested. Based on the results of the history and physical examination, your physician may order X-rays of your spine. This can help differentiate postural kyphosis (normal shaped vertebrae) from Scheuermann's kyphosis (wedged-shaped vertebrae). If your doctor finds any evidence of neurologic injury, you may also obtain an MRI of your spine. This can identify any compression of the spinal cord or nerves. If you have any chest pain or shortness of breath, your physician may order additional tests to evaluate your heart and lungs. Management Postural kyphosis 1. Physical therapy to help strengthen the muscles of back and correct posture. 2. Mild pain relievers and anti-inflammatory medications Scheuermanns kyphosis 1. Physical therapy 2. Mild pain relievers and anti-inflammatory medications 3. Braces can be effective if the patient is still growing. Braces are often recommended for curves of at least 45 degrees and can be continued until the patient is no longer growing. 4. Surgery - to partially correct the deformity of the kyphosis, relive pain and improve overall spinal alignment - There are various types of surgical procedures available depending on the specifics of each case. Surgery can be performed from the front (anterior approach), from the back (posterior approach), or both (combined anterior and posterior approach). This decision is made by your surgeon based on the specific characteristics of your curve. You may obtain X-rays bending forward and backward to determine how flexible your spine is. If it is flexible, a posterior approach may be adequate. If you are less flexible, you may need an anterior or combined approach. Regardless of the approach, the surgery involves partially straightening your spine and using rods and screws in the vertebrae to hold the spine while a bony fusion occurs.

 Congenital kyphosis 1. Surgery surgery in earlier life can help correct th kyphosis before it continues to worsen Kyphoplasty a ballon is inserted into the affected vertebra and filled with a liquid (methymethacrylate) that hardens to restore the vertebral height. Scoliosis A normal spine, when viewed from behind, appears straight. However, a spine affected by scoliosis shows evidence of a lateral, or side-by-side curvature, with the spine looking like an "S" or "C" and a rotation of the back bones (vertebrae), giving the appearance that the person is leaning to one side. The Scoliosis Research Society defines scoliosis as a curvature of the spine measuring 10 degrees or greater. Scoliosis is a type of spinal deformity and should not be confused with poor posture. Spinal curvature from scoliosis may occur on the right or left side of the spine, or on both sides in different sections. Both the thoracic (mid) and lumbar (lower) spine may be affected by scoliosis. Incidence Scoliosis is about two times more common in girls than boys. It can be seen at any age, but it is most common in those over 10 years of age. Scoliosis is hereditary in that people with scoliosis are more likely to have children with scoliosis; however, there is no correlation between the severity of the curve from one generation to the next. In over 80 percent of cases, the cause of scoliosis is unknowna condition called idiopathic scoliosis. Three Types of Scoliosis Congenital. This type of scoliosis occurs during fetal development. It is often caused by one of the following: o Failure of the vertebrae to form normally o Absence of vertebrae o Partially formed vertebrae o Lack of separation of the vertebrae Neuromuscular. This type of scoliosis is associated with many neurological conditions, especially in those children who do not walk, such as the following: o Cerebral palsy o Spina bifida o Muscular dystrophy o Paralytic conditions o Spinal cord tumors o Neurofibromatosis (This is a genetic condition that affects the peripheral nerves that causes changes to occur in the skin, called caf-au-lait spots.) Idiopathic. The cause of this type of scoliosis is unknown. There are three types of idiopathic scoliosis:

o Infantile (This type of scoliosis occurs from birth to age 3. The curve of the vertebrae is to the left and it is more commonly seen in boys. Typically, the curve resolves as the child grows.) o Juvenile (Juvenile scoliosis occurs in children between ages 3 and 10.) o Adolescent (This type of scoliosis occurs in children between ages 10 and 18. This is the most common type of scoliosis and is more commonly seen in girls.) Causes of Scoliosis Hereditary conditions that tend to run in families Differences in leg lengths Injury Infection Tumors Symptoms of Scoliosis The following are the most common symptoms of scoliosis. However, each may experience symptoms differently. Symptoms may include: Difference in shoulder height The head is not centered with the rest of the body Difference in hip height or position Difference in shoulder blade height or position When standing straight, difference in the way the arms hang beside the body When bending forward, the sides of the back appear different in height Back pain, leg pain, and changes in bowel and bladder habits are not commonly associated with idiopathic scoliosis. A person experiencing these types of symptoms requires immediate medical evaluation by a physician. The symptoms of scoliosis may resemble other spinal conditions or deformities, or may be a result of an injury or infection. Diagnosis for Scoliosis In addition to a complete medical history and physical examination, X-rays (a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film) are the primary diagnostic tool for scoliosis. In establishing a diagnosis of scoliosis, the physician measures the degree of spinal curvature on the X-ray. The following other diagnostic procedures may be performed for nonidiopathic curvatures, atypical curve patterns, or congenital scoliosis: Magnetic resonance imaging (MRI). This diagnostic procedure uses a combination of large magnets and a computer to produce detailed images of organs and structures within the body. Computed tomography (CT) scan. This diagnostic imaging procedure uses a combination of Xrays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays. Early detection of scoliosis is most important for successful treatment. Pediatricians or family physicians, and even some school programs, routinely look for signs that scoliosis may be present.

Treatment for scoliosis The goal of treatment is to stop the progression of the curve and prevent deformity. Treatment may include: Observation and repeated examinations. Observation and repeated examinations may be necessary to determine if the spine is continuing to curve, and are used when a person has a curve of less than 25 degrees and is still growing. Progression of the curve depends upon the amount of skeletal growth, or the skeletal maturity of the child. Curve progression slows down or stops after the child reaches puberty. Bracing. Bracing may be used when the curve measures more than 25 to 30 degrees on an X-ray, but skeletal growth remains. It may also be necessary if a person is growing and has a curve between 20 and 29 degrees that isn't improving. The type of brace and the amount of time spent in the brace will depend on your child's condition. Surgery. Surgery may be recommended when the curve measures 45 degrees or more on an Xray and bracing isn't successful in slowing down the progression of the curve when a person is still growing. According to the National Institute of Arthritis and Musculoskeletal and Skin Disorders, there is no scientific evidence to show that other methods for treating scoliosis (for example, chiropractic manipulation, electrical stimulation, nutritional supplementation, and exercise) prevent the progression of the disease. If left untreated, scoliosis can cause problems with heart and lung function.