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Journal articles on the topic 'Hyperkyphosis'

Author: Grafiati

Published: 4 June 2021

Last updated: 2 February 2022

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1

Bonthius, Daniel. "4273 An innovative rib construct for treatment of pediatric spinal deformity." Journal of Clinical and Translational Science 4, s1 (June 2020): 41. http://dx.doi.org/10.1017/cts.2020.156.

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OBJECTIVES/GOALS: The rib construct is a novel device for treating childhood hyperkyphosis and kyphoscoliosis. The purpose of this study was to investigate the biomechanics, mechanism, and clinical outcomes of this device. The overarching hypothesis was that the rib construct is safe and effective for correcting hyperkyphotic spinal deformity. METHODS/STUDY POPULATION: Biomechanical evaluation: An ex vivo porcine spine biomechanical study compared traditional pedicle screw proximal fixation to the rib construct in terms of proximal fixation strength and construct stiffness. Porcine model hyperkyphosis correction with rib construct: An in vivo hyperkyphotic porcine model was used to study the ability of the rib construct to correct hyperkyphosis in the developing porcine spine. Human hyperkyphotic correction with rib construct: A retrospective study was conducted to examine the radiographic outcomes, complication rates, procedure times, and blood losses experienced by human patients that received rib construct surgery. RESULTS/ANTICIPATED RESULTS: Biomechanical evaluation: The rib construct was significantly less prone to proximal fixation failure and less stiff compared to pedicle screws. Porcine model hyperkyphosis correction with rib construct: The average T6-T14 thoracic kyphosis was 35.8 ± 3.2° at the time of hyperkyphosis creation surgery. In response to corrective surgery with the rib-hook construct, T6-T14 thoracic hyperkyphosis decreased immediately post-op to 11.3 ± 7.8° and continued to decrease to 7.8 ± 7.6° until final follow-up 8 weeks post-op (n = 3). Human hyperkyphosis correction with rib construct: Pre-op sagittal Cobb angle was 81 ± 31° and fell to 43 ± 24° post-op and to 38 ± 24° at final follow-up; indicating ~100% correction (normal thoracic kyphosis is 40°). DISCUSSION/SIGNIFICANCE OF IMPACT: The results suggest that the rib construct is a highly effective technique and superior to existing methods.

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Eshraghi, Arezoo, Nader Maroufi, Mohammad Ali Sanjari, Hassan Saeedi, Mohammad Reza Keyhani, Hossein Gholizadeh, and Noor Azuan Abu Osman. "Effect of Milwaukee brace on static and dynamic balance of female hyperkyphotic adolescents." Prosthetics and Orthotics International 37, no. 1 (July 2, 2012): 76–84. http://dx.doi.org/10.1177/0309364612448805.

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Background: Biomechanical factors, such as spinal deformities can result in balance control disorders. Objectives: The purpose of this study was to examine the effect of bracing on static and dynamic balance control of hyperkyphotic female adolescents. Study Design: Clinical trial. Methods: A force platform was employed to record center of pressure (COP) parameters. Ten adolescents undergoing Milwaukee brace for hyperkyphosis and 14 normal subjects participated in the study. The COP data were collected with and without brace immediately on first day and after 120 days of continuous brace wear. Results: No significant difference was found in dynamic and static balance tests with and without brace on the first day ( P > 0.05). After 120 days, the values of COP displacement in functional reach to the right and left for the hyperkyphotic adolescents when performing without brace enhanced significantly compared to the first day. The forward reach distance was not significantly different between the normal and hyperkyphotic subjects ( P = 0.361); however, hyperkyphotic participants had significantly smaller reach distance in the functional reach to the right (21.88 vs. 25.56cm) and left (17.04 vs. 21.25cm). Conclusion: It might be concluded that bracing had a possible effect on improvement of dynamic balance performance, because the subjects could reach the target in dynamic reach tests with higher displacement in sagittal plane without losing their balance control. Clinical relevance Little is known about the biomechanical aspects of brace wear in individuals with hyperkyphosis. This study investigated balance differences between the healthy and hyperkyphotic individuals, and outcomes of Milwaukee brace wear. It might provide some new insight into the conservative treatment of hyperkyphosis for clinicians and researchers.

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&NA;. "Hyperkyphosis." Back Letter 24, no. 7 (July 2009): 76. http://dx.doi.org/10.1097/01.back.0000357543.09858.0a.

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Grenader, Tal. "Hyperkyphosis." Internal and Emergency Medicine 7, S1 (July 16, 2011): 55–56. http://dx.doi.org/10.1007/s11739-011-0665-9.

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Shimizu, Taro. "Severe Hyperkyphosis." Internal Medicine 57, no. 15 (August 1, 2018): 2281. http://dx.doi.org/10.2169/internalmedicine.0074-17.

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Winter, Robert B., John E. Lonstein, and Maren Anderson. "Neurofibromatosis Hyperkyphosis." Journal of Spinal Disorders 1, no. 1 (January 1988): 39???49. http://dx.doi.org/10.1097/00002517-198801000-00006.

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7

Burns, Krista. "35 The Impact of Postural Hyperkyphosis on Postural Stability and Cognition." Age and Ageing 48, Supplement_4 (December 2019): iv9—iv12. http://dx.doi.org/10.1093/ageing/afz164.35.

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Abstract Background Postural Hyperkyphosis results from flexor dominant posture habits. Flexor dominance occurs due to dysfunction of the pontomedullary reticular formation (PMRF) of the brainstem and the vestibular system. The role of the PMRF is to inhibit anterior flexion above T6 spinal level, and the vestibular system stimulates upright postural extension and balance. When patients present with flexor dominance they have a Postural Hyperkyphosis postural distortion pattern and abnormal muscle activation patterns. To correct flexor dominance, practitioners should perform brain-based exercises, not just structural exercises. Brain based stimulation of the vestibular system and the brainstem stimulates upright extension of the Posture System and inhibition of anterior flexion to reduce Postural Hyperkyphosis. Postural Hyperkyphosis contributes to multiple health discrepancies. According to Cohen, Vasavada, and Wiest et al. (2016) in the Frontiers of Neuroscience, Postural Hyperkyphosis is associated with a lower state of cognition. According to Kado, Huang, and Nguyen et al. (2007) in the Journals of Gerontology hyperkyphosis is associated with poor balance and injurious falls in the elderly. Brainstem and vestibular activation reduces flexion and improves extension for better postural correction outcomes. Results Brain Based exercises reduce Postural Hyperkyphosis and improve postural stability and cognition of elderly patients. Brain Based exercises are safe for the elderly to perform and can be easily implemented into physical rehabilitation treatment plans for better postural correction results. Conclusion Correcting Postural Hyperkyphosis to improve Postural Stability and cognition requires a Brain Based treatment protocol.

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Keyoung, H. Michael, Adam S. Kanter, and Praveen V. Mummaneni. "Delayed-onset neurological deficit following correction of severe thoracic kyphotic deformity." Journal of Neurosurgery: Spine 8, no. 1 (January 2008): 74–79. http://dx.doi.org/10.3171/spi-08/01/074.

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✓There are many potential risks associated with spinal deformity correction procedures including transient and/or permanent neurological deficits. Typically, neurological deficits caused by the surgical correction of spinal kyphosis occur acutely during surgery or immediately after surgery. Delayed postoperative neurological deficits are extremely rare. The authors report a case of delayed neurological deficit that occurred 48 hours after surgical correction of thoracic hyperkyphosis. An 18-year-old man with myotonic dystrophy presented with a 110° T7–L1 kyphosis. The patient underwent an uneventful two-stage correction procedure of the hyperkyphotic deformity. First, anterior discectomies and fusion were performed from T-7 to L-1 using rib autograft, and all segmental vessels were preserved. Subsequently, on the same day, the patient underwent posterior Smith–Petersen osteotomies and T7–L2 pedicle screw fixation. Intact somatosensory and motor evoked potentials were maintained throughout both operations. Postoperatively, he remained neurologically intact without sequelae for nearly 48 hours. On postoperative Day 2, the patient developed delayed monoplegia of the left leg and sensory level loss below T-10. Medical management enabled complete reversal of the patient's monoplegia and sensory loss. At 2-year follow-up, the patient had no adverse neurological sequelae. In this case, a delayed postoperative neurological deficit occurred following spinal hyperkyphosis correction. The authors discuss the possible etiological mechanisms behind this complication and suggest strategies for its management.

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Hayashi, Kazunori, Hiromitsu Toyoda, Hidetomi Terai, Akinobu Suzuki, Masatoshi Hoshino, Koji Tamai, Shoichiro Ohyama, and Hiroaki Nakamura. "Cervical lordotic alignment following posterior spinal fusion for adolescent idiopathic scoliosis: reciprocal changes and risk factors for malalignment." Journal of Neurosurgery: Pediatrics 19, no. 4 (April 2017): 440–47. http://dx.doi.org/10.3171/2016.9.peds16298.

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OBJECTIVE Numerous reports have been published on the effectiveness and safety of correction of the coronal Cobb angle and thoracolumbar sagittal alignment in patients with adolescent idiopathic scoliosis (AIS). Suboptimal sagittal alignment, such as decreased thoracic kyphosis (TK), after corrective surgery, is a possible cause of lumbar or cervical spinal degeneration and junctional malalignment; however, few reports are available on reciprocal changes outside of the fused segments, such as the cervical lordotic angle (CLA). This study aimed to investigate the relationship between the perioperative CLA and other radiographic factors or clinical results in AIS, and to identify independent risk factors of postoperative cervical hyperkyphosis. METHODS A total of 51 AIS patients who underwent posterior spinal fusion with the placement of pedicle screw (PS) constructs at thoracic levels were included in the study. Clinical and radiographic follow-up of patients was conducted for a minimum of 2 years, and the postoperative course was evaluated. The authors measured and identified the changes in the CLA and other radiographic parameters using whole-spine radiography, with the patient in the standing position, performed immediately before surgery, 2 weeks after surgery, and 2 years after surgery. The postoperative cervical hyperkyphosis group included patients whose CLA at 2-year follow-up was smaller than −10°. The reciprocal changes of the CLA and other parameters were also investigated. Univariate and multivariate analyses were conducted to determine the associated risk factors for postoperative cervical hyperkyphosis. RESULTS This study comprised 48 females and 3 males (mean age 16.0 years). The mean follow-up period was 47 months (range 24–90 months). The main coronal thoracic curve was corrected from 54.6° to 16.4°, and the mean correction rate was 69.8% at 2 years. The CLA significantly increased from the mean preoperative measurement (−5.4° ± 14°) to the 2-year follow-up measurement (−1.7° ± 11°) (p = 0.019). Twelve of the 51 patients had postoperative cervical hyperkyphosis. This group exhibited significantly smaller preoperative CLA and TK measurements (p = 0.001 and 0.004, respectively) than the others. After adjusting for confounding factors, preoperative CLA less than −5° and preoperative TK less than 10° were significantly associated with postoperative cervical hyperkyphosis (p < 0.05; OR 12.5 and 8.59, respectively). However, no differences were found in the clinical results regardless of cervical hyperkyphosis. CONCLUSIONS The CLA increased significantly from preoperatively to 2 years after surgery. Preoperative small CLA and TK measurements were independent risk factors of postoperative cervical hyperkyphosis. However, there was no difference in the clinical outcomes regardless of cervical hyperkyphosis.

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Cejudo, Antonio, Josep María Centenera-Centenera, and Fernando Santonja-Medina. "Sagittal Integral Morphotype of Competitive Amateur Athletes and Its Potential Relation with Recurrent Low Back Pain." International Journal of Environmental Research and Public Health 18, no. 16 (August 4, 2021): 8262. http://dx.doi.org/10.3390/ijerph18168262.

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Athletes have higher thoracic and lumbar curvature in standing than the reference values of the non-athletic population. The sagittal integral morphotype method (SIM) assessment has not previously been applied to competitive amateur athletes (CAA). The propose of the present study was to determine the SIM of CAA treated at a sports-medicine center and to identify spinal misalignments associated with recurrent low back pain (LBP). An observational analysis was developed to describe the SIM in 94 CAA. The thoracic and lumbar curvatures of the CAA were measured in standing, sitting, and trunk forward flexion. Association analysis (Pearson’s chi-square and Cramér’s V tests) was then performed to identify the SIM misalignments associated with LBP. Effect size was analyzed based on Hedges’ g. The most common thoracic SIMs in CAA were total hyperkyphosis (male = 59.02%; female = 42.42%) and static hyperkyphosis (male = 11.48%; female = 6.06%). Hyperlordotic attitude (female = 30.30%; male = 4.92%), static-functional hyperkyphosis (male = 16.39%; female = 3.03%), and structured hyperlordosis (female = 21.21%; male = 1.64%) were the most common lumbar SIMs. Hyperlordotic attitude, static functional lumbar hyperkyphosis, and structured hyperlordosis were associated with LBP in male and female athletes.

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Reisberg, Kirkke, and Caris-Helena Kaup. "Efficacy of a multimodal physiotherapy treatment program for postural disorders and pain: a case report." Acta Kinesiologiae Universitatis Tartuensis 26 (December 31, 2020): 49–60. http://dx.doi.org/10.12697/akut.2020.26.05.

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The participant of this study was a 40-year-old female, who mainly complained of middle thoracic stiffness and pain in extension at the mid thoracic level with hyperkyphosis, forward head and mild thoracic dextroscoliosis. The subject participated in multimodal home-based physiotherapy program with the duration of 9 months, consisting of posture exercises, soft tissue massage therapy and thoracic manipulations. Comparison of initial and final evaluation revealed the improvement in all evaluated variables, including the reduction of thoracic hyperkyphosis, forward head posture and thoracic dextroscoliosis, freer and less painful thoracic spine extension mobility, no pain in the sacroiliac joint, and increased satisfaction with the posture. There was also notable improvement in the algometry of the paraspinal muscles, equalization of functional lower-leg length and rib-pelvic distance of both sides of body. In conclusion, the proposed physiotherapy protocol can be beneficial in addressing postural faults such as thoracic hyperkyphosis, forward head and scoliosis. However, further research is needed with a larger sample.

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Hosseinabadi, Mostafa, Mojtaba Kamyab, Fatemeh Azadinia, and Javad Sarrafzadeh. "Effect of a Spinomed orthosis on balance performance, spinal alignment, joint position sense and back muscle endurance in elderly people with hyperkyphotic posture: A randomized controlled trial." Prosthetics and Orthotics International 44, no. 4 (June 7, 2020): 234–44. http://dx.doi.org/10.1177/0309364620923816.

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Background: Hyperkyphosis may cause balance impairment in elderly people. Although the effectiveness of orthoses for improving balance in hyperkyphotic elderly people has received much attention, the mechanisms by which devices affect balance remain unknown. Objectives: The objective of this study was to evaluate changes in balance performance, thoracic kyphosis angle, craniovertebral angle, back muscle endurance and joint position sense after 3 months of wearing a Spinomed orthosis. The study also included a secondary exploratory analysis to determine whether changes in any of the above-mentioned outcome measures can predict balance performance improvement in elderly people with hyperkyphosis. Study design: Parallel group randomized controlled trial. Methods: In total, 44 hyperkyphotic elderly people were randomly allocated to an experimental group, who wore a Spinomed orthosis and a control group, who did not. No other treatment or change in physical activity was permitted during the study. A blinded assessor evaluated thoracic kyphosis angle, joint position sense, craniovertebral angle, back muscle endurance, Timed Up and Go Test time and Berg Balance Scale score at baseline and after 5, 9 and 13 weeks. All dependent variables were measured without the orthosis and analyzed separately using a 2 × 4 (time × group) mixed model analysis of variance. Based on the results of correlation analysis, thoracic kyphosis angle, back muscle endurance and joint position sense were selected as independent variables in a stepwise multiple regression model. Results: The two-way (group × time) interactions were significant in terms of Berg Balance Scale ( F = 11.6, P ⩽ 0.001, [Formula: see text]), Timed Up and Go Test ( F = 3.74, P = 0.013, [Formula: see text]), thoracic kyphosis angle ( F = 43.39, P ⩽ 0.001, [Formula: see text]), craniovertebral angle ( F = 5.245, P = 0.002, [Formula: see text]) and joint position sense ( F = 4.44, P = 0.005, [Formula: see text]). The two-way interaction was not significant in terms of back muscle endurance; however, the main effect of group was significant for this variable ( F = 3.85, P = 0.025). Stepwise multiple regression showed that thoracic kyphosis angle and joint position sense were significant determinants of Timed Up and Go Test time ( R2 = 0.155, P = 0.037 and R2 = 0.292, P = 0.012, respectively). Conclusion: Wearing a Spinomed orthosis for 3 months improved the posture, position sense and muscle performance of hyperkyphotic elderly people. Orthoses may improve balance performance by correcting spinal alignment and increasing proprioceptive information.

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Kado, Deborah M. "Narrative Review: Hyperkyphosis in Older Persons." Annals of Internal Medicine 147, no. 5 (September 4, 2007): 330. http://dx.doi.org/10.7326/0003-4819-147-5-200709040-00008.

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Hoffmeister, Ellen. "Conservative Approaches to Treating Adolescent Hyperkyphosis." Lippincott's Bone and Joint Newsletter 16, no. 6 (June 2010): 61. http://dx.doi.org/10.1097/01.bonej.0000380347.16354.5e.

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&NA;. "Does Hyperkyphosis Lead to Premature Death?" Back Letter 24, no. 7 (July 2009): 77. http://dx.doi.org/10.1097/01.back.0000357544.17481.c9.

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Ashton-Miller, James A. "Thoracic Hyperkyphosis in the Young Athlete." Current Sports Medicine Reports 3, no. 1 (February 2004): 47–52. http://dx.doi.org/10.1249/00149619-200402000-00009.

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Bettany-Saltikov, Josette, Deborah Turnbull, Shu Yan Ng, and Richard Webb. "Management of Spinal Deformities and Evidence of Treatment Effectiveness." Open Orthopaedics Journal 11, no. 1 (December 29, 2017): 1521–47. http://dx.doi.org/10.2174/1874325001711011521.

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Introduction:The review evaluates the up-to-date evidence for the treatment of spinal deformities, including scoliosis and hyperkyphosis in adolescents and adults.Material and Methods:The PubMed database was searched for review articles, prospective controlled trials and randomized controlled trials related to the treatment of spinal deformities. Articles on syndromic scoliosis were excluded and so were the articles on hyperkyphosis of the spine with causes other than Scheuermann’s disease and osteoporosis. Articles on conservative and surgical treatments of idiopathic scoliosis, adult scoliosis and hyperkyphosis were also included. For retrospective papers, only studies with a follow up period exceeding 10 years were included.Results:The review showed that early-onset idiopathic scoliosis has a worse outcome than late-onset idiopathic scoliosis, which is rather benign. Patients with AIS function well as adults; they have no more health problems when compared to patients without scoliosis, other than a slight increase in back pain and aesthetic concern. Conservative treatment of adolescent idiopathic scoliosis (AIS) using physiotherapeutic scoliosis-specific exercises (PSSE), specifically PSSR and rigid bracing was supported by level I evidence. Yet to date, there is no high quality evidence (RCT`s) demonstrating that surgical treatment is superior to conservative treatment for the management of AIS. For adult scoliosis, there are only a few studies on the effectiveness of PSSEs and a conclusion cannot as yet be drawn.For hyperkyphosis, there is no high-quality evidence for physiotherapy, bracing or surgery for the treatment of adolescents and adults. However, bracing has been found to reduce thoracic hyperkyphosis, ranging from 55 to 80° in adolescents. In patients over the age of 60, bracing improves the balance score, and reduces spinal deformity and pain. Surgery is indicated in adolescents and adults in the presence of progression of kyphosis, refractory pain and loss of balance.Discussion:The available evidence reviewed has suggested that different approaches are needed towards the management of different spinal deformities. Specific exercises should be prescribed in children and adolescents with a Cobb angle in excess of 15°. In progressive curves, they should be used in conjunction with bracing. Clarity regarding differences and similarities is given as to what makes PSSE and PSSR specific exercises. As AIS is relatively benign in nature, conservative treatment should be tried when the curve is at a surgical threshold, before surgery is considered. Similarly, bracing and exercises should be prescribed for patients with hyperkyphosis, particularly when the lumbar spine is afflicted. Surgery should be considered only when the symptoms cannot be managed conservatively.Conclusion:There is at present high quality evidence in support of the conservative treatment of AIS. The current evidence supports the use of PSSE, especially those using PSSR, together with bracing in the treatment of AIS. In view of the lack of medical consequences in adults with AIS, conservative treatment should be considered for curves exceeding the formerly assumed range of conservative indications.There is, however a lack of evidence in support of any treatment of choice for hyperkyphosis in adolescents and spinal deformities in adults. Yet, conservative treatment should be considered first. Yet to date, there is no high quality evidence (RCT`s) demonstrating that surgical treatment is superior to conservative treatment for the management of AIS and hyperkyphosis. Additionally, surgery needs to be considered with caution, as it is associated with a number of long-term complications.

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Jung, Sung-hoon, Ui-jae Hwang, Sun-hee Ahn, Jun-hee Kim, and Oh-yun Kwon. "Effects of Manual Therapy and Mechanical Massage on Spinal Alignment, Extension Range of Motion, Back Extensor Electromyographic Activity, and Thoracic Extension Strength in Individuals with Thoracic Hyperkyphosis: A Randomized Controlled Trial." Evidence-Based Complementary and Alternative Medicine 2020 (November 23, 2020): 1–10. http://dx.doi.org/10.1155/2020/6526935.

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Background. Manual therapy has been recommended to reduce and prevent musculoskeletal problems related to thoracic hyperkyphosis. With recent rapid technological developments, manual techniques can now be implemented by mechanical devices; hence, mechanical massage can manipulate the back muscles and mobilize the spine. Purpose. Here, we aimed to 1) determine the effects of mechanical massage and manual therapy and 2) compare their effects on spinal posture, extension range of motion, trunk extensor electromyographic activity, and thoracic extension strength in individuals with thoracic hyperkyphosis. Methods. Participants with thoracic hyperkyphosis were randomly assigned to the manual therapy (n = 16) or mechanical massage (n = 19) group. Each intervention was applied for 8 weeks. The participants’ spinal posture, extension range of motion, trunk extensor electromyographic activity, and thoracic extension strength were measured before and after intervention. Results. Intergroup analyses revealed no significant differences in any variables. However, thoracic kyphosis angle, thoracic extension range of motion, longissimus thoracis electromyographic activity, iliocostalis lumborum pars lumborum activity, and thoracic extension strength differed significantly in intertime analyses. The results of paired t-test analysis showed that thoracic kyphosis angle, thoracic extension range of motion, longissimus thoracis electromyographic activity, and thoracic extension strength were significantly different after intervention in both groups p < 0.05 . Conclusions. Mechanical massage and manual therapy effectively improve thoracic kyphosis angle, thoracic extension range of motion, and thoracic extension strength. Therefore, mechanical massage is an alternative intervention to manual therapy for improving thoracic kyphosis angle, thoracic extension range of motion, and thoracic extension strength in participants with hyperkyphosis. This trail is registered with KCT0004527.

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Azadinia, Fatemeh, Mojtaba Kamyab, Hamid Behtash, Nader Maroufi, and Bagher Larijani. "The effects of two spinal orthoses on balance in elderly people with thoracic kyphosis." Prosthetics and Orthotics International 37, no. 5 (February 11, 2013): 404–10. http://dx.doi.org/10.1177/0309364612474487.

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Background:Hyperkyphosis increases the risk of falls for elderly people by reducing postural balance. Spinomed orthosis and the posture-training support are two available options for improving postural balance but have never been compared.Objectives:To compare the effect of the Spinomed orthosis and the posture-training support on balance in elderly people with thoracic hyperkyphosis.Study Design:This study is a clinical trial on an accessible sample of elderly people with thoracic kyphosis.Method:Eighteen participants (16 women and 2 men), aged 60–80 years, with thoracic kyphosis greater than 50°, completed the study procedure. Subjects were randomly allocated to two groups, namely, Spinomed orthosis and the posture-training support groups. Sensory organization test and limits of stability were assessed using the EquiTest system and the Balance Master system, respectively. Balance score, directional control, and reaction time were measured to evaluate balance with and without orthosis in a random order.Results:In the posture-training support group, significant changes were observed in the studied balance parameters: balance score ( p < 0.001), directional control ( p = 0.027), and reaction time ( p = 0.047). There was a significant change in balance score ( p < 0.001) and directional control ( p = 0.032) in the Spinomed group. However, there were no significant differences in the effect of the two orthoses, the Spinomed orthosis and posture-training support, on balance factors.Conclusion:Both Spinomed orthosis and posture-training support may improve balance in the elderly with thoracic hyperkyphosis in a similar manner.Clinical relevanceDespite the importance of falls suffered by elderly people, not much attention has been paid to balance improvement and fall prevention while managing hyperkyphosis. This study evaluates the effect of the Spinomed orthosis and posture-training support on balance in hyperkyphotic elderly people. It provides some new insights into reducing the risk of falls for elderly people.

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Reddy, M. Mahendra Kumar, C. Jagan Babu, K. Muni Muralidhar Rao, and K. Usha Sree. "Idiopathic clubfoot management by Ponsetti technique hyperkyphosis." MedPulse International Journal of Orthopedics 10, no. 2 (2019): 45–47. http://dx.doi.org/10.26611/10201027.

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Katzman, Wendy B., Stephanie L. Harrison, Howard A. Fink, Lynn M. Marshall, Eric Orwoll, Elizabeth Barrett-Connor, Peggy M. Cawthon, and Deborah M. Kado. "Physical Function in Older Men With Hyperkyphosis." Journals of Gerontology Series A: Biological Sciences and Medical Sciences 70, no. 5 (November 27, 2014): 635–40. http://dx.doi.org/10.1093/gerona/glu213.

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Robledo, Raymond F., Kevin L. Seburn, Anthony Nicholson, and Luanne L. Peters. "Strain-specific hyperkyphosis and megaesophagus inAdd1null mice." genesis 50, no. 12 (September 12, 2012): 882–91. http://dx.doi.org/10.1002/dvg.22342.

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Perriman, Diana M., Jennifer M. Scarvell, Andrew R. Hughes, Christian J. Lueck, Keith B. G. Dear, and Paul N. Smith. "Thoracic Hyperkyphosis: A Survey of Australian Physiotherapists." Physiotherapy Research International 17, no. 3 (December 30, 2011): 167–78. http://dx.doi.org/10.1002/pri.529.

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Sainz de Baranda, Pilar, Antonio Cejudo, María Teresa Martínez-Romero, Alba Aparicio-Sarmiento, Olga Rodríguez-Ferrán, Mónica Collazo-Diéguez, José Hurtado-Avilés, Pilar Andújar, and Fernando Santonja-Medina. "Sitting Posture, Sagittal Spinal Curvatures and Back Pain in 8 to 12-Year-Old Children from the Region of Murcia (Spain): ISQUIOS Programme." International Journal of Environmental Research and Public Health 17, no. 7 (April 9, 2020): 2578. http://dx.doi.org/10.3390/ijerph17072578.

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To explore sagittal spinal alignment and pelvic disposition of schoolchildren in a slump sitting position is needed in order to establish preventive educational postural programs. The purposes of this study were to describe sagittal spinal alignment and pelvic tilt (LSA) in a slump sitting position and to explore the association of sagittal spine and pelvic tilt with back pain (BP) among 8–12-year-old children. It was a cross-sectional study. Sagittal spinal curvatures, BP and pelvic tilt were assessed in 582 students from 14 elementary schools. It was found that 53.44% of children had slight thoracic hyperkyphosis and that 48.80% presented moderate lumbar hyperkyphosis and 38.66% presented slight lumbar hyperkyphosis. Those who did not suffer from BP in any part of the back had a higher lumbar kyphosis (24.64 ± 7.84) or a greater LSA (107.27 ± 5.38) than children who had some type of BP in the previous year or week (lumbar kyphosis: 23.08 ± 8.06; LSA: 105.52 ± 6.00), although with no clinically relevant differences. In fact, neither sufferers nor those who did not have BP presented normal mean values for lumbar kyphosis or LSA according to normality references. This study demonstrates the need to assess sagittal morphotype in childhood since schoolchildren remain incorrectly seated for many hours and it greatly affects their spinal curvatures.

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Sainz de Baranda, Pilar, Antonio Cejudo, Victor Jesus Moreno-Alcaraz, Maria Teresa Martinez-Romero, Alba Aparicio-Sarmiento, and Fernando Santonja-Medina. "Sagittal spinal morphotype assessment in 8 to 15 years old Inline Hockey players." PeerJ 8 (January 2, 2020): e8229. http://dx.doi.org/10.7717/peerj.8229.

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Background Physiological sagittal spinal curvatures play an important role in health and performance in sports. For that reason, several scientific studies have assessed spinal morphology in young athletes. However, to our knowledge, no study has assessed the implications of Inline Hockey (IH) practice on sagittal integrative spinal morphotype in adolescent players. Objectives The aims of the present study were to describe habitual sagittal spinal posture in young federated IH players and its relationship with training load and to determine the sagittal integrative spinal morphotype in these players. Methods An observational analysis was developed to describe the sagittal spinal morphotype in young federated IH players. A total of 74 IH players from the Technification Plan organized by the Skating Federation of the Valencian Community (aged from 8 to 15 years) participated in the study. Thoracic and lumbar curvatures of the spine were measured in a relaxed standing position (SP), in a slump sitting position (SSP) and in maximum flexion of the trunk (MFT) to determine the “Sagittal Integrative Morphotype” of all players. An unilevel inclinometer was used to quantify the sagittal spinal curvatures. The Hip Joint Angle test was used to quantify the Lumbo-Horizontal angle in flexion (L-H fx) of all participants with a goniometer. Results When thoracic curvature was analyzed according to normality references, it was found that 64.9% of IH players had thoracic hyperkyphosis in a SSP, while 60.8% and 74.3% of players were classified as normal in a SP and in MFT, respectively. As for the lumbar curve, 89.2% in a SP and 55.4% in MFT were normal, whereas 68.9% of IH players presented lumbar hyperkyphosis in a SSP. Regarding the “Sagittal Integrative Morphotype,” only 17.6% of players were classified as “Normal” in the three measured positions for the thoracic curve, while 37.8% had “Thoracic Hyperkyphosis” and 41.8% presented “Functional Thoracic Hyperkyphosis.” As for the “Sagittal Integrative Lumbar Morphotype,” only 23% of athletes had a normal curve in the three positions, whereas 66.2% presented “Functional Lumbar Hyperkyphosis.” When the L-H fx was evaluated, the results showed that only 16.2% of the athletes were classified as normal. Conclusions Federative IH practice seems to cause specific adaptations in spinal sagittal morphotype. Taking into account the “Sagittal Integrative Morphotype” only 17.6% IH players presented “Normal Morphotype” with a normal thoracic kyphosis in the three measured positions, while only 23% IH players presented “Normal Morphotype” with a normal lumbar curvature in the three assessed positions. Furthermore, only 16.2% of IH players showed normal pelvic tilt. Exercise programs to prevent or rehabilitate these imbalances in young IH players are needed.

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Mehdikhani, Mahboobeh, Hamid Behtash, Mohammad Saleh Ganjavian, Noor Azuan Abu Osman, and Nafiseh Khalaj. "Treatment stability of Milwaukee brace in idiopathic hyperkyphosis." Prosthetics and Orthotics International 38, no. 4 (August 15, 2013): 316–20. http://dx.doi.org/10.1177/0309364613499063.

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Background:The Milwaukee brace is an efficient method for correcting hyperkyphosis before skeletal maturity. However, loss of correction in long-term follow-up is inevitable.Objectives:To determine loss of correction and factors affecting the loss of correction.Study design:Retrospective study.Methods:A total of 49 corrected patients by Milwaukee brace participated minimum 2 years after treatment completion. The participants were categorized into two groups based on their roentgenograms: Group 1 (n = 36) had kyphotic curves of 45° or less and Group 2 (n = 13) had kyphotic curves of more than 45°.Results:The mean loss of corrections for Group 1 and Group 2 were 3.80° (ranges = 0°–13°) and 12.92° (ranges = 8°–22°), respectively. Group 1 showed no significant difference between the average hyperkyphosis of the patients for the part-time and full-time treatment duration (p = 0.02). By contrast, a significant difference was observed between the average hyperkyphosis of patients in Group 2 for the part-time and full-time treatment duration (p < 0.05).Conclusions:Patients with kyphosis of 60° or less who can save the correction in full-time orthotic treatment in part-time treatment may have the least loss of correction over time.Clinical relevanceAs the orthotic treatment is a time-consuming method that needs the close collaboration of patient and treatment team, it is possible that clinicians predict the probable result of treatment and efficiency of orthotic treatment. Thus, a clinician can abandon orthotic treatment and refer the patient for an operation.

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Lundine, Kristopher, Peter Turner, and Michael Johnson. "Thoracic Hyperkyphosis: Assessment of the Distal Fusion Level." Global Spine Journal 2, no. 2 (June 2012): 065–70. http://dx.doi.org/10.1055/s-0032-1319771.

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Study Design This is a retrospective study. Objective The objective of this study was to assess the sagittal stable vertebra (SSV) versus the first lordotic vertebra (FLV) as the inferior fusion level in patients undergoing spinal surgery for thoracic hyperkyphosis. The main outcome of interest was the development of distal junctional kyphosis (DJK). Summary of Background Data Prior research has pointed to selection of the FLV for the distal instrumentation level in fusion for thoracic hyperkyphosis. In 2009, Cho et al introduced the concept of the SSV after recognizing the development of DJK despite fusion to the FLV. Methods Patients were reviewed who had undergone spinal fusion for thoracic hyperkyphosis. Preoperative radiographs were reviewed to assess thoracic kyphosis, lumbar lordosis, SSV, and FLV. Postoperative radiographs were reviewed to assess curve correction and whether patients developed DJK or implant failure. Results We reviewed 22 patients with a mean age at surgery of 18 (range 14 to 22). Mean preoperative kyphosis was 85 ± 14 degrees, and mean postoperative kyphosis at final follow-up was 59 ± 12 degrees for a mean correction of 26 ± 12 degrees. Eleven patients developed DJK and four patients experienced hardware failure. In 12 patients, the SSV was inferior to the FLV. Rates of DJK when the instrumentation included the SSV or FLV were 13 and 38%, respectively. Conclusions Fusion to the SSV is superior at preventing DJK when compared with fusion to the FLV.

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Gonçalves, Márcia Aparecida, Bruna Estima Leal, Liseane Gonçalves Lisboa, Michelle Gonçalves de Souza Tavares, Wellington Pereira Yamaguti, and Elaine Paulin. "Comparison of diaphragmatic mobility between COPD patients with and without thoracic hyperkyphosis: a cross-sectional study." Jornal Brasileiro de Pneumologia 44, no. 1 (February 2018): 5–11. http://dx.doi.org/10.1590/s1806-37562016000000248.

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ABSTRACT Objective: To compare diaphragmatic mobility, lung function, and respiratory muscle strength between COPD patients with and without thoracic hyperkyphosis; to determine the relationship of thoracic kyphosis angle with diaphragmatic mobility, lung function, and respiratory muscle strength in COPD patients; and to compare diaphragmatic mobility and thoracic kyphosis between male and female patients with COPD. Methods: Participants underwent anthropometry, spirometry, thoracic kyphosis measurement, and evaluation of diaphragmatic mobility. Results: A total of 34 patients with COPD participated in the study. Diaphragmatic mobility was significantly lower in the group of COPD patients with thoracic hyperkyphosis than in that of those without it (p = 0.002). There were no statistically significant differences between the two groups of COPD patients regarding lung function or respiratory muscle strength variables. There was a significant negative correlation between thoracic kyphosis angle and diaphragmatic mobility (r = −0.47; p = 0.005). In the sample as a whole, there were statistically significant differences between males and females regarding body weight (p = 0.011), height (p < 0.001), and thoracic kyphosis angle (p = 0.036); however, there were no significant differences in diaphragmatic mobility between males and females (p = 0.210). Conclusions: Diaphragmatic mobility is lower in COPD patients with thoracic hyperkyphosis than in those without it. There is a negative correlation between thoracic kyphosis angle and diaphragmatic mobility. In comparison with male patients with COPD, female patients with COPD have a significantly increased thoracic kyphosis angle.

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Mehdikhani, Mahboobeh, Hamid Behtash, Mohammad S. Ganjavian, and Nafiseh Khalaj. "Orthotic treatment of idiopathic hyperkyphosis with Milwaukee brace." Journal of Back and Musculoskeletal Rehabilitation 29, no. 3 (August 10, 2016): 515–19. http://dx.doi.org/10.3233/bmr-150651.

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Vosse, D. "Determinants of hyperkyphosis in patients with ankylosing spondylitis." Annals of the Rheumatic Diseases 65, no. 6 (June 1, 2006): 770–74. http://dx.doi.org/10.1136/ard.2005.044081.

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NADIA A. FAYAZ, Ph.D., EMAN M. A. TANTAWY, M. Sc ;., and KARIMA A. HASSAN, Ph D. ;. AHMED H.E. AZZAM, Ph.D. "Relationship between Mechanical Neck Pain and Dorsal Hyperkyphosis." Medical Journal of Cairo University 86, no. 6 (June 1, 2018): 1099. http://dx.doi.org/10.21608/mjcu.2018.56123.

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Carlson, J. Martin. "Clinical Biomechanics of Orthotic Treatment of Thoracic Hyperkyphosis." JPO Journal of Prosthetics and Orthotics 15, SUPPLEMENT (October 2003): S31—S35. http://dx.doi.org/10.1097/00008526-200310001-00005.

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Katzman, Wendy B., Linda Wanek, John A. Shepherd, and Deborah E. Sellmeyer. "Age-Related Hyperkyphosis: Its Causes, Consequences, and Management." Journal of Orthopaedic & Sports Physical Therapy 40, no. 6 (June 2010): 352–60. http://dx.doi.org/10.2519/jospt.2010.3099.

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Obeid, Ibrahim, Bassel G. Diebo, Louis Boissiere, Anouar Bourghli, Derek T. Cawley, Daniel Larrieu, Vincent Pointillart, Vincent Challier, Jean Marc Vital, and Virginie Lafage. "Single Level Proximal Thoracic Pedicle Subtraction Osteotomy for Fixed Hyperkyphotic Deformity: Surgical Technique and Patient Series." Operative Neurosurgery 14, no. 5 (July 22, 2017): 515–23. http://dx.doi.org/10.1093/ons/opx158.

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Abstract BACKGROUND Thoracic hyperkyphosis can display pathological deterioration, resulting in either hyperlordotic cervical compensation or sagittal malalignment. Various techniques have been described to treat fixed malalignment. Pedicle subtraction osteotomy (PSO) is commonly used in the lumbar spine and frequently limited to the distal thoracic spine. This series focuses on the surgical specificities of proximal thoracic PSO, with clinical and radiological outcomes. OBJECTIVE To report the surgical specificities and assess the clinical and radiological outcomes of proximal thoracic osteotomies for correction of rigid kyphotic deformities. METHODS This is a retrospective review of 10 consecutive patients who underwent single level proximal thoracic PSO (T2-T5). Preoperative and postoperative full-body EOSTM radiographs, perioperative data, and complications were recorded. The surgical technique and its nuances were described in detail. RESULTS Patients had mean age of 41.8 yr and 50% were female. The technique provided correction of segmental and global kyphosis, 26.6° and 29.5°, respectively. Patients reported reciprocal reduction in C2-C7 cervical lordosis (37.6°-18.6°, P < .001), significantly correlating with the reduction of thoracic hyperkyphosis (R = 0.840, P = .002). Mean operative time was 291 min, blood loss 1650 mL, and mean hospital stay was 13.8 d. Three patients reported complications that were resolved, including 1 patient who was revised because of a painful cross link. There were no neurological complications, pseudarthroses, instrumentation breakage, or wound infections at a minimum of 2-yr follow-up. CONCLUSION Proximal thoracic PSO can be a safe and effective technique to treat fixed proximal thoracic hyperkyphosis leading to kyphosis reduction and craniocervical relaxation.

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Barcelos, Alecio Cristino Evangelista Santos, Sterphany Ohana Soares Azevedo Pinto, Thaise Ellen de Moura Agra Teixeira, and Rayana Ellen Fernandes Nicolau. "Four-rod Technique Stabilization after Pedicle Subtraction Osteotomy (PSO) for the Treatment of Thoracolumbar Hyperkyphosis Secondary to Pott Disease: A Two-Year Follow-Up Case Report." Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 38, no. 03 (August 2, 2019): 219–26. http://dx.doi.org/10.1055/s-0039-1693723.

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AbstractPedicle subtraction osteotomy (PSO) is a powerful tool for the management of sagittal misalignment. However, this procedure has a high rate of implant failure, particularly rod breakages. The four-rod technique diminishes this complication in the lumbar spine. The aim of the present study is to provide a case report regarding PSO and four-rod technique stabilization in the treatment of short-angle hyperkyphosis in the thoracolumbar (TL) junction. The authors describe the case of a patient with TL hyperkyphosis secondary to spinal tuberculosis treated with L1 PSO and fixation with a four-rod technique. There were no major surgical complications. The self-reported quality of life questionnaires (the Short-Form Health Survey 36 [SF-36] and the Oswestry disability index) and radiological parameters were assessed preoperatively, as well as 6, 12 and 24 months after surgery, and they showed considerable and sustained improvements in pain control and quality of life. No hardware failure was observed at the two-year follow-up.

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Senthil, P., S. Sudhakar, R. Radhakrishnan, and S. Jeyakumar. "Efficacy of corrective exercise strategy in subjects with hyperkyphosis." Journal of Back and Musculoskeletal Rehabilitation 30, no. 6 (November 6, 2017): 1285–89. http://dx.doi.org/10.3233/bmr-169668.

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Whitaker, Camden, Perry L. Schoenecker, and Lawrence G. Lenke. "Hyperkyphosis As an Indicator of Syringomyelia in Idiopathic Scoliosis." Spine 28, no. 1 (January 2003): E16—E20. http://dx.doi.org/10.1097/00007632-200301010-00027.

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Ferris, Abbie E., Man-Ying Wang, Shiu-Ling Chiu, Michelle Nadalin, Emanuel Ramirez, Gale A. Greendale, and Groege J. Salem. "Tri-planar Lumbopelvic Motion of Older Adults with Hyperkyphosis." Medicine & Science in Sports & Exercise 39, Supplement (May 2007): S6. http://dx.doi.org/10.1249/01.mss.0000272892.07629.c6.

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Charles, Yann Philippe, Sébastien Schuller, Gergi Sfeir, and Jean-Paul Steib. "Vertebral column resection for thoracic hyperkyphosis in Pott’s disease." European Spine Journal 23, no. 3 (February 19, 2014): 708–10. http://dx.doi.org/10.1007/s00586-014-3225-y.

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Cejudo, Antonio, Sebastián Gómez-Lozano, Pilar Sainz de Baranda, Alfonso Vargas-Macías, and Fernando Santonja-Medina. "Sagittal Integral Morphotype of Female Classical Ballet Dancers and Predictors of Sciatica and Low Back Pain." International Journal of Environmental Research and Public Health 18, no. 9 (May 10, 2021): 5039. http://dx.doi.org/10.3390/ijerph18095039.

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The aims of this study were to describe the sagittal integral morphotype (SIM) of classical ballet (CB) dancers, and to establish predictor factors and their cut off values for high risk of experiencing sciatica or low back pain (LBP). This retrospective cohort study was performed in 33 female professional CB dancers. Data related to anthropometric parameters, CB dance experience, sciatica or LBP history, and sagittal spine curvatures were collected. A binary logistic regression and receiver-operating characteristic analysis were performed. The main spine misalignments observed in the SIM of CB dancers were thoracic functional hyperkyphosis, hypomobile kyphosis, and hypokyphosis, and those for the lumbar curvature were hyperlordotic attitude and functional hyperkyphosis. The lumbar curvature in slump sitting and trunk forward bending positions, together with the stature, were significant predictor factors of sciatica history, while the years of dance experience was a significant predictor factor of LBP history. The cut off values analysis revealed that dancers with a stature of 161 cm or less, and those with 14 years of experience or more, have a greater probability of experiencing sciatica or LBP history, respectively.

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Katzman, Wendy B., Eric Vittinghoff, Deborah M. Kado, Anne L. Schafer, Shirley S. Wong, Amy Gladin, and Nancy E. Lane. "Study of Hyperkyphosis, Exercise and Function (SHEAF) Protocol of a Randomized Controlled Trial of Multimodal Spine-Strengthening Exercise in Older Adults With Hyperkyphosis." Physical Therapy 96, no. 3 (March 1, 2016): 371–81. http://dx.doi.org/10.2522/ptj.20150171.

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Background Hyperkyphosis negatively affects health status, physical mobility, and quality of life, but there is no standard protocol for treating people with hyperkyphosis. Treatment options include targeted exercise. Objectives This single-site randomized controlled trial (RCT) will determine the efficacy of a targeted multimodal spine-strengthening exercise program, compared with no exercise intervention, among community-dwelling men and women aged ≥60 years. Design The RCT is a parallel-group design, with 1:1 randomization to exercise and attentional control groups. Setting The study will be conducted at one primary site (one academic medical center partnered with one local community medical center). Participants One hundred men and women, aged ≥60 years, with thoracic kyphosis ≥40 degrees will be randomized. Intervention The targeted multimodal spine-strengthening exercise intervention includes exercise and postural training delivered by a physical therapist in a group of 10 participants, 3 times a week for 6 months. Controls receive monthly health education meetings in a group of 10 participants and monthly calls from the study coordinator to monitor physical activity and any adverse events. Measurements The primary outcome is change in Cobb angle of kyphosis measured from lateral spine radiographs at baseline and 6 months. Secondary outcomes include change in physical function (assessed with the modified Physical Performance Test, Timed “Up & Go” Test, timed loaded standing, 4-m walk, and Six-Minute Walk Test) and health-related quality of life (assessed with the modified Scoliosis Research Society instrument [SRS-30] self-image domain and Patient Reported Outcomes Measurement Information System [PROMIS] global health and physical function indexes). Additional secondary outcomes include pain, physical activity level, spinal flexion and extension muscle strength, paraspinal extensor muscle density, and adverse events. Limitations Blinding of the participants and instructors providing the intervention is not possible. Conclusions The efficacy of a high-quality, adequately powered exercise intervention in men and women with kyphosis ≥40 degrees will be evaluated to determine whether targeted multimodal spine-strengthening exercise reduces hyperkyphosis in older adults and improves important secondary outcomes of physical function and health-related quality of life.

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Brubaker, Morgan L., and Mehrsheed Sinaki. "Successful management of iliocostal impingement syndrome: A case series." Prosthetics and Orthotics International 40, no. 3 (November 2, 2015): 384–87. http://dx.doi.org/10.1177/0309364615605394.

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Background: Iliocostal impingement syndrome is a rare, painful, and disabling condition associated with thoracic hyperkyphosis and kyphoscoliosis. There is little published literature regarding management of this syndrome. The purpose of this case series is to report treatment outcomes for iliocostal impingement syndrome with improving posture and back muscle strength. Case Description and Methods: Thirty-eight women with thoracic hyperkyphosis or kyphoscoliosis and back and/or flank pain were diagnosed with iliocostal impingement syndrome on the basis of symptoms and spine radiographs. They were instructed in weighted kypho-orthosis use and taught a home back-extensor strengthening program. Outcome measures included posture evaluation and pain level. Findings and Outcomes: All patients reported immediate pain reduction with weighted kypho-orthosis trial. Nineteen patients returned within 2 years, and all had continued pain relief and posture improvement. Conclusions: Our findings suggest that successful management of iliocostal impingement syndrome is possible with a weighted kypho-orthosis and back strengthening program focusing on posture improvement. Clinical relevance Iliocostal syndrome is a rare, painful, and disabling condition that severely affects quality of life. This report discusses our diagnostic and treatment approach to this syndrome, which has proven successful in our patient population.

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Kado, Deborah M. "Hyperkyphosis Predicts Mortality Independent of Vertebral Osteoporosis in Older Women." Annals of Internal Medicine 150, no. 10 (May 19, 2009): 681. http://dx.doi.org/10.7326/0003-4819-150-10-200905190-00005.

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Greendale, Gail A., Anna McDivit, Annie Carpenter, Leanne Seeger, and Mei-Hua Huang. "Yoga for Women With Hyperkyphosis: Results of a Pilot Study." American Journal of Public Health 92, no. 10 (October 2002): 1611–14. http://dx.doi.org/10.2105/ajph.92.10.1611.

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VASA1, S. "Surgical correction of hyperkyphosis: new etiology for acute biliary obstruction." American Journal of Gastroenterology 96, no. 9 (September 2001): S252—S253. http://dx.doi.org/10.1016/s0002-9270(01)03586-9.

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MOON, MARY ANN. "Young Elite Cross-Country Skiers Found at Risk for Hyperkyphosis." Pediatric News 40, no. 10 (October 2006): 54. http://dx.doi.org/10.1016/s0031-398x(06)71419-9.

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Kelley, Samuel W. "Hyperkyphosis in Longnose Gar (Lepisosteus osseus) of North Central Texas." Western North American Naturalist 71, no. 1 (April 2011): 121–26. http://dx.doi.org/10.3398/064.071.0118.

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Kado, Deborah M. "Is hyperkyphosis associated with increased mortality in the elderly population?" Aging Health 5, no. 6 (December 2009): 727–28. http://dx.doi.org/10.2217/ahe.09.61.

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Sun, Edward, Ron Alkalay, David Vader, and Brian D. Snyder. "Preventing Distal Pullout of Posterior Spine Instrumentation in Thoracic Hyperkyphosis." Journal of Spinal Disorders & Techniques 22, no. 4 (June 2009): 270–77. http://dx.doi.org/10.1097/bsd.0b013e31816a6887.

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NISSINEN, MAUNU, MARKKU HELIÖVAARA, JORMA SEITSAMO, and MIKKO POUSSA. "Left Handedness and Risk of Thoracic Hyperkyphosis in Prepubertal Schoolchildren." International Journal of Epidemiology 24, no. 6 (1995): 1178–81. http://dx.doi.org/10.1093/ije/24.6.1178.

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