Ciphers: Causes, Symptoms, Classification, Complications, Treatment and Prognosis

From the Greek κυφός kyphos “a hump” is an abnormally excessive convex kyphotic curvature of the spine as it occurs in the cervical, thoracic and sacral regions.

The lordotic curve concave into the abnormal interior of the cervical and lumbar regions of the spine is called lordosis. Kyphosis can be called round back or Kelso hump .


It can be the result of degenerative diseases such as arthritis, developmental problems, most commonly Scheuermann’s disease, osteoporosis with compression fractures of the vertebra and multiple myeloma or trauma.

A normal thoracic spine extends from the 1st to the 12th vertebra and should have a slight kyphotic angle, which varies between 20 ° and 45 °.

When the “roundness” of the upper spine increases beyond 45 °, it is called kyphosis or ” hyperchitosis “. Scheuermann kyphosis is the most classic form of hyperkyphosis and is the result of wedge vertebrae that develop during adolescence.

The cause is not currently known and the condition appears to be multifactorial and is seen more often in men than in women.

In the sense of a deformity, is the pathological curvature of the spine, where parts of the spine lose part or all of its lordotic profile. This causes a tilt of the back, seen as a stooped posture.

While most cases of kyphosis are mild and only require routine monitoring, severe cases can be debilitating.

High degrees of kyphosis can cause intense pain and discomfort, difficulty in breathing and digestion, cardiovascular irregularities, neurological compromise and, in the most severe cases, significantly shorter life expectancy.

These types of high-end curves usually do not respond well to conservative treatment and almost always justify spinal fusion surgery, which can restore the natural degree of curvature of the body.

The prevalence of kyphosis has been linked to nasal obstruction in one study.

Symptoms of kyphosis

If you have kyphosis, the easiest symptom to recognize is rounded. The extreme curve at the top of your spine will cause you to bend forward.

In addition to having a rounded back, you may have these other symptoms:

  • Mild to severe back pain.
  • Back pain with movement.
  • Fatigue.
  • Tenderness and stiffness in the spine.
  • Posture forward of the head.
  • Chest pain or shortness of breath (severe cases).
  • Difference in shoulder height.
  • Tight hamstring tendons (muscles in the back of the thighs).


There are several types of kyphosis (ICD-10 codes are provided):

Postural kyphosis (M40.0) : the most common type, which is usually attributed to stooped posture, can occur in both the elderly and the young. In ancient times, it can be a case of hyperchitosis and is called “widow’s hump”.

About one third of the cases of more severe hyperchistephosis in older people have vertebral fractures.

Otherwise, the aging body tends to a loss of musculoskeletal integrity, and the hyperphysis can develop only due to aging.

Scheuermann kyphosis (M42.0) : is significantly worse from the cosmetic point of view and can cause different degrees of pain, and can also affect different areas of the spine (the most common is the thoracic area).

Fatigue is a very common symptom, most likely due to the intense muscular work that has to be put on standing or sitting correctly. The condition seems to occur between families.

The majority of patients who undergo surgery to correct their kyphosis have Scheuermann’s disease.

Congenital kyphosis (Q76.4) : can result in children whose spine has not developed properly in the uterus.

A congenital kyphosis can also appear suddenly in adolescence, most commonly in children with cerebral palsy and other neurological disorders.

Nutritional kyphosis can be the result of nutritional deficiencies, especially during childhood, such as vitamin D deficiency (which causes rickets), which softens the bones and produces a curvature of the spine and extremities below the child’s body weight. .

The Gibbus deformity is a form of structural kyphosis, often a sequel to tuberculosis.

Post-traumatic kyphosis (M84.0) : may arise from vertebral fractures not treated or ineffectively treated.

Post-traumatic kyphosis occurs most frequently in the lumbar and thoracolumbar regions (mid-to-lower back) after an injury.

As the name implies, it is a condition that results from serious injuries, such as a fall from a height, an automobile accident, an accident on horseback or even a bounce on a wave while sailing in a boat.

When the impact of such events causes fractures and / or dislocation of the vertebrae (disks of the spine), a kyphotic deformity may develop, an abnormal curve of the spine, especially if the injury is not treated promptly.

Patients with posttraumatic kyphosis usually have severe neurological deficits, such as tetraplegia or paraplegia.

Traumatic kyphosis can get worse quickly if the injury is allowed to heal without treatment. The options depend on a variety of factors, including the type and location of the fracture, the degree of curvature of the spine, and the size of the patient.

To understand the effect of these injuries, it may be useful to think of the healthy spine as a series of bony blocks, the vertebrae, which are connected by facet joints that allow movement in the spine.

The discs sit between the vertebrae and provide cushioning and protection. The spinal cord passes through the spinal canal, a passage created by the vertebrae.

Posttraumatic kyphosis can occur from the lower part of the lumbar spine (in the lower part of the back) to the cervical spine (in the neck).

Structural kyphosis : structural kyphosis refers to an increased curve of the spine not related to the posture or vagina. Patients with structural kyphosis can not consciously straighten the spine.

Patients with kyphosis may notice difficulty in standing or having continuous back or leg pain.

The symptoms usually get worse as the day progresses and the patient will feel that they lean more and more forward the longer they try to stop. The severity of symptoms generally depends on the amount of kyphosis present.


The risk of serious complications of spinal fusion surgery for kyphosis is estimated at 5%, similar to the risks of surgery for scoliosis .

Possible complications include inflammation of the soft tissues or deep inflammatory processes, respiratory problems, hemorrhages and nerve injuries. According to the latest tests, the actual rate of complications can be substantially higher.

Even among those who do not suffer serious complications, 5% of patients require a new operation within five years of the procedure and, in general, it is not yet clear what one would expect from long-term spinal surgery.


The diagnosis of kyphosis is usually made through observation and measurement. Idiopathic causes, such as vertebral wedging or other abnormalities, can be confirmed by X-rays.

Osteoporosis, a possible cause of kyphosis, can be confirmed with a bone density scintigraphy. Thoracic postural kyphosis can often be treated with reeducation of posture and focused strengthening exercises.

Idiopathic thoracic kyphosis due to vertebral wedging, fractures or vertebral anomalies is more difficult to manage, since it may not be possible to adopt a correct posture with structural changes in the vertebrae.

Children who have not completed their growth can show lasting improvements with orthotics. Exercises may be prescribed to relieve the discomfort associated with excessively stretched back muscles.

A variety of positions assisted by gravity or gentle traction can minimize the pain associated with nerve root compression. Surgery may be recommended for severe idiopathic kyphosis.

Mild kyphosis

Most patients have mild kyphosis, which does not require treatment other than taking over-the-counter medications to relieve back pain and exercises to strengthen the back muscles.

Physiotherapy is best combined with basic exercises, such as martial arts or Pilates. This also controls and eliminates back pain if done regularly.

Light to moderate kyphosis

Mild to moderate kyphosis is initially treated with a posterior brace until the bone growth stops around 15 years. Surgery is not recommended in most cases due to the risky nature of the procedures.

Therefore, only severe kyphosis is routinely corrected by surgical techniques, most often spinal fusion. This is more if cardiorespiratory problems arise due to kyphosis.

In addition, a very prominent curvature, which causes severe intractable pain or compromises spinal integrity, is also an indication for surgical intervention.

In the case of postural kyphosis, correction of posture, along with avoidance of activities such as carrying heavy loads on the back, usually leads to a good result.

Scheuermann’s kyphosis (that is, the kyphosis of development) can be treated according to age, sex, the magnitude of the curve and the rigidity of the person. This curve generally increases during accelerated growth and can then become static.

If the curve is severe, surgery is recommended, but the prognosis for normal spinal function is extremely good, because the condition does not progress later.

With congenital kyphosis, surgical correction is often recommended. The surgery is usually followed by a subsequent reinforcement for several months to allow the spine to heal properly without tension.

However, this does not restrict normal physical activity after about a month or two. Athletics should be resumed only after normal and complete spinal function is regained, which is within one year after the operation.

Specialized surgery and careful monitoring produce a normal spinal result in the vast majority of cases.


Body braces showed benefits in a randomized controlled trial.

The Milwaukee brace is a particular bodily brace that is often used to treat kyphosis in the United States. Modern CAD / CAM keys are used in Europe to treat different types of kyphosis.

These are much easier to use and have better corrections in the corset than those reported for the Milwaukee corset.

Since there are different curve patterns (thoracic, thoracolumbar and lumbar), different types of orthopedic devices are used, with different advantages and disadvantages.

Physical therapy

In Germany, a standard treatment for Scheuermann’s disease and lumbar kyphosis is the Schroth method, a physical therapy system for scoliosis and related spinal deformities.

It involves lying in the supine position, placing a pillow under the scapular region and then stretching the cervical spine.


Those with a severe form of kyphosis can experience a lot of pain and breathing problems due to a large deformity of the spine. In such conditions, surgery may be required.

Although it rarely occurs, surgical treatment can be used in severe cases. In patients with progressive kyphotic deformity due to vertebral collapse, a procedure called kyphoplasty can stop the deformity and relieve pain.

Surgery can help correct the excessive spinal curvature that some people experience due to kyphosis.

Some people are born with the problem known as congenital kyphosis and usually need early surgical treatment to prevent the progression of the curvature of the spine.

Kyphoplasty is a minimally invasive procedure that only requires a small opening in the skin. The main objective is to return the damaged vertebrae as close as possible to its original height.

Spinal fusion is rarely necessary, but it can involve complications, such as:

  • Postoperative infection
  • Bleeding around the surgical site.
  • Nervous damage with loss of visceral function, as bowel and bladder continence.

Typical candidates for later surgery are those who experience very severe back pain that does not respond to any other treatment, and children or adolescents with Scheuermann kyphosis and spinal curvature of more than 75 degrees.

Sunlight and vitamin D and foods with calcium to relieve kyphosis

If your kyphosis is the result of osteoporosis, you may be able to stop the progression of the spinal problem by treating osteoporosis.

The natural ways of doing this are increasing the intake of calcium and vitamin D through diet and exposure to sunlight.

Eat calcium-rich foods : your choices include milk, yogurt, and dairy products such as cheese, beans and legumes, dried fruits such as figs, vegetables such as spinach, broccoli, pumpkin, tofu, fortified orange juice, sesame seeds, and fish such as salmon .

Have foods rich in vitamin D : increase your dietary intake of vitamin D by eating fatty fish such as mackerel, tuna or salmon, cheeses, organ meats such as beef liver or egg yolks.

Get some sunlight : while you can get your vitamin D through your diet, exposure to sunlight is still one of the most effective ways to help your body generate the vitamin internally.

Combine your sunny time with some exercise, such as walking; Or just sit or lie in the sun every day for a while to absorb the rays.

How much time you’ll need to sit in the sun depends on the color of your skin, with light-skinned people who require less time than people with darker skin. This could mean between 15-20 minutes to an hour or more.

Swimming training and weight lifting to improve mobility

Exercise can help those who suffer from kyphosis; The key is to choose exercises that are not discordant. Execute them first with your doctor and your physiotherapist. Swimming is usually a good option.

Maintain high levels of activity on a regular basis to improve and maintain mobility, include stretching exercises and work to strengthen the muscles of the back and center. Pilates and yoga can work well.

Weight-bearing exercises can be very beneficial for those with kyphosis related to aging or osteoporosis.

Yoga to reeducate posture and strengthen the back / central muscles and bones

Researchers believe that there is a possibility that yoga helps those who have kyphosis to be more upright.

The asanas work by strengthening the spinal and central muscles, and by stretching the shoulder muscles to allow you to retrain your posture as well.

Yoga can also help improve bone health, balance, reduce the risk of falls and reduce kyphosis in the elderly, a population susceptible to age-related kyphosis and osteoporosis.

Supported backrests that can help stretch the ligaments of the frontal column, shortened muscles of the thorax and abdominal muscles are good for people with kyphosis.

Be careful not to overextend or work too much in the cervical and lumbar regions and focus on your middle part.

Stretches of 2 minutes or more are best for connective tissue. Folds of the trunk back can help. Just make sure you do not force yourself to feel pain. You should be able to breathe comfortably while doing these postures.

Yoga postures for spinal kyphosis

Arched back supported – reclining
  • Lie on the floor with a rolled blanket and placed under the middle of the back (between the shoulder blades and the lower ribs).
  • Stretch the pectoral muscles by opening the arms to the sides to create a 90 degree angle from the elbows and shoulders.
  • Your knees should be a little bent to avoid the upper part of your back.
  • Stay in this arch for 2 to 5 minutes, increasing retention slowly over time.
Arched back compatible – sitting
  • This arching needs you to sit on the floor, with the middle part pressed back on the edge of a chair seat.
  • Lie back, letting your head return to the back of the chair.
  • Avoid hyperextend the neck, hold the head with your hands or a firm pillow to maintain control.
  • Your knees should remain bent along.
  • Stay in this arch for 2 to 5 minutes, increasing retention slowly over time.
Salabhasana or lobster posture
  • Lie face down on a comfortable yoga mat, with your arms at your side.
  • Lift the nose and sternum between 3 and 4 inches off the ground.
  • Be sure to make sure your pubic bone stays pressed against the floor; this helps avoid general tension and lumbar strain.
  • Lift your head and chest only as much as is comfortable.
  • Look at the ground with your eyes, not with the wall, as this can cause hyperextension.
  • Hold the posture for a few seconds, increasing up to 30 seconds. 3-4 repetitions at a time are adequate.
Tadasana or the mountain posture

This posture helps you to be more aware of your posture and involve the muscles, also applying the methods learned in the lobster posture.

  • Just stand up with the base of both fat fingers touching but the heels separated a little so that the fingers of your two fingers are now parallel.
  • Make sure your weight is balanced on both feet.
  • Firm by your thighs and turn the top of your thighs a little inward.
  • Let your shoulder blades press on your back, first widened and then released.
  • Your arms should hang on the side of your torso. The crown of your head should be centered with your pelvis.
  • Feel how your legs extend towards the ground and your column stretches towards the sky.
  • Remember where you felt the chair or blanket to press on the middle part of your back and lift up from that point. You should feel how the sternum rises and a space opens in the upper sections of the lungs.

Your muscles in the middle part of your back should feel revived and invigorated.

Forecast without treatment

Untreated severe or progressive kyphosis is also associated with limiting complications, which can significantly reduce quality of life.

These include severe and chronic back pain, deformity of the spine , poor respiratory capacity and neurological symptoms and signs, such as paralysis of the extremities or weakness.