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

Authors:

Ratcliff, J. – Scoliosis Center of Utah. Utah, United States.
Dean, K. – Scoliosis Center of Utah. Utah, United States.
McAviney J. – ScoliCare. Sydney, Australia.
Brown BT. – Macquarie University. Sydney, Australia.

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
(-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

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

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:

  • External research consultant for ScoliCare

No other conflicts to declare

Contact Infomration

Dr. Benjamin Brown

Department of Chiropractic
Faculty of Science and Engineering
Macquarie University, NSW, 2109
Australia

Email: benjamin.brown@mq.edu.au
Phone: +61 434 209 812