The CBP® mirror image® approach to reducing thoracic hyperkyphosis: a retrospective case series of 10 patients

[Purpose] To present a case series demonstrating the reduction of thoracic hyperkyphosis by the Chiropractic BioPhysics^® multimodal rehabilitation program. [Participants and Methods] Ten randomly selected files and corresponding radiographs were chosen from recent clinic archives of patients who were treated for thoracic hyperkyphosis. All patients were treated by CBP mirror image^® thoracic extension traction and exercises, as well as spinal manipulative therapy. [Results] Results demonstrated an average reduction in hyperkyphosis of 11.3° over an average of 25 treatments, over an average of 9 weeks. Patients also experienced a reduction in pain levels and disability ratings. [Conclusion] Postural hyperkyphosis is a serious progressive deformity that is related to a plethora of symptoms, syndromes, and early death. Thoracic hyperkyphosis may be reduced/corrected by posture-specific, thoracic extension protocols including mirror image extension traction and exercises, as well as spinal manipulation as part of the CBP multi-modal rehabilitation program.

The effect of interspinous implant surgery on back surface shape and radiographic lumbar curvature

BACKGROUND

Interspinous process implants, used to augment lumbar spine surgery, putatively induce a local segmental lumbar kyphosis yet few investigations outline the effect in vivo on thoracolumbar sagittal curvature. Changes in lumbar skeletal alignment and posture have traditionally relied upon radiographic and back surface spinal curvature measurements, respectively.

METHODS

Lumbar lordosis curvature in 10 healthy subjects (6F, 4M; mean age 36 years) and 10 interspinous implant lumbar surgery patients (5F, 5M; mean age 51 years) was assessed with rasterstereography at baseline and at 6 weeks. Skeletal lumbar lordosis in standing was measured from lateral erect radiography pre- and 6 weeks post-operatively in the surgical cohort, and compared to angulation obtained for surface lordosis curvature derived from rasterstereography.

FINDINGS

Repeatable measurement of standing lumbar lordosis from rasterstereographic back shape imaging in healthy volunteers and lumbar surgery cases was demonstrated. Reductions of 0.6 (NS) in healthy and 3.1 (significant, P<0.001) in surgical subjects were recorded for surface lumbar lordosis angle between the 6 week time-points. Slight flattening of the segmental angle and regional lordosis after DIAM surgery was revealed by radiography. Skeletal and surface lumbar lordosis changes were uncorrelated preoperatively (rho=0.28) and postoperatively (rho=0.26).

INTERPRETATION

Rasterstereography is sensitive in assessing lumbar lordosis changes in healthy and lumbar surgical individuals over time. Surgery with DIAM for lumbar pathology may result in an initial mild flattening of lordosis. Serial investigations of spinal curvature after surgery with DIAM interspinous implant are warranted in order to better understand the time-course of spinal posture changes of such cases.

Balance disorder and increased risk of falls in osteoporosis and kyphosis: significance of kyphotic posture and muscle strength

This controlled trial was designed to investigate the influence of osteoporosis-related kyphosis (O-K) on falls. Twelve community-dwelling women with O-K (Cobb angle, 50-65 degrees measured from spine radiographs) and 13 healthy women serving as controls were enrolled. Mean age of the O-K group was 76 years (+/-5.1), height 158 cm (+/-5), and weight 61 kg (+/-7.9), and mean age of the control group was 71 years (+/-4.6), height 161 cm (+/-3.8), and weight 66 kg (+/-11.7). Quantitative isometric strength data were collected. Gait was monitored during unobstructed level walking and during stepping over an obstacle of four different heights randomly assigned (2.5%, 5%, 10%, and 15% of the subject's height). Balance was objectively assessed with computerized dynamic posturography consisting of the sensory organization test. Back extensor strength, grip strength, and all lower extremity muscle groups were significantly weaker in the O-K group than the control group (P <0.05), except right ankle plantar flexors (P =0.09). There was a significant difference in the anteroposterior and mediolateral displacements and velocities. The O-K subjects had less anteroposterior displacement, greater mediolateral displacement, reduced anteroposterior velocity, and increased mediolateral velocity compared with controls for all conditions of unobstructed and obstructed level walking. Obstacle height had a significant effect on all center-of-mass variables. The O-K subjects had significantly greater balance abnormalities on computerized dynamic posturography than the control group (P =0.002). Data show that thoracic hyperkyphosis on a background of reduced muscle strength plays an important role in increasing body sway, gait unsteadiness, and risk of falls in osteoporosis.

Prediction of osteoporotic spinal deformity

STUDY DESIGN

A biomechanical model was developed from full-spine lateral radiographs to predict osteoporotic spinal deformity in elderly subjects.

OBJECTIVE

To investigate the biomechanics of age-related spinal deformity and concomitant height loss associated with vertebral osteoporosis.

SUMMARY OF BACKGROUND DATA

Vertebral bone loss and disc degeneration associated with aging causes bone and disc structures to weaken and deform as a result of gravity and postural stresses.

METHODS

An anatomically accurate sagittal-plane, upright-posture biomechanical model of the anterior spinal column (C2-S1) was created by digitizing lateral full-spine radiographs of 20 human subjects with a mean height of 176.8 cm and a mean body weight of 76.6 kg. Body weight loads were applied to the model, after which intervertebral disc and vertebral body forces and deformation were computed and the new spine geometry was calculated. The strength and stiffness of the vertebral bodies were reduced according to an osteopenic aging model and modulus reduction algorithm, respectively.

RESULTS

The most osteopenic model (L3 F(ult) = 750 N) produced gross deformities of the spine, including anterior wedge-like fracture deformities at T7 and T8. In this model, increases in thoracic kyphosis and decreases in vertebral body height resulted in a 25.2% decrease in spinal height (C2-S1), an 8.6% decrease in total body height, and a 15.1-cm anterior translation of the C2 spine segment centroid. The resulting deformity qualitatively resembled deformities observed in elderly individuals with osteoporotic compression fractures.

CONCLUSIONS

These predictions suggest that postural forces are responsible for initiation of osteoporotic spinal deformity in elderly subjects. Vertebral deformities are exacerbated by anterior translation of the upper spinal column, which increases compressive loads in the thoracolumbar region of the spine.