What is a "dowager's hump"? Can it be reversed?
The clinical term for "dowager's hump" is kyphosis. It's a bending forward of the top part of the spine causing a rounded hump appearance. Kyphosis is not the same as scoliosis, which is an "S" curve of the spine and is usually diagnosed in childhood or adolescence (Figure 16).
Figure 16 Osteoporosis can cause irreversible damage to the spine, leading to significant disability. Courtesy of the National Association of Nurse Practitioners in Women's Health (NPWH).
Progressive kyphosis eventually causes the abdomen to protrude. It came to be known by its colloquial name "dowager's hump" because it was traditionally noted in older women. The curving of the spine is caused by the collapse of the front of the vertebrae due to tiny fractures. (Figure 6 in Question 18 shows the progression of kyphosis.)
Once you reach a certain point in the curving of the spine, the kyphosis is not reversible. Figure 16 shows the progression from a spine unaffected by osteoporosis to the point at which the kyphosis resulting from osteoporosis cannot be reversed. After your fractures are healed, it is important to begin an exercise program to prevent kyphosis and to even reverse some of the curve before it reaches the point where it cannot be reversed. Figure 17 shows exercises that can be done to stretch the muscles around the spine, increase flexibility, and reduce the likelihood of more fractures. These are great exercises to do even if you have never had a vertebral fracture, because they strengthen the muscles surrounding the spine.
What is kyphoplasty? Would it help my spinal fractures?
Spinal (or vertebral) fractures are a major concern for men and women with osteoporosis because they can lead to severe pain and disability (see Question 84). These fractures can also lead to kyphosis (see Figure 14 in Question 83). The spine deteriorates and curves due to fractures in individual vertebrae. Most osteoporotic vertebral fractures are traditionally treated with pain medications and a gradual return to normal activities. Although back braces to prevent twisting and support the spine were used in the past, they are infrequently
Figure 17 Exercises to prevent or improve deformity and reduce pain. Source: Duke University Medical Center's Bone and Metabolic Disease Clinic. Reprinted with permission. Gold DT, Lee LS, Tresolini CP, eds. Working with Patients to Prevent, Treat, and Manage Osteoporosis: A Curriculum Guide for the Health Professions, 3rd ed. Durham, NC: Center for the Study of Aging and Human Development, Duke University Medical Center; 2001.
used today. Immobility associated with the brace or bed rest can increase the risk for blood clots, isolation, depression, and increased bone loss, and is usually not advised (see Question 83).
Kyphoplasty is a surgical procedure that helps to correct the collapse of the lumbar (lower back) and thoracic (mid to upper back) vertebrae. More important, this procedure can significantly reduce the pain of fractures and help individuals return to normal activities, sometimes within hours of surgery. Kyphoplasty is normally reserved for patients experiencing significant pain for at least 3 to 4 weeks, patients who may be in danger of developing bedsores from extended bed rest and immobility, and those who are not responding to conservative treatment. Kyphoplasty is more successful if performed within 2 to 3 months following the fracture.
For kyphoplasty, an incision is made in the spine under local anesthesia. The patient can be awake so that pain and neurological problems arising from the surgery can be immediately identified. An uninflated balloonlike instrument is inserted into the vertebra. The balloon is inflated, increasing the space within the vertebra. Sometimes this maneuver straightens the vertebra. Sometimes it doesn't. The balloon is removed and a special cement compound fills in the space, somewhat like a cast supporting the bone. Pain relief is almost immediate. Being able to resume normal daily activities can also be expected, thereby reducing the amount of disability caused by the vertebral fractures. Kyphoplasty is not a substitute for other treatments for osteoporosis, however. You may still need to take prescription medications, and you must take adequate calcium and vitamin D. You should also exercise regularly once your clinician has given you the go-ahead after surgery.
Kyphoplasty was originally based on the principles of vertebroplasty, which is a procedure usually performed by radiologists, who inject a cement-like substance into the fractured vertebrae using special x-ray techniques. This procedure does not require a surgical incision and does not use the balloon technique before cement is injected. Patients have said that they get immediate relief from the pain caused by the fractures.
Kyphoplasty is also used for patients with vertebral fractures resulting from metastases (that is, spread of disease from one part of the body to another) of cancers, which weaken bones, often in the spine. These fractures are extremely painful. The surgical procedure for fractures that result from metastases is often followed by radiofrequency waves to the affected areas of the spine.