What to do about lumbar kyphosis

Nowadays, there are all kinds of diseases. Take the lumbar spine for example, there are many kinds of diseases. Today I will not introduce them to you one by one. Today I will talk about lumbar kyphosis. Lumbar kyphosis is a bone deformity caused by relaxation of muscles and ligaments, softening of bones, standing or sitting for long periods of time, and the action of gravity. So what should we do if our lumbar spine is kyphotic, and how should we treat it? Please study with me.

1. Basic definition of lumbar kyphosis

Lumbar kyphosis is a bone deformity caused by relaxation of muscles and ligaments, softening of bones, and the effect of gravity due to standing or sitting for long periods of time.

Lumbar kyphosis is a common spinal deformity. The normal physiological kyphosis of the thoracic spine is less than 50°, and the apex of the kyphosis is at T6-8, forming a balanced physiological arc with the lumbar lordosis. At this time, the vertical line of gravity in the sagittal plane passes through C1T1T12 and S1, maintaining the optimal physiological curve and body balance, ensuring that the human body can see forward normally. Congenital spinal deformity, spinal trauma, tuberculosis and other diseases can lead to an increase in the kyphosis angle. When the kyphosis deformity is greater than 60°, the deformity will continue to worsen and cause back pain, or even paraplegia, and corrective treatment is generally required [1, 2]. The following is a summary of the classification and surgical treatment of kyphosis, as well as existing problems, combined with the author's practice.

2. Classification

1.1 Non-fixed deformities include postural kyphosis, kyphosis due to weak muscles, or thoracic kyphosis due to compensatory lumbar lordosis.

1.2 Fixed deformities such as Scheherman’s disease, ankylosing spondylitis (most common), kyphosis caused by senile osteoporosis, congenital posterior hemivertebra, tuberculosis or trauma.

3. Surgical treatment of lumbar kyphosis

2.1 The purpose of surgery is to restore the physiological curve of the spine in the anterior view and sagittal plane.

2.2 Some factors related to surgical design［3,4］ a) Ankylosing hip joint should be treated with arthroplasty first. b) For severe kyphosis, multi-plane osteotomy is best performed. Generally, for a 60°± deformity, one plane is sufficient. c) When there is neck stiffness, correction should not be excessive. The correction angle should be designed according to the angle between the brow and jaw line and the body's gravity line. The angle between the brow and jaw line is the angle between the line connecting the brow arch and mandible and the body's gravity line. Generally, 20° is appropriate, so that the patient can see the desk and the area 10 feet below his feet after the operation. d) Osteotomy should be performed at the site where the anterior longitudinal ligament is not ossified. If ossification is present, anterior release should be performed first, or a posterior wedge osteotomy or pedicle hollowing should be performed via a posterior approach. e) The width of the osteotomy is wedge-shaped 521 (5 cm between the spinous processes and 2 cm at the lamina and 1 cm at the posterior edge of the vertebral body).

2.3 Surgical methods and procedures

2. Some methods suitable for ankylosing spondylitis

1. The Smith-Peterson method was created in 1945. It involves V-shaped osteotomy of the posterior component of the spine → strong extension (the surgeon on the stage presses down the back, and the assistant below the stage lifts the shoulders) to close the osteotomy line → internal fixation. During the operation, it is important to thin the inner lamina of the V-shaped vertebral lamina to prevent the inner lamina from compressing the spinal cord when closing. Disadvantages: This method cannot be used for people with calcification of the anterior longitudinal ligament; elderly people with arteriosclerosis should be careful to avoid tearing the celiac artery.

2. Internal fixation method: The spinous process plate method was used in the early days, and the Harrington pressure stick method (not easy to operate) was used in the 1980s. In recent years, C-D, CDH, TSRH methods have been used more, but they are expensive, difficult to place the hook, and the transverse process is easy to break. In cases where ossification is severe, the pedicle positioning structure disappears, often leading to surgical difficulties. In the past three years, the PRSS method has been used for correction. It is not only inexpensive, but also has firm fixation, is easy to operate, and can prevent paraplegia caused by excessive extension correction. Regarding short-segment correction, we have tried Dick fixation, which has good short-term effects. However, long-term follow-up showed recurrent deformity at the upper and lower ends of the osteotomy, so the upper fixation still needs to reach the level of the third vertebra above the apex of the thoracic kyphosis. However, if the kyphosis is mainly in the lumbar spine, and the thoracic kyphosis is close to normal after the lumbar deformity is corrected, short-segment lumbar fixation can also be performed.