Abnormal Curvatures Of Vertebral Column
To detect an abnormal curvature of the vertebral column , have the individual stand in the anatomical position. Inspect the profile of the vertebral column from the person’s side and then from the posterior aspect. With the person bending over, observe the ability to flex directly forward and whether the back is level once the flexed position is assumed.
Abnormal curvatures in some people result from developmental anomalies; in others, the curvatures result from pathological processes. The most prevalent metabolic disease of bone occurring in the elderly people, especially in women, is osteoporosis (atrophy of skeletal tissue).
Excessive thoracic kyphosis (clinically shortened to kyphosis, although this term actually applies to the normal curvature, and colloquially known as humpback or hunchback ) is characterized by an abnormal increase in the thoracic curvature; the vertebral column curves posteriorly. This abnormality can result from erosion (due to osteoporosis) of the anterior part of one or more vertebrae. Dowager humpis a colloquial name for excessive thoracic kyphosis in older women resulting from osteoporosis. However, this type of kyphosis also occurs in elderly men (Swartz, 2009).
Osteoporosis especially affects the horizontal trabeculae of the trabecular bone of the vertebral body. The remaining, unsupported vertical trabeculae are less able to resist compression and sustain compression fractures, resulting in short and wedge-shaped thoracic vertebrae. Progressive erosion and collapse of vertebrae also result in an overall loss of height. The excessive kyphosis leads to an increase in the AP diameter of the thorax and a significant reduction in dynamic pulmonary capacity.
Excessive lumbar lordosis (clinically shortened to lordosis , although once again this term actually describes the normal curvature; colloquially, excessive lumbar lordosis is known as hollow back or sway back) is characterized by an anterior tilting of the pelvis (the upper sacrum is flexed or rotated antero-inferiorly—nutation), with increased extension of the lumbar vertebrae, producing an abnormal increase in the lumbar kyphosis.
This abnormal extension deformity is often associated with weakened trunk musculature, especially the anterolateral abdominal muscles. To compensate for alterations to their normal line of gravity, women develop a temporary excessive lumbar lordosis during late pregnancy. This lordotic curvature may cause lower back pain, but the discomfort normally disappears soon after childbirth.
Obesity in both sexes can also cause excessive lumbar lordosis and lower back pain because of the increased weight of the abdominal contents (e.g., “potbelly”) anterior to the normal line of gravity. Loss of weight and exercise of the anterolateral abdominal muscles facilitate correction of this type of excessive lordosis.
Scoliosis (G., crookedness or curved back) is characterized by an abnormal lateral curvature that is accompanied by rotation of the vertebrae. The spinous processes turn toward the cavity of the abnormal curvature, and when the individual bends over, the ribs rotate posteriorly (protrude) on the side of the increased convexity.
Deformities of the vertebral column, such as failure of half of a vertebra to develop (hemivertebra ), are causes of structural scoliosis . Sometimes a structural scolioses is combined with excessive thoracic kyphosis— kyphoscoliosis—in which an abnormal AP diameter produces a severe restriction of the thorax and lung expansion (Swartz, 2009). Approximately 80% of all structural scolioses are idiopathic (a disease of unknown cause), occurring without other associated health conditions or an identifiable cause. Idiopathic scoliosis first develops in girls between the ages of 10 and 14 and in boys between the ages of 12 and 15. It is most common and severe among females.
Problems extrinsic to a structurally normal vertebral column, such as asymmetrical weakness of the intrinsic back muscles (myopathic scoliosis ), or a difference in the length of the lower limbs with a compensatory pelvic tilt, may lead to a functional scoliosis . When a person is standing, an obvious inclination or listing to one side may be a sign of scoliosis that is secondary to a herniated IV disc. Habit scoliosisis supposedly caused by habitual standing or sitting in an improper position. When the scoliosis is entirely postural, it disappears during maximum flexion of the vertebral column. Functional scolioses do not persist once the underlying problem has been effectively treated.
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