Orthopedics - Oleksa A.P. 2006

Kyphosis
Senile kyphosis

This orthopedic spinal deformity typically occurs in elderly individuals (aged 60-70 and older), more frequently in women, and is clinically characterized by an arced curvature of the thoracic spine. In 1950, J. Forestier described senile kyphosis as "senile ankylosing vertebral hyperostosis" and established it as a distinct nosological entity, which is why it is sometimes referred to as "Forestier's disease."

Senile kyphosis is localized in the thoracic and cervical spine (Fig. 267), developing and progressing gradually, sometimes involving the lower thoracic and lumbar vertebrae due to age-related weakness of the back Muscles and gravity.

In senile kyphosis, the primary pathological changes generally occur in the intervertebral discs of osteoporotic vertebrae. These discs shift in position and become overloaded anteriorly, leading to degeneration, fiber splitting, Connective Tissue invasion, and eventual ossification. Consequently, a continuous bone bridge forms beneath the anterior longitudinal ligament of the spine.

In addition to spinal deformity, patients may complain of rapid fatigue, difficulties with daily activities, and even pain, typically located in the lower back.

Examination of patients reveals varying degrees of spinal curvature in the sagittal plane. The spinous processes are clearly visible against the backdrop of atrophied back muscles. As a rule, the kyphotic curvature of the spine is so fixed that it cannot be corrected. Lateral and rotational Movements of the spine are also sharply restricted or impossible. The upper body is inclined forward, resulting in a noticeable loss of patient height.

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Fig. 267. Senile kyphosis resulting from spinal Osteoporosis.

In the Cytology/cytology/16.html">Early stages of the disease, lateral spinal radiographs reveal nearly normal vertebral body shapes without wedge-shaped deformity, accompanied by narrowed intervertebral spaces on their anterior surface. Later, these spaces narrow to the extent that the anterior portions of the vertebral bodies come into contact and fuse together with the disc into a solid block.

The anterior concave surface of the spine is smooth, and later, following vertebral fusion, previously formed accompanying osteophytes may disappear.

Unlike Bechterew's disease, the articular processes of the vertebrae remain unchanged. Senile kyphosis also differs radiologically from deforming spondylosis, since intervertebral discs retain their anatomical shape in spondylosis.

Treatment for senile kyphosis should be initiated at the very onset of the disease to prevent or slow down its progression.

Patients are advised to Sleep on a firm, flat mattress without a pillow; Therapeutic Exercises, back Muscle massage, and a mild spinal traction regimen are also prescribed. It is essential to carry out the Prevention and treatment of osteoporosis, as outlined in the "Osteoporosis" section.