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Kyphosis is a spinal condition characterized by an excessive forward curve in the upper back, leading to a visibly rounded posture. Often referred to as “roundback,” and “hunchback” in more severe cases, kyphosis can develop at any age but frequently appears during adolescence.
In most instances, kyphosis presents minimal issues and may not require treatment. Some individuals may benefit from wearing a back brace or engaging in specific exercises to improve posture and enhance spinal support. However, severe kyphosis can lead to back pain, notable spinal deformities, and even respiratory issues. In such cases, surgical intervention may be necessary to correct the curvature and alleviate symptoms.
Anatomy of the Spine
The spine is composed of three main segments, each forming a distinct curve that, when viewed from the side, contributes to the natural alignment of the body.
The neck (cervical spine) and lower back (lumbar spine) have C-shaped curves known as lordosis, while the chest (thoracic spine) has a reverse C-shaped curve referred to as kyphosis. These spinal curves play an essential role in balancing the body, allowing us to stand upright. When any of these curves become exaggerated or reduced, it disrupts balance and can result in abnormal posture.
The spine also includes smaller anatomical components:
- Vertebrae: Typically, the spine consists of 24 stacked, rectangular-shaped bones called vertebrae. These bones form the natural curves of the spine and create a protective canal for the spinal cord.
- Intervertebral Disks: Positioned between each vertebra, intervertebral disks are flat, round, and about a half-inch thick. These disks act as shock absorbers, cushioning the spine and reducing impact during movement.
Description of Kyphosis
While the thoracic spine naturally curves between 20 and 45 degrees, certain postural or structural abnormalities can increase this curvature beyond normal limits. Known medically as hyperkyphosis when it exceeds 50 degrees, this excessive curvature is often simply referred to as kyphosis by doctors to describe the clinical condition resulting in a rounded upper back.
The severity of kyphosis can vary. Generally, more pronounced curves lead to a more serious condition. Milder kyphosis may cause minimal discomfort or none at all, while more severe cases can result in noticeable spinal deformity, often producing a visible hump on the upper back.
Understanding Kyphosis
The thoracic spine normally maintains a kyphotic curve between 20 and 45 degrees. However, postural issues or structural irregularities can cause this curvature to extend beyond the typical range. When the curve exceeds 50 degrees, it is medically termed hyperkyphosis. Nonetheless, doctors often use the term “kyphosis” to describe any excessive curvature in the thoracic spine that leads to a rounded appearance in the upper back.
Kyphosis severity can vary widely. Generally, the more pronounced the curve, the more significant the impact on the individual. Mild cases may produce minimal symptoms, such as mild back discomfort or none at all, while severe cases can lead to noticeable spinal deformities, including a visible hump on the back.
Types of Kyphosis
Kyphosis can present in various forms, with the three most common types affecting children and adolescents being:
- Postural Kyphosis
- Scheuermann’s Kyphosis
- Congenital Kyphosis
Postural Kyphosis
Postural kyphosis, the most prevalent form, typically emerges during adolescence. It appears as a slouched posture and is generally not related to significant structural changes in the spine. The curve from postural kyphosis is often smooth and rounded, and patients can usually correct it by standing up straight.
More common in girls than boys, postural kyphosis is rarely painful and does not tend to progress. Since the curvature does not worsen over time, it usually does not lead to issues in adulthood.
Scheuermann’s Kyphosis
Scheuermann’s kyphosis, named after the radiologist who first identified it, often becomes evident during teenage years and can result in a more pronounced deformity compared to postural kyphosis.
This type is caused by a structural anomaly in the spine, where an X-ray reveals that three or more consecutive vertebrae take on a wedge-like shape rather than the typical rectangular form. This irregular shape causes the vertebrae to press together toward the front, reducing the disk space and creating a sharper forward curve in the upper back. Unlike postural kyphosis, the curve in Scheuermann’s kyphosis is more rigid and cannot be corrected by simply standing up straight.
Scheuermann’s kyphosis commonly affects the thoracic spine, although it can also occur in the lumbar spine. It is more frequently observed in boys than girls and generally stops progressing once growth is complete.
In some cases, Scheuermann’s kyphosis can be painful, with discomfort usually concentrated at the curve’s apex. Additional pain may develop in the lower back as the body compensates by increasing the lumbar curve. Physical activities, as well as prolonged sitting or standing, can intensify the pain.
Clinical photos of an adolescent male show an abnormally rounded upper back. His severe kyphosis is most obvious when bending forward.
Rephrased Section on Congenital Kyphosis:
Congenital kyphosis is a spinal condition present at birth, arising from abnormal spinal column development during fetal growth. This condition may result from vertebrae that do not form correctly or from multiple vertebrae that are fused together. Congenital kyphosis commonly progresses as the child grows.
Children with congenital kyphosis often require surgical intervention at a young age to halt further curve progression. Additionally, many children with this condition have other congenital anomalies affecting various body systems, such as the heart and kidneys.
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Rephrased Symptoms Section:
The symptoms of kyphosis can vary widely depending on the underlying cause and the severity of the spinal curve. Common signs and symptoms may include:
- Rounded shoulders
- A noticeable hump on the back
- Mild back pain
- Fatigue
- Spinal stiffness
- Tightness in the hamstrings (muscles at the back of the thigh)
In rare cases, progressive kyphotic curves can lead to additional symptoms over time, such as:
- Weakness, numbness, or tingling sensations in the legs
- Loss of sensation
- Changes in bowel or bladder function
- Shortness of breath or breathing difficulties
Rephrased Doctor Examination Section:
Mild kyphosis can often go unnoticed until a routine scoliosis screening at school leads to a referral to a doctor. However, when visible changes in the patient’s back become apparent, it can be distressing for both the child and the parents, often prompting concerns about the back’s cosmetic appearance and a visit to a healthcare provider.
Rephrased Physical Examination Section:
During the initial consultation, the doctor will review your child’s medical history and inquire about their overall health and specific symptoms. The examination begins with an assessment of your child’s spine, where the doctor will press along the back to identify any tender areas.
In this exam, your child will be asked to bend forward with feet together, knees straight, and arms relaxed at the sides. This test, known as the Adam’s forward bend test, helps the doctor observe the spine’s slope and identify any deformity. Additionally, the doctor may have your child lie down to check if the curve straightens—a sign that the kyphosis may be flexible, often indicating postural kyphosis.
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Rephrased Tests Section:
X-rays: X-rays are commonly used to capture images of dense structures like bones. Your doctor may request X-rays from multiple angles to examine the vertebrae for any structural abnormalities and determine the degree of the kyphotic curve. Curves exceeding 50 degrees are considered outside the normal range, though this doesn’t necessarily imply a need for invasive treatment.
Pulmonary Function Tests: For more severe curves, the doctor may recommend pulmonary function tests to evaluate any potential impact on lung function due to reduced chest space.
Additional Tests: In cases of congenital kyphosis, progressive curvature can lead to symptoms of spinal cord compression, including pain, tingling, numbness, or weakness in the lower limbs. If these symptoms arise, or if the curve changes significantly over time, neurologic testing or an MRI scan may be recommended to assess the spinal cord’s condition.
Rephrased Treatment Section:
The primary goal of treatment for kyphosis is to halt curve progression and prevent spinal deformity. Your doctor will consider several factors in developing a treatment plan, including:
- Your child’s age and general health
- Remaining years of growth
- The type of kyphosis
- The curve’s severity
Rephrased Nonsurgical Treatment Section:
Nonsurgical treatment is typically advised for individuals with postural kyphosis and for those with Scheuermann’s kyphosis whose curves are below 70 to 75 degrees.
Nonsurgical approaches may include:
- Observation: For some cases, regular monitoring is sufficient. The doctor may schedule follow-up visits and X-rays to ensure the curve does not worsen until the child reaches skeletal maturity. If the curve remains stable and does not cause pain, no further treatment may be necessary.
- Physical Therapy: Targeted exercises can help alleviate back pain and improve posture by strengthening core and back muscles. Stretching exercises may also help release tight hamstrings, supporting better alignment.
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Medications like ibuprofen, aspirin, or naproxen can help reduce back pain.
- Bracing: For growing patients with Scheuermann’s kyphosis, bracing may be recommended. The type of brace and the recommended daily wear time depend on the curve’s severity. The doctor will adjust the brace periodically as the curve improves. Typically, the brace is worn until the child reaches full skeletal maturity.
Rephrased Surgical Treatment Section:
Surgery is frequently recommended for individuals with congenital kyphosis, especially to prevent curve progression and associated complications.
Surgical intervention may also be advised for patients with Scheuermann’s kyphosis when the spinal curve exceeds 70 to 75 degrees or in cases where severe back pain is present. Those with kyphosis in the lower back (thoracolumbar region) may require surgery even for smaller curves, typically above 25 to 30 degrees.
The most common surgical method for treating kyphosis is spinal fusion.
The primary objectives of spinal fusion are to:
- Decrease the curvature
- Prevent further curvature progression
- Ensure long-term stability of the correction
- Relieve significant back pain if it exists
Rephrased Surgical Procedure Section:
Spinal fusion functions like a “welding” process in which the affected vertebrae are fused, allowing them to heal into a single, solid structure. By stabilizing these vertebrae, the procedure reduces the degree of curvature and can alleviate back pain by eliminating motion between the affected vertebrae.
During surgery, the doctor typically uses metal rods and screws to realign the vertebrae. The goal is often to achieve a safe, partial correction—reducing the curve’s magnitude without always aiming for a fully straightened spine. Ideally, the procedure reduces the curvature by about 50% of its original angle. After alignment, small bone fragments, or bone grafts, are placed between the vertebrae to facilitate fusion. Over time, these bones grow together, similar to how a broken bone heals.
The extent of the spine that is fused depends on the curvature’s size. Only the affected vertebrae are fused, leaving the remaining spinal bones free to move, allowing for bending, straightening, and rotation. For larger curves, more vertebrae may need to be fused, resulting in fewer mobile segments for flexibility in bending and twisting
Long-Term Outcomes
If kyphosis is diagnosed early, many patients can be treated successfully without surgery and go on to lead active, healthy lives. However, curve progression could potentially lead to problems during adulthood. Patients with kyphosis need regular to monitor the condition and check progression of the curve, whether or not it is treated with surgery.