Orthopedic & Neurologic Surgery of the Spine
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Sagittal Imbalance (Kyphosis)

Kyphosis, or sagittal imbalance, refers to a particular deformity of the spine where the front-and-back (sagittal) curvature of the spine is out of balance. In a healthy spine you’ll find two curves, a gentle inward curve of the lower spine called a lordosis, and a thoracic (middle spine) outward curvature is known as kyphosis. These two curves work together to help keep a harmonious balance to the body, aligning the center of gravity of the hips and pelvis. Should one of these curves flatten, or become too pronounced, the spine becomes out of balance in a condition known as a sagittal imbalance.

Kyphosis, or hyperkyphosis, occurs when the thoracic curve mentioned above becomes too pronounced, in severe cases, it will create a hunched appearance, and in the most severe cases can become chin-on-chest syndrome. Symptoms indicative of sagittal imbalance include lower back pain, an inability to look straight ahead when upright, and difficulty in walking. Additionally, sagittal imbalance can put pressure on spinal nerves, leading to conditions associated with nerve compression. These can include weakness, pain, numbness, and in the worst cases difficulty breathing.

If you think you may be suffering from kyphosis, speak to Dr. Peelle who will schedule tests to determine if you have it, and what the severity is. From these determinations treatment options can be discussed.


1. What types of testing are there for kyphosis?

Kyphosis is most commonly diagnosed by using an x-ray. The results of that test may have Dr. Peelle order more tests, which can include an MRI (Magnetic Resonance Imaging) and Computer Tomography (CT) scan, both of which will provide more detailed information about your condition for Dr. Peelle.

2. What treatments are available for kyphosis?

There are several treatment options available for kyphosis, dependent on your particular case and Dr. Peelle’s preference. In all cases, the surgery will be aimed at adding or removing lordosis or kyphosis to your sine to help correct the imbalance. These surgeries usually include three steps, an osteotomy to correct the spinal deformity, typically by removing a bone from the spine to add flexibility. The next step is spinal fixation, a technique that is aimed at fixing the spine into the new, correct, alignment. This is followed by spinal fusion, where the gaps created by the former procedures are closed by bone graft material fusing the spine to create greater stability. Good bone fusion is key to successful correction of kyphosis.

3. What are the risks associated with surgery to correct kyphosis?

All surgeries come with some element of risk associated, but each is particular to the form of surgery performed. As the techniques used in correcting your particular case of kyphosis is dependent on your case, the risks will vary. However, the complications most commonly associated with spinal fusion surgery are infection, blood loss, nerve damage, back pain, and side-effects of the anesthesia used in the surgery. If you have concerns please discuss them with Dr. Peelle prior to the surgery.

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