kyphoscoliosis

Kyphoscoliosis is a spinal deformity characterized by the concurrent presence of kyphosis (an excessive forward curvature) and scoliosis (a lateral curvature) in the same region of the spine. The deformity most commonly involves the thoracic region and can be rigid or flexible. It may be congenital or acquired and can result from a variety of musculoskeletal or systemic conditions.

Causes and classification: Idiopathic kyphoscoliosis is the most common form in adolescents when no other cause is found. Other etiologies include congenital vertebral malformations, neuromuscular diseases (such as cerebral palsy or muscular dystrophy), osteoporosis with vertebral fractures, previous spinal trauma, Scheuermann's kyphosis, infections, and certain syndromic disorders. The condition is often described by the contributing planes of deformity and the underlying cause (idiopathic, congenital, neuromuscular, etc.).

Pathophysiology and clinical features: The condition involves abnormal growth and rotation of vertebrae, producing rigid or flexible curves in sagittal and coronal planes. Severe kyphoscoliosis can cause rib cage deformity, truncal imbalance, back pain, reduced exercise tolerance, and in advanced cases cardiopulmonary compromise.

Diagnosis and assessment: Diagnosis relies on history and physical examination, and radiographic imaging. The Cobb angle is used to quantify scoliosis and kyphosis. Scoliosis is defined by a Cobb angle of 10 degrees or more; kyphosis beyond approximately 40 degrees is considered abnormal. Additional imaging (MRI or CT) may be used to evaluate underlying causes or concomitant spinal abnormalities, and pulmonary function tests assess respiratory involvement in severe cases.

Management and prognosis: Mild, progressive curves in skeletally immature patients may be monitored or managed with physical therapy and bracing to slow progression. Surgical options include posterior spinal fusion with instrumentation, anterior-posterior fusion, and growing-rod systems in children. In very severe cases or thoracic insufficiency syndrome, specialized implants such as vertical expandable prosthetic titanium rib devices may be used. Outcomes depend on severity and underlying etiology; timely treatment can prevent progression and improve function.