Kyphosis: Definition, Signs, Symptoms, Causes, Diagnosis, Treatment and Overview

It is defined as an excessive curvature in the upper part (thoracic or part of the chest) of the spine.

In most people with this condition, these curves of the upper spine briefly form forward, but can also occasionally manifest towards the rear in a more rounded shape than normal.

It is a fairly common condition that affects adolescents and young adults.

The spine has a series of normal curves when viewed from the side. These curves help absorb the loads applied to the spine from the weight of the body.

The cervical spine (neck) and lumbar spine (lower back) have a normal internal curvature that health professionals call lordosis or lordotic curvature whereby the spine bends backwards.

The thoracic spine (upper back) has a normal external curvature that healthcare providers call kyphosis, or the kyphotic curve where the spine bends forward.

The official medical term for an abnormal curvature of the thoracic spine is hyperkyphosis.

However, the medical community commonly refers to abnormal kyphosis and hyperkyphosis as kyphosis, so in this discussion, the term kyphosis will be used to discuss abnormal kyphosis.

In other words, kyphosis is a spinal deformity of the upper back that causes an exaggerated outward curve.

The spine is normally straight when viewed from the front. Scoliosis is an abnormal curve when viewed from the front.

Scoliosis can occur from bony abnormalities of the spine at birth, growth abnormalities, especially in adolescence, degenerative changes of the spine in adulthood, or abnormal sprains of the vertebrae due to muscle spasm after injury.

The normal curves of the spine allow the head to balance directly on the pelvis.

If one or more of these curves is too large or too small, the head may not balance properly on the pelvis. This can lead to back pain, stiffness, and an altered gait or gait.

What Causes Kyphosis?

Kyphosis occurs when the vertebrae in the upper back form a wedge shape, causing the spine to curve forward more than usual.

The Postural kyphosis is the most common form, which tends to occur in teenagers. As the name implies, this curve is due to poor posture and becomes more apparent during the adolescent stretch.

It is more common in boys than girls.

Cifosis de Scheuermann

It usually occurs during a period of rapid growth and is when the back of the vertebrae in the upper spine grow the fastest.

In an X-ray, the vertebrae instead of being seen as rectangular building blocks, are embedded in the front of the spine.

Congenital kyphosis is rare, but it occurs when a baby is born with an abnormal spine. The spine has not developed properly and the curve may get worse as the child grows.

What are the signs and symptoms of kyphosis?

In most cases, the curvature of the spine is minimal and the kyphosis barely perceptible. The most common symptoms are pain and stiffness in the back.

Severe cases of the disease can lead to other health problems. The child may be in pain and have trouble breathing.

The most common symptoms for patients with abnormal kyphosis are the appearance of poor posture with a hump-back or “kickback” appearance.

Symptoms can include back pain, muscle fatigue, and a stiff back.

Most often, these symptoms remain constant and do not get progressively worse over time.

In more severe situations, the patient may notice that their symptoms get worse over time. Kyphosis can progress, causing a more exaggerated hunchback.

In rare cases, this can lead to compression of the spinal cord with neurological symptoms including weakness, loss of sensation, or loss of bowel and bladder control.

Severe cases of thoracic kyphosis can also limit the amount of space in the chest and cause heart and lung problems that can lead to chest pain or shortness of breath with eventual lung and / or heart failure.

How is kyphosis usually diagnosed?

A doctor will look at the curvature of the spine through the physical exam.

An X-ray will confirm the diagnosis and learn the extent of the kyphosis. This will help determine what type of treatment is necessary.

Your doctor will likely start by getting your medical history, including when you first notice your symptoms, any history of family members with similar problems, and other history of back or neck problems.

The physical exam will assess the curve of your spine both upright and while leaning forward.

A healthcare professional will test your strength, feel, reflexes, and flexibility in your arms and legs.

Based on the results of your medical history and physical exam, your doctor may order X-rays of your spine.

This can help differentiate postural kyphosis (normal-shaped vertebrae) from Scheuermann’s kyphosis (wedge-shaped vertebrae).

If your doctor finds any evidence of neurological injury, he may also get an MRI of your spine. This can identify any compression of the spinal cord or nerves.

If you have any chest pain or shortness of breath, your doctor may order additional tests to evaluate your heart and lungs.

How is kyphosis treated?

Treatment depends on the severity of the symptoms and their cause. Physical therapy is offered for postural kyphosis to help improve posture.

A brace is sometimes used for patients with Scheuermann’s kyphosis and in some congenital cases to support their back as they grow older.

Severe cases in young children with congenital kyphosis sometimes need surgery.

This corrective surgery is called a spinal fusion, and it involves inserting metal bars into the spine to keep it in a straight position.

Non-surgical treatment is the most common. Physical therapy strengthens the back muscles and corrects posture in people with postural kyphosis.

Mild pain relievers and anti-inflammatory medications can also help with symptoms.

These curves do not continue to get worse over time or lead to complications that are more serious. Surgery is unnecessary for postural kyphosis.

Initially, healthcare professionals treat Scheuermann’s kyphosis with a combination of physical therapy exercises and mild pain and anti-inflammatory medications.

If the patient is still growing, a brace can be effective.

Doctors often recommend braces for more severe kyphosis with curves of at least 45 degrees and can continue until the patient is no longer growing.

X-rays are often used to monitor the degree of kyphosis over time. Booster is usually not recommended for adults who are no longer growing.

In some cases, the doctor recommends surgery for Scheuermann’s kyphosis.

The goals of surgery are to partially correct the kyphosis deformity, relieve pain, and improve overall spinal alignment.

Indications for surgery include a curve greater than 75 degrees, uncontrolled pain, and neurological, heart, or lung conditions.

There are several types of surgical procedures available depending on the specific characteristics of each case.

Surgery can be performed from the front (anterior approach), from the back (posterior approach), or both (combined anterior and posterior approach).

A surgeon makes the decision based on the specific characteristics of the spinal curve.

A healthcare professional can obtain X-rays by leaning back and forth to determine how flexible the spine is. If it is flexible, a posterior approach may be appropriate.

If the spine is less flexible, an anterior or combined approach can be used.

Regardless of the approach, the surgery involves partially straightening the spine and using rods and screws in the vertebrae to support the spine while bone fusion (spinal fusion) occurs.

Treatment of congenital kyphosis often involves surgery while the patient is an infant. An abnormality in the developing vertebrae causes congenital kyphosis.

Surgical treatment earlier in life can help correct the spinal deformity before it worsens.

Sometimes a procedure called kyphoplasty treats kyphosis from the painful collapse of the vertebrae due to osteoporosis. With kyphoplasty, a balloon is inserted into the affected vertebra and filled with a liquid (methmethacrylate) that hardens to restore vertebral height.

This procedure is a last resort after non-invasive treatment failure.

What happens next?

Kyphosis caused by poor posture usually improves over time. In most cases, children or adolescents respond well to physical therapy.

Even children who require surgery often grow up without significant restrictions and can lead normal lives.