Cervical Kyphosis and Disc Herniation in An Adolescent

This is a question asked on CareCure by a mother concerning her daughter cervical spine (Link)

Ant0niaZ:  “Im new to this so please be patient….. 🙂
My 14 year old daughter was diagnosed yesterday with an [U]abnormal kyphosis of the Cspine associated with a posterior disc bulging at C3/C4 and C5/C6 level causing a mild narrowing of the thecal sac[/U]…. the Doctor advised us that [B]she must give-up[/B] all dancing and sport activities….. can some-one please help me comprehen the severity of this so I can find a way to comfort my daughter. She is an active child that all of the sudden she was advised to give-up 10 years of ballet and jazz dance with plans on dance studies and also volleyball that she adores……

Of course things could have been worst…… but only us adults can understand that.
Thank you
:)”

Ant0niaZ,

The thecal sac is the membrane (called dura mater) that covers the spinal cord.  It usually holds the cerebrospinal fluid that surrounds the spinal cord.  When there is spinal canal narrowing or a herniated spinal disc that is bulging into the spinal canal, the bone or disc may impinge on the spinal cord.  Usually, when a radiologist says “mild” narrowing of the thecal sac, this means that something is just indenting it.

I am surprised that the doctor is nixing all dancing and sports activity forever.  Perhaps he or she is just recommending no sports for a period of time until a followup study can be done to ascertain whether the condition is progressive and requires surgery.  The first question that you should ask is whether this condition is progressive.  If it is, then surgery may be necessary.

The levels of the disc hernations (C3/4 and C5/6) are probably what is causing the doctor to be nervous.  The breathing centers of the spinal cord are at C3/4 while C5/6 innervates the biceps and wrist extensors.  So, if the discs were to herniate further and compress the spinal cord at those levels, there may life-threatening loss of function.

I wonder why your daughter has this problem?  Did your daughter have any neck problems as a baby, have a traffic accident involving the neck, have Larsen’s syndrome, Cushing’s syndrome, or diastrophic dysplasia?  Larsen’s is a genetic condition associated with abnormal vertebral development, knee dislocations, and club feet.  Cushing’s syndrome results from excessive cortisol due a pituitary tumor secreting ACTH.  People with diastrophic dysplasia have narrow spinal canals, may have dark intervertebral discs  (suggestive of early degenerative changes) on MRI, and often have exceptionally wide foramen magnum (source)

Does your daughter have low calcium?  Some young athletic women suffer from stress fractures of the spine although these tend to occur in the lumbar and sacral spine.  There has been a rash of stress fractures in women who are specializing in one particular sport, such as running, tennis, gymnastics, basketball, or volleyball.  Women athletes need to cross-train and take 1200-1500 milligrams of calcium and 800 international units of vitamin D3 daily (Source)

Did your daughter have pain or a neurological deficit that prompted the visit with the doctor?  If so, the compression of the spinal cord may have been more significant that it appears on the MRI.  MRI’s are only a snapshot of the structure in one position (usually lying down).  It may be different when the neck is up and supporting the weight of the head.  If your daughter has any of the above predisposing condition to cervical kyphosis, I think that the better part of valor would be for her to find some other activity that that involve less stress of the neck, at least until appropriate corrective actions can be taken.

The cervical spine normally has a lordotic curve, i.e. the curve goes towards the front.  Kyphosis occurs when a vertebral body or disc has been damaged.  The collapse of the damaged disc or vertebra causes a kyphotic curve that is convex towards the back.  In the case of your daughter, she seems to have damage to discs at C3/4 and C5/6, enough so that the discs are actually herniating into the spinal canal and pressing against the spinal cord.

Should surgery be done?  Removing herniated portions of the discs is not difficult.  Likewise, the spine can be fused at C3/4 and C5/6 so that these two levels will not pose any more risk.  However, fusions reduce flexibility of the neck and concentrate movements of the neck on remaining moving joints of the neck.  This may cause more stress and wear on the other vertebral levels.  So, most experienced surgeons are reluctant to fuse unless there is neurological deficits.

In summary, this is a potentially dangerous condition and one that should be taken seriously.  I was surprised that the doctor nixed all dancing and sports, especially since your daughter is considering a career in dance.  On the other hand, the fact that she has a cervical kyphosis and herniations at two levels.  This is not something that should be ignored.  I wonder why your daughter has this condition and tried to suggest a couple of possible reasons  If she has neck pain now, a cervical collar, rest, and re-evaluation after 6 months may be a reasonable approach.

Wise.

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2 Responses to “Cervical Kyphosis and Disc Herniation in An Adolescent”

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