Kyphoscoliosis: Thoracic Cage Deformity

• The thoracic cage, which includes the ribs, sternum, and thoracic spine, is vital for respiration and organ protection
• Presentation focuses on Kyphoscoliosis, Flail Chest, and Ankylosing Spondylitis, conditions affecting the thoracic cage
• Scoliosis affects 2-3% of the US population under 16 years old

Kyphoscoliosis: Definition and Causes

• Kyphoscoliosis is a spinal deformity combining kyphosis (outward curvature) and scoliosis (lateral curvature)
• Results in a three-dimensional deformity causing functional and cosmetic issues

Kyphoscoliosis: Causes

• Congenital vertebral anomalies
• Neuromuscular conditions like cerebral palsy and muscular dystrophy
• Connective tissue disorders such as Marfan syndrome
• Idiopathic, or unknown causes

Kyphoscoliosis: Symptoms and Diagnosis

• Symptoms include visible spinal deformity, back pain, breathing difficulties, fatigue, and potential neurological symptoms like leg weakness

Kyphoscoliosis: Diagnosis

• Diagnosis involves physical exams like the Adam's forward bend test
• X-rays measure the Cobb angle for spinal curvature
• Pulmonary function tests and MRI assess spinal cord involvement
• A Cobb angle >10 degrees defines scoliosis, and >40 degrees defines kyphosis.

Kyphoscoliosis Treatment: Non-Surgical

• Observation and bracing are used for growing children with moderate curves
• Physical therapy strengthens back muscles and improves posture

Kyphoscoliosis Treatment: Surgical

• Spinal fusion surgery is for severe curves (>45-50 degrees Cobb angle) or progressing curves despite bracing

Flail Chest: Definition and Causes

• Flail chest is a life-threatening condition with multiple rib fractures (typically ≥3 ribs in ≥2 places) causing paradoxical chest wall movement during respiration

Flail Chest: Causes

• Primary causes are blunt trauma, such as vehicle accidents, falls, or direct blows

Flail Chest: Symptoms and Treatment

• Symptoms include severe chest pain, shortness of breath, paradoxical chest wall movement, and potential lung contusion or pneumothorax
• Treatment involves pain management, oxygen therapy, mechanical ventilation, and surgical fixation of rib fractures

Ankylosing Spondylitis: Definition and Impact

• Ankylosing Spondylitis is a chronic inflammatory disorder affecting the spine, causing inflammation of vertebrae and sacroiliac joints, potentially leading to spinal fusion (ankylosis)
• Results in reduced spinal mobility, chronic back pain, fatigue, and potential involvement of other organs

Ankylosing Spondylitis:

• The progressive nature of AS can lead to disability and reduced quality of life
• Prevalence affects 0.1-1% of the population, with higher rates in certain ethnic groups like Native Americans

Ankylosing Spondylitis: Management: Non-Pharmacological

• Physical therapy, exercise, and smoking cessation are important

Ankylosing Spondylitis: Management: Pharmacological

• NSAIDs, TNF inhibitors (etanercept, infliximab), and IL-17 inhibitors (secukinumab) are common medications
• TNF inhibitors reduce disease activity scores (BASDAI) by an average of 50% in responsive patients