Saturday, September 26, 2009

Big-time kyphosis

When some of my older female patients lie back on the exam table, their heads drop backward, necks extended, due to a forward curve in their thoracic spine between the shoulder blades. This hunchback thing is an exaggeration of the kyphosis or the gentle curve normally present in this area. It can result from weakness of the upper back muscles aggravated by poor posture but it becomes particularly prominent in women suffering from osteoporosis.

The lady in the above x-ray* has a helluva kyphosis based on osteoporosis. Her T score which compares her bone density to the ideally mineralized skeleton is -4.2 (normal range is greater than -1). This means that she has lost 42% of her bone mineral density and is severely osteoporotic. As a result, her normally block-shaped vertebral bones have collapsed anteriorly and become wedge-shaped due to compression fractures. She has lost height; her head and upper body have permanently sunk forward as her spine curled.

She no longer has room for her abdominal organs which have pooched out as her ribs sank into her pelvic bones (yes, that's bowel gas just below her chin--she is permanently gazing at her navel!). Worse yet, her thorax is severely shrunken, and her lungs can no longer fully inflate. She presented to the ER in respiratory failure as she could no longer exchange high CO2 exhaled air for high O2 inhaled air. She died during this hospital admission.

You do NOT want this collapsing spinal column thing. Lie on the floor--does your head flop backwards due to the forward curve of your upper spine? Are you uncomfortable without a pillow when lying flat on your back? Get your bone density checked. Find a physical trainer to nag you about your posture and work on your upper back strength. Take extra D and calcium!
*Blechacz, B. Images in Clinical Medicine. NEJM 6/12/08.


Ruth said...

Excellent post. That Xray is very dramatic.

Carla said...

bowel gas below her chin?? well you certainly got my attention; I'm hitting the gym tomorrow! Thanks once again for a wake up call.

Anonymous said...

Just re-upped at the gym after reading this -- and seeing the film. Poor lady.

Wendy said...

Poor lady for sure. We have osteo in the family, so I'm taking supplements and trying to exercise consistently. Does lugging around 20 lb. grandchildren count???

Thanks for popping by my blog. I missed you!

dorsey said...

I'm usually happy to go to Pilates but some mornings I just want to skip it. I tell myself "that's how it starts," and go. Now I'll look at this picture instead. great motivation, especially for a life-long sloucher.