Physiotherapy Department, St John & St Elizabeth Hospital, 60 Grove End Rd., St John's Wood, London, UK.
Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK.
J Orthop Surg Res. 2021 Jul 9;16(1):447. doi: 10.1186/s13018-021-02592-2.
Thoracic kyphosis is reported to increase with ageing. However, this relationship has not been systematically investigated. Peoples' kyphosis often exceeds 40°, but 40° is the widely accepted cut-off and threshold for normality. Consequently, patients may be misclassified. Accurate restoration of kyphosis is important to avoid complications following spinal surgery. Therefore, specific reference values are needed. The objective of the review is to explore the relationship between thoracic kyphosis and age, provide normative values of kyphosis for different age groups and investigate the influence of gender and ethnicity.
Two reviewers independently conducted a literature search, including seven databases and the Spine Journal, from inception to April 2020. Quantitative observational studies on healthy adults (18 years of age or older) with no known pathologies, and measuring kyphosis with Cobb's method, a flexicurve, or a kyphometer, were included. Study selection, data extraction, and study quality assessment (AQUA tool) were performed independently by two reviewers. The authors were contacted if clarifications were necessary. Correlation analysis and inferential statistics were performed (Microsoft Excel). The results are presented narratively. A modified GRADE was used for evidence quality assessment.
Thirty-four studies (24 moderate-quality, 10 high-quality) were included (n = 7633). A positive moderate correlation between kyphosis and age was found (Spearman 0.52, p < 0.05, T5-T12). Peoples' kyphosis resulted greater than 40° in 65% of the cases, and it was significantly smaller in individuals younger than 40 years old (x < 40) than in those older than 60 years old (x > 60) 75% of the time (p < 0.05). No differences between genders were found, although a greater kyphosis angle was observed in North Americans and Europeans.
Kyphosis increases with ageing, varying significantly between x < 40 and x > 60. Furthermore, kyphosis appears to be influenced by ethnicity, but not gender. Peoples' thoracic sagittal curvature frequently exceeds 40°.
The review protocol was devised following the PRISMA-P Guidelines, and it was registered on PROSPERO ( CRD42020175058 ) before study commencement.
胸椎后凸随着年龄的增长而增加。然而，这种关系尚未得到系统的研究。人们的后凸往往超过 40°，但 40°是广泛接受的正常范围的截止点和阈值。因此，患者可能被错误分类。准确恢复后凸对于避免脊柱手术后的并发症很重要。因此，需要特定的参考值。本综述的目的是探讨胸椎后凸与年龄的关系，为不同年龄组提供后凸的正常值，并研究性别和种族的影响。
两名审查员独立进行文献检索，包括从成立到 2020 年 4 月的七个数据库和《脊柱杂志》。纳入了对无已知病理的健康成年人（18 岁或以上）进行的定量观察性研究，并且使用 Cobb 法、flexicurve 或 kyphometer 测量后凸。两名审查员独立进行研究选择、数据提取和研究质量评估（AQUA 工具）。如果需要澄清，将与作者联系。进行了相关性分析和推理统计（Microsoft Excel）。结果以叙述性方式呈现。使用改良的 GRADE 对证据质量进行评估。
纳入了 34 项研究（24 项为中等质量，10 项为高质量）（n=7633）。发现后凸与年龄之间存在中度正相关（Spearman 0.52，p<0.05，T5-T12）。65%的情况下，人们的后凸大于 40°，而 40 岁以下的个体（x<40）比 60 岁以上的个体（x>60）小 75%（p<0.05）。未发现性别差异，但在北美和欧洲人观察到更大的后凸角度。
后凸随年龄增长而增加，在 x<40 和 x>60 之间变化显著。此外，后凸似乎受到种族的影响，但不受性别的影响。人们的胸脊柱矢状曲率经常超过 40°。
本综述方案遵循 PRISMA-P 指南制定，并在研究开始前在 PROSPERO（CRD42020175058）上进行了注册。
