Kyphosis – diagnosis, treatment, symptoms, causes

Kyphosis is a forward rounding of your upper back. Some rounding is normal, but the term “kyphosis” usually refers to an exaggerated rounding, more than 40 to 45 degrees. This deformity is also called round back or hunchback.

With kyphosis, your spine may look normal or you may develop a hump. Kyphosis can occur as a result of developmental problems; degenerative diseases, such as arthritis of the spine; osteoporosis with compression fractures of the vertebrae; or trauma to the spine. It can affect children, adolescents and adults.

Mild cases of kyphosis may cause few problems. But severe cases can affect your lungs, nerves and other tissues and organs, causing pain and other problems. Treatment for kyphosis depends on the cause of the curvature and its effects.

Causes

Your spine (vertebral column) is composed of bones (vertebrae), which are held together by tough, fibrous bands (ligaments). The vertebral column consists of seven neck (cervical) vertebrae, 12 middle back (thoracic) vertebrae and five lower back (lumbar) vertebrae. Lumbar vertebrae are the largest, and they carry most of your body’s weight. The sacrum, containing five fused vertebrae, is below the lumbar vertebrae. The last three tiny vertebrae, also fused together, are called the tailbone (coccyx).

Kyphosis is a forward rounding of the vertebrae in your thoracic spine. The vertebrae in your thoracic spine connect to your ribs.

Causes of kyphosis depend on the different types of kyphosis.

Types of kyphosis in children and adolescents
For children or adolescents, the most common types include:

  • Postural kyphosis. This type mainly becomes apparent in adolescence. The onset of postural kyphosis generally is slow. It’s more common in girls than in boys. Poor posture or slouching may cause stretching of the spinal ligaments and abnormal formation of the bones of the spine (vertebrae). Postural kyphosis often is accompanied by an exaggerated inward curve (hyperlordosis) in the lower (lumbar) spine. Hyperlordosis is the body’s way of compensating for the exaggerated outward curve in the upper spine.
  • Scheuermann kyphosis. Like postural kyphosis, Scheuermann kyphosis typically appears in adolescence, often between ages 10 and 15, while the bones are still growing. Also called Scheuermann disease, it’s about twice as common in boys as it is in girls. Scheuermann may deform the vertebrae so that they appear wedge shaped, rather than rectangular, on X-rays. There may be another finding, known as Schmorl nodes, on the affected vertebrae. These nodes are the result of the cushion (disk) between the vertebrae pushing through bone at the bottom and top of a vertebra (end plates).

    The cause of Scheuermann kyphosis is unknown, but it tends to run in families. Some people with this type of kyphosis also have scoliosis, a spinal deformity that causes a side-to-side curve. Adults who developed Scheuermann during childhood may experience increased pain as they get older.

  • Congenital kyphosis. A malformation of the spinal column during fetal development causes kyphosis in some infants. Several vertebrae may be fused together or the bones may not form properly. This type of kyphosis may worsen as the child grows. After trauma and infection, congenital kyphosis is the next most common cause of paralysis of the lower body (paraplegia).

Causes in adults
Disorders that may cause a curvature of the spine in adults, resulting in kyphosis, include:

  • Osteoporosis, a bone-thinning disease that’s associated with fractures of the vertebrae, which cause compression of the spine and contribute to kyphosis
  • Degenerative arthritis of the spine, which can cause deterioration of the bones and disks of the spine
  • Ankylosing spondylitis, an inflammatory arthritis that affects the spine and nearby joints
  • Connective tissue disorders, such as Marfan syndrome, that may affect the connective tissue’s ability to hold joints in their proper position
  • Tuberculosis and other infections of the spine, which can result in destruction of joints
  • Cancer or benign tumors that impinge on bones of the spine and force them out of position
  • Spina bifida, a birth defect in which part of the spine doesn’t form completely, and which causes defects of the spinal cord and vertebrae
  • Conditions that cause paralysis, such as cerebral palsy and polio, and that stiffen the bones of the spine

Symptoms

Kyphosis symptoms may include:

  • Slouching posture or hunchback
  • Mild back pain
  • Spinal stiffness or tenderness
  • Fatigue

In mild cases, kyphosis may produce no noticeable signs or symptoms.

Certain groups of people are at higher risk of kyphosis:

  • Adolescent girls with poor posture are at greater risk of postural kyphosis.
  • Boys between the ages of 10 and 15 are at greater risk of Scheuermann kyphosis.
  • Older adults with osteoporosis are at greater risk of spinal fractures that can contribute to kyphosis.
  • People who have connective tissue disorders, such as Marfan syndrome, also are at greater risk.

Because kyphosis often produces no signs and symptoms, it may go unnoticed until a routine physical examination or a school screening for scoliosis. But some people may notice pain, a rounding of the shoulders or a hump on the upper back.

Have your child examined if you see any of the signs of kyphosis. Also, if you develop any of the signs or symptoms, see your doctor for an examination to determine whether you need further evaluation.

Although rare, kyphosis can lead to serious health problems, such as physical deformity, breathing difficulties or damage to internal organs that are affected by the postural changes. So it’s important to see a doctor if you experience signs or symptoms of kyphosis.

Diagnosis

Your doctor will record a history of your condition and conduct a physical exam. The exam may include the following:

  • Forward bend test. Your doctor asks you to bend forward from the waist while he or she views the spine from the side. With kyphosis, the rounding of the upper back may become more obvious in this position. In postural kyphosis, the deformity corrects itself when you lie on your back.
  • Neurological functions test. Although neurological changes accompanying kyphosis are rare, your doctor may check for them by looking for weakness, changes in sensation or paralysis below the site of the kyphosis.
  • Spinal imaging tests. Your doctor may take an X-ray to confirm the kyphosis, determine the degree of curvature and detect any deformity of the vertebrae, which helps identify the type of kyphosis. For example, the appearance of wedge-shaped vertebrae or other features on X-ray differentiates between postural kyphosis and Scheuermann kyphosis. In older adults, X-rays may show arthritic changes in the spine, which can contribute to an increase in pain. If your doctor suspects a tumor or infection, he or she may request an MRI of your spine.
  • Pulmonary function tests. Your doctor may also use breathing tests to assess any breathing difficulty caused by the kyphosis.

Treatment

Kyphosis treatment depends on the cause of the condition and the signs and symptoms that are present.

Less serious cases
In some cases, less aggressive types of treatment are appropriate:

  • Postural kyphosis. This type of kyphosis doesn’t progress and may improve on its own. Exercises to strengthen back muscles, training in using correct posture and sleeping on a firm bed may help. Pain relievers may help ease discomfort if exercise and physical therapies aren’t fully effective.
  • Structural kyphosis. For kyphosis caused by spinal abnormalities, treatment typically depends on your age and sex, the severity of your symptoms and how rigid the curve in your spine is. With Scheuermann kyphosis, monitoring for progression of the curvature may be all that’s recommended if you have no symptoms. Anti-inflammatory medications may help relieve pain. General conditioning exercises and physical therapy may help alleviate symptoms.
  • Osteoporosis-related kyphosis. Multiple compression fractures in people who have low bone density can lead to abnormal curvature of the spine. If no pain or other complications are present, treatment for the kyphosis may not be necessary. But your doctor may recommend treatment of the osteoporosis to prevent further fractures and worsening of the kyphosis.

More serious cases
More severe cases of kyphosis require more aggressive treatment. The primary approaches are bracing and, as a last resort, surgery. With children and adolescents, the sooner treatment begins, the more effective it may be in halting the deformity.

When bracing is necessary
If your teenager is still growing and has moderate to severe kyphosis, your doctor may recommend bracing. Wearing a brace may prevent further progression of the curvature and may even provide some correction.

There are several types of braces for children who have kyphosis. Your doctor can help you decide which brace would be most effective for your child.

Children who wear braces usually have few restrictions and can participate in most activities. Although a brace may feel uncomfortable and awkward at first, it must be worn as prescribed to be effective. Once the bones are fully grown, your child can be weaned off the brace according to your doctor’s instructions.

There are different types of braces for treating kyphosis in adults, varying from postural training devices to rigid body jackets. The goal of bracing in adults is typically to control pain.

When surgery is necessary
Spinal surgery carries many risks, so your doctor may recommend surgery only if you or your child has any of the following:

  • Severe curvature of the spine that doesn’t respond to other treatment measures
  • Kyphosis that continues to worsen
  • Debilitating pain that doesn’t respond to medication
  • Resulting neurological problems, such as paralysis
  • Kyphosis related to a tumor or infection

Surgery also may be recommended for an infant with congenital kyphosis, in order to straighten the spine.

The goal of surgery is to reduce the degree of curvature. This is commonly done by fusing or joining the affected vertebrae. Doctors typically perform the surgery through incisions in the back, using general anesthetic.

Fusing the vertebrae involves connecting two or more of them with pieces of bone taken from the pelvis. Eventually, the vertebrae fuse with the bone pieces to prevent further progression of the curvature. Doctors attach metal rods, hooks, screws or wires to the spine to hold the vertebrae together while the bones fuse, which may take several months. Doctors leave the metal in the body to help support the fused area even after the bones have fused.

A drawback of spinal fusion is that it stops growth in that area of the spine. A child’s ultimate height isn’t affected greatly because the leg bones and the unaffected portion of the spine continue to grow normally.

The complication rate for spinal surgery is relatively high. Complications include bleeding, infection, pain, nerve damage, arthritis and disk degeneration. If the surgery fails to correct the problem, a second surgery may be needed.

Other procedures
Procedures called vertebroplasty and kyphoplasty have been developed recently to treat vertebral fractures. These procedures involve injecting a type of inert cement into the affected vertebrae. They can be effective in controlling pain associated with compression fractures.