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Lawrence G Lenke - One of the best experts on this subject based on the ideXlab platform.
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progressive spinal Kyphosis in the aging population
Neurosurgery, 2015Co-Authors: Tamir Ailon, Lawrence G Lenke, Christopher I Shaffrey, James S Harrop, Justin S SmithAbstract:Thoracic Kyphosis tends to increase with age. HyperKyphosis is defined as excessive curvature of the thoracic spine and may be associated with adverse health effects. HyperKyphosis in isolation or as a component of degenerative kyphoscoliosis has important implications for the surgical management of adult spinal deformity. Our objective was to review the literature on the epidemiology, etiology, natural history, management, and outcomes of thoracic hyperKyphosis. We performed a narrative review of literature on thoracic hyperKyphosis and its implications for adult spinal deformity surgery. HyperKyphosis has a prevalence of 20% to 40% and is more common in the geriatric population. The cause is multifactorial and involves an interaction between degenerative changes, vertebral compression fractures, muscular weakness, and altered biomechanics. It may be associated with adverse health consequences including impaired physical function, pain and disability, impaired pulmonary function, and increased mortality. Nonoperative management may slow the progression of Kyphosis and improve function. Surgery is rarely performed for isolated hyperKyphosis in the elderly due to the associated risk, but is an option when Kyphosis occurs in the context of significant deformity. In this scenario, increased thoracic Kyphosis influences selection of fusion levels and overall surgical planning. Kyphosis is common in older individuals and is associated with adverse health effects and increased mortality. Current evidence suggests a role for nonoperative therapies in reducing Kyphosis and delaying its progression. Isolated hyperKyphosis in the elderly is rarely treated surgically; however, increased thoracic Kyphosis as a component of global spinal deformity has important implications for patient selection and operative planning.
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sternum into abdomen deformity with abdominal compression following osteoporotic vertebral compression fractures managed by 2 level vertebral column resection and reconstruction
Spine, 2015Co-Authors: R Krishnakumar, Lawrence G LenkeAbstract:Study Design. A unique case report. Objective. To report a case of severe thoracolumbar Kyphosis with abdominal compression causing gastric disturbance after treatment of an osteoporotic vertebral compression fracture and its ultimate management by vertebral column resection (VCR). We propose a new terminology “sternum-into-abdomen deformity” to describe this condition. Summary of Background Data. Management of osteoporotic vertebral compression fractures mainly aims at pain control and deformity reduction. VCR for decreasing abdominal compression due to the development of severe Kyphosis after treatment of osteoporotic compression fractures has never been reported in the literature to our knowledge. Methods. This is a case report on a single patient. The hospital and office charts were reviewed. Reports of prior treatment of his compression fracture were analyzed. Results. This 73-year-old cachectic patient underwent vertebroplasty for a midthoracic compression fracture with progressive, severe Kyphosis. His condition worsened and spinal reconstruction with a 2-level VCR restored more normal sagittal alignment and decreased his gastric compression. His back pain decreased and his ability to tolerate oral intake returned. Conclusion. We propose the term “sternum-into-abdomen deformity” to describe this type of severe Kyphosis with abdominal compression. Treatment with a VCR and fusion for realignment of focal Kyphosis can improve the quality of life for patients with this condition. Conclusion. Level of Evidence: 5
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can intraoperative spinal cord monitoring reliably help prevent paraplegia during posterior vertebral column resection surgery
Spine deformity, 2015Co-Authors: Samuel K Cho, Woo-jin Cho, Lawrence G Lenke, Shelly M Bolon, Joshua M Pahys, Matthew M Kang, Lukas P Zebala, Linda A KoesterAbstract:Abstract Study Design Retrospective case series. Objective Analyze patients who underwent posterior vertebral column resection (PVCR) above the conus medullaris with intraoperative spinal cord monitoring (SCM) data loss. Summary of Background Data PVCR is a powerful technique for treating severe spinal deformity but carries a high risk for major spinal cord deficits. Methods We assessed clinical, radiographic, and electrophysiologic monitoring and operative records of 90 consecutive adult and pediatric patients (mean age, 24.8 years; range, 7.5–76.8) who underwent PVCR above the conus medullaris for severe spinal deformity performed from 2002 to 2010 by one surgeon at one institution. Results Fifteen of 90 patients (16.7%) (10 male/5 female; mean age, 15 years) lost SCM (n = 13) or had data degradation meeting warning criteria (n = 2). Diagnoses were kyphoscoliosis (n = 8), angular Kyphosis (n = 3), global Kyphosis (n = 2), and severe scoliosis (n = 2). Seven were revisions. The average pre-/postoperative scolioses were 99° (range, 32°–152°) and 43° (range, 6°–76°), respectively. The average pre-/postoperative kyphoses were +100° (range, 60°–170°) and +54° (range, 28°–100°), respectively. SCM fluctuated during osteotomy on nine occasions, stabilizing with elevation of blood pressure in addition to anterior spinal cord decompression in four, correction of subluxation in one, and traction reduction in one. Seven patients had SCM changes during rod compression. Three required partial release of correction, two larger cage insertion, one subluxation correction, and one pedicle screw removal. One experienced changes during rod placement/removal, and another, as a result of hypothermia. Data returned in all after prompt intervention (mean, 10.1 minutes; range, 1–60) and all awoke with intact lower extremity function. Conclusion The prevalence of SCM changes during PVCR above the conus medullaris was 16.7%, mostly during osteotomy and rod/screw compression. Data returned with prompt intervention and all had intact lower extremity motor function postoperatively. These SCM “saves” strongly emphasize the importance of multimodality neurophysiologic monitoring during high-risk cases, minimizing postoperative complications.
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rapidly progressive scheuermann s disease in an adolescent after pectus bar placement treated with posterior vertebral column resection case report and review of the literature
Spine, 2013Co-Authors: Patrick A Sugrue, Brian A Oʼshaughnessy, Kathy Blanke, Lawrence G LenkeAbstract:STUDY DESIGN Case report and review of the literature. OBJECTIVE This case illustrates the importance of the costosternal complex in maintaining the stability and alignment of the thoracic spine. The patient was iatrogenically destabilized by placement of a pectus bar leading to rapid symptomatic progression of his Scheuermann's Kyphosis, ultimately requiring surgical correction. SUMMARY OF BACKGROUND DATA Scheuermann's Kyphosis is a disease process defined by strict radiographical and clinical criteria. Surgical treatment is generally recommended for curves greater than 75°. This case demonstrates the critical role of the costosternal complex in maintaining the stability of the thoracic spine. The patient described in this report underwent placement of a pectus bar for correction of symptomatic pectus excavatum. He subsequently developed a progressive symptomatic Scheuermann's Kyphosis as a result of the destabilization of his costosternal complex. This patient ultimately required removal of the pectus bar and posterior instrumented Kyphosis correction. METHODS Progressive symptomatic Scheuermann's Kyphosis (105°) corrected by removal of the pectus bar, T11 posterior vertebral-column resection and T4-L3 instrumented posterior spinal fusion. RESULTS The patient had an uneventful immediate postoperative course. He was discharged neurologically intact with dramatic Kyphosis correction and significant symptomatic improvement. Radiographs obtained 3 years postoperatively reveal stable thoracolumbar correction. CONCLUSION The costosternal complex plays a critically important role in the intrinsic stability of the thoracic spine. Iatrogenic disruption of the costosternal complex can result in rapid progression of thoracic/thoracolumbar Kyphosis in the setting of Scheuermann's disease.
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restoration of thoracic Kyphosis after operative treatment of adolescent idiopathic scoliosis a multicenter comparison of three surgical approaches
Spine, 2008Co-Authors: Daniel J Sucato, Thomas G Lowe, Sundeep Agrawal, Michael F Obrien, Stephens B Richards, Lawrence G LenkeAbstract:STUDY DESIGN Multicenter analysis of 3 groups of patients who underwent surgical treatment for adolescent idiopathic scoliosis (AIS). OBJECTIVE.: To evaluate 3 surgical approaches to determine the modality that has the greatest influence on improving thoracic Kyphosis. SUMMARY OF BACKGROUND DATA AIS is characterized by thoracic hypoKyphosis which may be restored to normal to varying degrees with surgery. METHODS A multicenter retrospective AIS surgical database was reviewed. Patients with only a structural main thoracic curve (Lenke 1, 2, or 3), and instrumentation of only the main thoracic curve were included. Lateral radiographs were analyzed to determine sagittal plane measurements before surgery, after surgery at 6 to 8 weeks, 1 year, and 2 years. The 3 groups were compared and statistical significance was defined as P < 0.05. RESULTS Three groups were analyzed: (1) ASF group (n = 135), Anterior spinal fusion and instrumentation, (2) PSF-Hybrid group (n = 86), PSF with proximal hooks, +/- apical wires and distal pedicle screws, and 3) PSF-Hooks group (n = 132), PSF with only hooks. All groups had similar preoperative coronal main thoracic curve magnitudes (ASF: 50.6 degrees , PSF-Hybrid: 49.1 degrees , PSF-Hooks: 52.0 degrees ) and thoracic Kyphosis (ASF: 23.7 degrees , PSF-Hybrid: 19.3 degrees , PSF-Hooks: 21.9 degrees ). After surgery, the T5-T12 Kyphosis was greater in the ASF group (25.1 degrees ) compared with PSF-Hooks (19.0 degrees ) and PSF-Hybrid (18.5 degrees (P < 0.05). At 1 year, thoracic Kyphosis (T5-T12) remained greater in the ASF group (28.8 degrees ) compared with PSF-Hooks (22.6 degrees ) and PSF-Hybrid (20.2 degrees ) (P < 0.05), and was also greater at 2 years (29.9 degrees vs. 23.8.8 degrees and 19.7 degrees ) (P < 0.05). Kyphosis at the thoracolumbar junction was not seen in the PSF-Hybrid group. Lumbar lordosis increased only in the ASF group in response to the increase in thoracic Kyphosis. CONCLUSION ASFI is the best method to restore thoracic Kyphosis when compared with posterior approaches using only hooks or a hybrid construct in the treatment of thoracic adolescent idiopathic scoliosis.
Chun Kee Chung - One of the best experts on this subject based on the ideXlab platform.
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posterior only versus combined anterior posterior fusion in scheuermann disease a systematic review and meta analysis
Journal of Neurosurgery, 2020Co-Authors: Chang Hyun Lee, Young Ii Won, Seung Heon Yang, Chi Heon Kim, Sung Bae Park, Chun Kee ChungAbstract:OBJECTIVE Combined anterior-posterior (AP) surgery is considered the gold standard for surgical treatment of Scheuermann Kyphosis. There are trends toward posterior-only (PO) surgery for correcting this deformity because of the availability of multisegmental compression instruments and posterior shortening osteotomy. To date, surgical strategies for Scheuermann Kyphosis remain controversial. The purpose of this study was to compare various surgical approaches for the treatment of Scheuermann Kyphosis, including radiological correction and intraoperative outcomes, using a systematic review and meta-analysis. METHODS A comprehensive database search of PubMed, EMBASE, Web of Science, and Cochrane Library was performed to identify studies concerning Scheuermann Kyphosis. The inclusion criteria were direct comparisons between AP and PO surgeries for Scheuermann Kyphosis and assessment of the angle of thoracic Kyphosis preoperatively and postoperatively. The authors used the principles of a cumulative meta-analysis by updating the pooled estimate of the treatment effect. RESULTS Data from 13 studies involving 1147 participants (542 patients in the AP group and 605 patients in the PO group) were included. The average age was 18.2 years for the AP and 17.9 years for the PO group. The overall mean difference of changes in thoracic Kyphosis angles between the AP and PO surgeries was 0.23° (95% CI -2.24° to 2.71°). In studies in which posterior shortening osteotomies were not performed, PO surgery resulted in a significantly low degree of correction of thoracic Kyphosis, with a mean difference of 5.59° (95% CI 0.34°-10.83°). Studies in which osteotomies were performed revealed that the angle of correction for PO surgery was comparable to that of AP surgery. Regardless of fixation methods, PO surgical approaches achieved comparable angles. CONCLUSIONS PO surgery using posterior osteotomies can achieve correction of Scheuermann Kyphosis as successfully as AP surgery does. Reflecting the advancement of surgical technology, large prospective studies are necessary to identify the proper treatments for Scheuermann Kyphosis.
Mary L Bouxsein - One of the best experts on this subject based on the ideXlab platform.
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the effect of thoracic Kyphosis and sagittal plane alignment on vertebral compressive loading
Journal of Bone and Mineral Research, 2012Co-Authors: Alexander G Bruno, Dennis E Anderson, John Dagostino, Mary L BouxseinAbstract:To better understand the biomechanical mechanisms underlying the association between hyperKyphosis of the thoracic spine and risk of vertebral fracture and other degenerative spinal pathology, we used a previously validated musculoskeletal model of the spine to determine how thoracic Kyphosis angle and spinal posture affect vertebral compressive loading. We simulated an age-related increase in thoracic Kyphosis (T1-T12 Cobb angle 50° to 75°) during two different activities (relaxed standing and standing with 5 kg weights in the hands) and three different posture conditions: 1) an increase in thoracic Kyphosis with no postural adjustment (uncompensated posture), 2) an increase in thoracic Kyphosis with a concomitant increase in pelvic tilt that maintains a stable center of mass and horizontal eye gaze (compensated posture), and 3) an increase in thoracic Kyphosis with a concomitant increase in lumbar lordosis that also maintains a stable center of mass and horizontal eye gaze (congruent posture). For all posture conditions, compressive loading increased with increasing thoracic Kyphosis, with loading increasing more in the thoracolumbar and lumbar regions than in the mid-thoracic region. Loading increased the most for the uncompensated posture, followed by the compensated posture, with the congruent posture almost completely mitigating any increases in loading with increased thoracic Kyphosis. These findings indicate that thoracic Kyphosis and spinal posture both influence vertebral loading during daily activities, implying that thoracic Kyphosis measurements alone are not sufficient to characterize the impact of spinal curvature on vertebral loading.
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the effect of thoracic Kyphosis and sagittal plane alignment on vertebral compressive loading
Journal of Bone and Mineral Research, 2012Co-Authors: Alexander G Bruno, Dennis E Anderson, John Dagostino, Mary L BouxseinAbstract:To better understand the biomechanical mechanisms underlying the association between hyperKyphosis of the thoracic spine and risk of vertebral fracture and other degenerative spinal pathology, we used a previously validated musculoskeletal model of the spine to determine how thoracic Kyphosis angle and spinal posture affect vertebral compressive loading. We simulated an age-related increase in thoracic Kyphosis (T(1) -T(12) Cobb angle 50-75 degrees) during two different activities (relaxed standing and standing with 5-kg weights in the hands) and three different posture conditions: (1) an increase in thoracic Kyphosis with no postural adjustment (uncompensated posture); (2) an increase in thoracic Kyphosis with a concomitant increase in pelvic tilt that maintains a stable center of mass and horizontal eye gaze (compensated posture); and (3) an increase in thoracic Kyphosis with a concomitant increase in lumbar lordosis that also maintains a stable center of mass and horizontal eye gaze (congruent posture). For all posture conditions, compressive loading increased with increasing thoracic Kyphosis, with loading increasing more in the thoracolumbar and lumbar regions than in the mid-thoracic region. Loading increased the most for the uncompensated posture, followed by the compensated posture, with the congruent posture almost completely mitigating any increases in loading with increased thoracic Kyphosis. These findings indicate that both thoracic Kyphosis and spinal posture influence vertebral loading during daily activities, implying that thoracic Kyphosis measurements alone are not sufficient to characterize the impact of spinal curvature on vertebral loading.
Amanda L Lorbergs - One of the best experts on this subject based on the ideXlab platform.
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a longitudinal study of trunk muscle properties and severity of thoracic Kyphosis in women and men the framingham study
Journals of Gerontology Series A-biological Sciences and Medical Sciences, 2019Co-Authors: Douglas P Kiel, Amanda L Lorbergs, Adrienne L Cupples, Brett T Allaire, Laiji Yang, Mohamed Jarraya, Ali GuermaziAbstract:BACKGROUND Cross-sectional studies suggest that trunk muscle morphology in the lumbar spine is an important determinant of Kyphosis severity in older adults. The contribution of age-related changes in muscle morphology in the thoracic and lumbar spine to progression of Kyphosis is not known. Our objective was to determine cross-sectional and longitudinal associations of thoracic and lumbar muscle size and density with Kyphosis. METHODS Participants were 1,087 women and men (mean age: 61 years) of the Framingham Heart Study who underwent baseline and follow-up quantitative computed tomography (QCT) scanning 6 years apart. We used QCT scans to measure trunk muscle cross-sectional area (CSA, cm2) and density (HU) at the thoracic and lumbar spine and Cobb angle (degrees) from T4 to T12. Linear regression models estimated the association between muscle morphology and Kyphosis. RESULTS At baseline, smaller muscle CSA and lower density of thoracic (but not lumbar) spine muscles were associated with a larger (worse) Cobb angle in women and men. For example, each standard deviation decrease in baseline thoracic paraspinal muscle CSA was associated with a larger baseline Cobb angle in women (3.7 degrees, 95% CI: 2.9, 4.5) and men (2.5 degrees, 95% CI: 1.6, 3.3). Longitudinal analyses showed that loss of muscle CSA and density at the thoracic and lumbar spine was not associated with progression of Kyphosis. CONCLUSIONS Our findings suggest that Kyphosis severity is related to smaller and lower density trunk muscles at the thoracic spine. Future studies are needed to determine how strengthening mid-back musculature alters muscle properties and contributes to preventing Kyphosis progression.
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thoracic Kyphosis and physical function the framingham study
Journal of the American Geriatrics Society, 2017Co-Authors: Douglas P Kiel, Amanda L Lorbergs, Brett T Allaire, Laiji Yang, Mohamed Jarraya, Ali Guermazi, Joanne M Murabito, Adrienne L CupplesAbstract:Objective To evaluate the association between thoracic Kyphosis and physical function. Design Prospective cohort. Setting Framingham, Massachusetts. Participants Framingham Heart Study Offspring and Third Generation cohort members who had computed tomography (CT) performed between 2002 and 2005 and physical function assessed a mean 3.4 years later (N = 1,100; mean age 61 ± 8, range 50–85). Measurements Thoracic Kyphosis (Cobb angle, T4-T12) was measured in degrees using supine CT scout images. Participants were categorized according to Cobb angle to compare those in the highest quartile (Q4, most-severe Kyphosis) with those in the lowest quartiles (Q1-Q3). Quick walking speed (m/s), chair-stand time (seconds), grip strength (kg), and self-reported impairments were assessed using standardized procedures. Analyses were adjusted for age, height, weight, smoking, follow-up time, vertebral fractures, and prevalent spinal degeneration. Results Thoracic Kyphosis was not associated with physical function in women or men, and these results were consistent in those younger than 65 and those aged 65 and older. For example, walking speed was similar in adults younger than 65 with and without severe Kyphosis (women, Q4: 1.38 m/s, Q1-Q3: 1.40 m/s, P = .69; men, Q4: 1.65 m/s, Q1-Q3: 1.60 m/s; P = .39). Conclusion In healthy relatively high-functioning women and men, Kyphosis severity was not associated with subsequent physical function. Individuals at risk of functional decline cannot be targeted based on supine CT thoracic curvature measures alone.
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severity of Kyphosis and decline in lung function the framingham study
Journals of Gerontology Series A-biological Sciences and Medical Sciences, 2016Co-Authors: Douglas P Kiel, Amanda L Lorbergs, George T Oconnor, Yanhua Zhou, Thomas G Travison, Adrienne L CupplesAbstract:Background HyperKyphosis reduces the amount of space in the chest, mobility of the rib cage, and expansion of the lungs. Decline in pulmonary function may be greater in persons with more severe Kyphosis; however, no prospective studies have assessed this association. We conducted a longitudinal study to quantify the impact of Kyphosis severity on decline in pulmonary function over 16 years in women and men. Methods Participants included a convenience sample of 193 women and 82 men in the Framingham Study original cohort (mean age: 63 years; range: 50-79 years), who had measurements of Kyphosis angle from lateral spine radiographs obtained in 1972-1976 and forced expiratory volume in 1 second (FEV1) from spirometry taken four times over 16 (±1.87) years from 1972 through 1988. Results Kyphosis severity was associated with greater decline in FEV1 in women but not in men. Adjusted mean change in FEV1 over 16 years was -162, -245, and -261mL (trend, p = .02) with increasing tertile of Kyphosis angle in women and -372, -297, and -257mL (trend, p = .20) in men, respectively. Conclusions This longitudinal study found that Kyphosis severity increased subsequent decline in pulmonary function in women but not in men. Reasons for an association between Kyphosis and pulmonary function in women but in not men may be due, at least in part, to the small number of men in our study. Nevertheless, our findings suggest that preventing or slowing Kyphosis progression may reduce the burden of pulmonary decline in older adults.
Alexander G Bruno - One of the best experts on this subject based on the ideXlab platform.
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the effect of thoracic Kyphosis and sagittal plane alignment on vertebral compressive loading
Journal of Bone and Mineral Research, 2012Co-Authors: Alexander G Bruno, Dennis E Anderson, John Dagostino, Mary L BouxseinAbstract:To better understand the biomechanical mechanisms underlying the association between hyperKyphosis of the thoracic spine and risk of vertebral fracture and other degenerative spinal pathology, we used a previously validated musculoskeletal model of the spine to determine how thoracic Kyphosis angle and spinal posture affect vertebral compressive loading. We simulated an age-related increase in thoracic Kyphosis (T1-T12 Cobb angle 50° to 75°) during two different activities (relaxed standing and standing with 5 kg weights in the hands) and three different posture conditions: 1) an increase in thoracic Kyphosis with no postural adjustment (uncompensated posture), 2) an increase in thoracic Kyphosis with a concomitant increase in pelvic tilt that maintains a stable center of mass and horizontal eye gaze (compensated posture), and 3) an increase in thoracic Kyphosis with a concomitant increase in lumbar lordosis that also maintains a stable center of mass and horizontal eye gaze (congruent posture). For all posture conditions, compressive loading increased with increasing thoracic Kyphosis, with loading increasing more in the thoracolumbar and lumbar regions than in the mid-thoracic region. Loading increased the most for the uncompensated posture, followed by the compensated posture, with the congruent posture almost completely mitigating any increases in loading with increased thoracic Kyphosis. These findings indicate that thoracic Kyphosis and spinal posture both influence vertebral loading during daily activities, implying that thoracic Kyphosis measurements alone are not sufficient to characterize the impact of spinal curvature on vertebral loading.
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the effect of thoracic Kyphosis and sagittal plane alignment on vertebral compressive loading
Journal of Bone and Mineral Research, 2012Co-Authors: Alexander G Bruno, Dennis E Anderson, John Dagostino, Mary L BouxseinAbstract:To better understand the biomechanical mechanisms underlying the association between hyperKyphosis of the thoracic spine and risk of vertebral fracture and other degenerative spinal pathology, we used a previously validated musculoskeletal model of the spine to determine how thoracic Kyphosis angle and spinal posture affect vertebral compressive loading. We simulated an age-related increase in thoracic Kyphosis (T(1) -T(12) Cobb angle 50-75 degrees) during two different activities (relaxed standing and standing with 5-kg weights in the hands) and three different posture conditions: (1) an increase in thoracic Kyphosis with no postural adjustment (uncompensated posture); (2) an increase in thoracic Kyphosis with a concomitant increase in pelvic tilt that maintains a stable center of mass and horizontal eye gaze (compensated posture); and (3) an increase in thoracic Kyphosis with a concomitant increase in lumbar lordosis that also maintains a stable center of mass and horizontal eye gaze (congruent posture). For all posture conditions, compressive loading increased with increasing thoracic Kyphosis, with loading increasing more in the thoracolumbar and lumbar regions than in the mid-thoracic region. Loading increased the most for the uncompensated posture, followed by the compensated posture, with the congruent posture almost completely mitigating any increases in loading with increased thoracic Kyphosis. These findings indicate that both thoracic Kyphosis and spinal posture influence vertebral loading during daily activities, implying that thoracic Kyphosis measurements alone are not sufficient to characterize the impact of spinal curvature on vertebral loading.
