THE POSTURAL DEFORMITIES OF THE SPINE The formation of kyphosis of the spine is explained by the assump tion of an habitual attitude characterized by an increased posterior curvature of the spine. The German term for this postural anomaly is "round back" (runde Rficken). Kyphosis may involve the entire spinal column from the first cervical vertebra down to the sacrum. Such cur vature of the spine is called total kyphosis. This is an exceptionally rare occurrence. I found it only twice in children as a congenital de formity; it was probably the result of deficient amniotic fluid in intra uterine life where the kyphotic position was retained for a long period and, as it were, grew stiff and rigid in its attitude. The deformities of the spine which present pathological kyphosis in the dorsolumbar region arc much more frequent while the cervical part shows the physiological lordosis. This form of kyphosis is most frequently observed during the first and second year in raehitic children (Fig. 63).
Rachitic Ayphosis.—A characteristic symptom of this form of round back is the marked posterior projection of the lumbar portion of the spine. Assuming the sitting posture in bed at too early a period is the main reason in rnehitic children for this marked kyphosis of the lumbar region. Extension of the legs at the knee-joint, and rectangular flexion in the hip force the muscles to contract and to rotate the pelvis back ward in such manner as to decrease the inclination of the sacrum and to change the forward position into a more posterior direction. The lumbar region following the excursion of the sacrum necessarily forms an increased kyphosis. Carrying children on the 'arms aggra vates the disposition to kyphosis. Finally, faulty arrangement of the bed (too many pillows and a soft feather mattress instead of a hard even mattress) may result in an increased kyphosis of the soft rachitic vertebral column.
This rachitie kyphosis becomes especially damaging when children fail to stand and walk at the proper time. At that time the factor is
suppressed which, as described above, has the greatest influence on the development of the physiological lumbar lordosis. This results in of the lumbar region of the spine in the form of an habitual kyphotic curvature.
Very little attention is paid to a rachitic kyphosis. Although the marked degree of kyphosis which is found in children (luring the first and second years disappears later to a great extent, yet much trouble has often resulted from these kyphoses of rachitic origin.
Spitzy observed that rachitic kyphoses very often develop later into scolioses. I have noticed that children with rachitic kyphoses acquired during infancy have developed pronounced round shoulders in their second decade. Similar observations have also been made by other authors.
One must bear in mind the later results of a rachitic kyphosis to realize fully the importance of early treatment.
to kyphotic posture is best observed in infants while in the sitting position. The spinal column of a normal child of six months when seated with hip and knee-joints in rectangular flexion, assumes the position as reproduced in Fig. 5S. Any marked posterior projection of the lumbar portion of the :spine must be looked upon as an inclination to kyphosis and treated accordingly. An incip ient rigidity can more readily he detected when the baby lies on its stomach. Upon grasping the baby by the legs and raising it a little the spinal column, if normal, assumes the most marked lordotic shape pos sible, and presents a picture as reproduced in Fig.
The rigid rachitic kyphosis, however, presents a posterior convex curvature in the dorsolumbar portion of the spine (Fig. 65).
Naturally, treatment in the first place aims at remedying the general rachitic affection. The steps to prevent kyphosis have already been mentioned in the etiology. Rachitie children should sleep on an even, hard mattress and should not be carried on one arm or sit up in their carriages with the knees extended.