Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive thoracic hyperkyphosis, reporting chronic postural back pain exacerbated by prolonged sitting or physical activity. No history of trauma. Symptoms noted during adolescence, now presenting with increasing spinal stiffness and cosmetic concern regarding thoracic rounding. Denies radicular symptoms, bowel/bladder dysfunction, or constitutional symptoms.
Clinical Examination Findings
Physical examination reveals a rigid thoracic kyphosis that does not correct with hyperextension (Adamโs forward bend test). Increased lumbar lordosis noted as compensatory mechanism. Palpation demonstrates tenderness over the apex of the kyphotic deformity. Neurological exam is intact with no focal deficits. Range of motion of the thoracic spine is significantly restricted.
Treatment Protocol
Management plan includes physical therapy focusing on core stabilization and thoracic extension exercises. For skeletally immature patients with curves 50-75 degrees, a custom-molded thoracolumbar orthosis (TLSO) is indicated. Surgical intervention (posterior spinal fusion and instrumentation) is reserved for progressive curves exceeding 75 degrees or refractory pain unresponsive to conservative measures.