Infantile kyphosis secondary to lumbar hypoplasia: six cases with excessive upright sleeping as a possible cause

Area of Science:

• Pediatric Orthopedics
• Developmental Pediatrics
• Spinal Deformity Research

Background:

• Infantile thoracolumbar kyphosis is a spinal deformity whose etiology is not fully understood.
• Lumbar hypoplasia is a potential contributing factor that may resolve with upright posture development.
• Previous studies have not identified the specific cause of this condition.

Purpose of the Study:

• To investigate the potential role of excessive upright posture during sleep and sitting in the development of infantile thoracolumbar kyphosis.
• To identify etiological factors contributing to this spinal deformity in infants.

Main Methods:

• Retrospective review of infants diagnosed with kyphosis between 2001 and 2005.
• Inclusion criteria: diagnosis before age 3, no syndromic/neuromuscular/congenital kyphosis, and a minimum 2-year follow-up.
• Serial radiographic evaluation to assess kyphotic deformity changes and Cobb angle measurements.

Main Results:

• Six infants diagnosed with thoracolumbar kyphosis (average age 7 months) were identified.
• All presented with marked kyphosis, vertebral wedging/scalloping, and pseudosubluxation; initial average Cobb angle was 30°.
• Following correction of sleeping/sitting habits, all patients achieved normal sagittal alignment (average Cobb angle 1.3°).

Conclusions:

• Excessive time spent in upright posture while sleeping and sitting may be a significant factor in the etiology of infantile thoracolumbar kyphosis.
• Implementing proper sleeping and sitting habits with adequate spinal support is recommended for managing this condition.
• Encouraging "tummy time" can strengthen paraspinal muscles, aiding spinal support, though radiographic restoration may take years.