The management of an adult male with hyper-kyphosis using a rigid thoracolumbosacral orthosis and manual therapy approach

Background:

There is a paucity of research data pertaining to the conservative management of adult spinal deformity, particularly hyper-kyphosis. Given that overt changes in sagittal balance are associated with increased morbidity, and that the incidence of these changes increases with age, it is imperative that strategies aimed at reversing/minimizing this type of deformity are explored.

Aim:

  • The aim of this presentation is to detail the successful management of an adult patient with hyper-kyphosis cases using a novel thoracolumbosacral orthosis (KyphoBrace) and multi-modal manual therapy approach

Case Details

32-year-old, male, Caucasian, correctional officer

Five years prior to the initial consultation the patient had been involved in an altercation with inmates that resulted in him losing in consciousness

Presenting Symptoms:

  • Neck pain: constant 2-4 /10 Visual Analogue Scale (VAS)
  • Lower back pain: constant 2-4/10 VAS
  • Headaches: constant 2-4/10 VAS

Other:

  • Vertigo, fatigue, migraines, anxiety, insomnia and shoulder pain

Management Plan

Active Care:

– Rigid thoracolumbosacral orthosis (KyphoBrace):

  • 8-10 hours

– Mirror image exercises
– Home Denneroll orthotic device use (20 minutes daily)
– Frequency:

  • Daily

Passive Care:

– Mirror image Chiropractic adjustments
– Chiropractic Biophysics traction
– Frequency:

  • 3 x per week
Hyper-kyphosis and significant posterior sagittal imbalance

Hyper-kyphosis and significant posterior sagittal imbalance
(-60mm) [T1-S1]

KyphoBrace

The KyphoBrace (right) is a customized, lightweight, rigid, thoracolumbosacral orthosis (TSLO) made from polypropylene copolymer

The brace is designed to normalize the sagittal alignment and balance:

  • Via a three-point-pressure brace-action the orthosis encourages extension through the thoracic spine thereby reducing hyper-kyphosis and improving sagittal alignment

See More Case Study – Thoracolumbar Scoliosis Treatment

KyphoBrace

Outcomes: 9 months post-treatment

Thoracic Kyphosis angle:

  • Out-of-brace
  • Reduced from 74° to 55° (Cobb)

Posterior sagittal imbalance:

  • Reduced from -60mm to -20mm (T1-S1)

Neck pain, lower back pain and headaches:

  • Significant reduction in frequency and mild reduction in intensity

Other:

  • Significant reduction the frequency of vertigo, fatigue, migraines, anxiety, and insomnia
kyphosis before and after

Conclusion

This case study highlights that the KyphoBrace, in combination with a multi-modal manual therapy approach, may be useful in reducing the magnitude of abnormal sagittal plane curves and reducing symptoms in adults with hyper-kyphosis

Further investigation into this type of treatment is warranted

Conflict of Interest

Jeb McAviney:

  • Owner and director of ScoliCare, a company that provides treatment and educational products for practitioners, and patients with scoliosis and related spinal disorders
  • Creator of the ScoliBrace orthosis and related orthoses and the ScoliRoll rehabilitation tool

Benjamin Brown:

No other conflicts to declare

ScoliCare, Australia