What is Kyphosis?
Kyphosis is a spinal disorder in which an excessive outward curve of the spine results in an abnormal rounding of the upper back. The condition is sometimes known as “roundback” or—in the case of a severe curve—as “hunchback.” Kyphosis can occur at any age, but is common during adolescence.
In the majority of cases, kyphosis causes few problems and does not require treatment. Occasionally, a patient may need to wear a back brace or do exercises in order to improve his or her posture and strengthen the spine. In severe cases, however, kyphosis can be painful, cause significant spinal deformity, and lead to breathing problems. Patients with severe kyphosis may need surgery to help reduce the excessive spinal curve and improve their symptoms.
Causes of Kyphosis
The individual bones (vertebrae) that make up a healthy spine look like cylinders stacked in a column. Kyphosis occurs when the vertebrae in the upper back become more wedge shaped.
Abnormal vertebrae can be caused by:
• Fractures. Broken or crushed vertebrae (compression fractures) can result in curvature of the spine. Mild compression fractures often don’t produce noticeable signs or symptoms.
• Osteoporosis. This bone-thinning disorder can cause spinal curvature, especially if weakened vertebrae result in compression fractures. Osteoporosis is most common in older women and people who have taken corticosteroids for long periods of time.
• Disk degeneration. Soft, circular disks act as cushions between spinal vertebrae. With age, these disks dry out and shrink, which often worsens kyphosis.
• Scheuermann’s disease. Also called Scheuermann’s kyphosis, this disease typically begins during the growth spurt that occurs before puberty. Boys are affected more often than girls.
• Birth defects. Spinal bones that don’t develop properly before birth can cause kyphosis.
• Syndromes. Kyphosis in children can also be associated with certain syndromes, such as Ehlers-Danlos syndrome and Marfan syndrome.
• Cancer and cancer treatments. Cancer in the spine can weaken vertebrae and make them more prone to compression fractures, as can chemotherapy and radiation cancer treatments.
Symptoms of Kyphosis
The primary symptom of kyphosis is an abnormal forward curve in the upper part of the spine. It causes the upper back to appear hunched over, with the shoulders rounded forward.
In mild cases, the spinal curve is not always noticeable. In other instances, a person may look as if they are bending forwards.
Kyphosis often occurs without any other symptoms. However, other symptoms can include:
• back pain
• stiffness in the upper back
• a rounded back
• tight hamstrings
How is Kyphosis Diagnosed?
A doctor will diagnose kyphosis by performing a physical exam and assessing a person’s medical history.
The doctor may ask a person to do several exercises or stretches to assess how the condition affects their balance and range of motion.
Another common test involves laying on a flat surface while a doctor examines the spine. If the spine straightens out, this indicates it is flexible, and the cause is likely to be poor posture. If the spine remains curved, it is likely to be another form of kyphosis.
The doctor may take an X-ray to look at the structure of the vertebrae. In more severe cases, they may order other tests, such as a blood test or a lung function test.
Treatment of Kyphosis
The goal of treatment is to stop progression of the curve and prevent deformity. Your doctor will consider several things when determining treatment for kyphosis, including:
• Age and overall health
• The number of remaining growing years
• The type of kyphosis
• The severity of the curve
Nonsurgical treatment may include:
Your doctor may recommend simply monitoring the curve to make sure it does not get worse. You may be asked to return for periodic visits and x-rays.
Unless the curve gets worse or becomes painful, no other treatment may be needed.
Specific exercises can help relieve back pain and improve posture by strengthening muscles in the abdomen and back. Certain exercises can also help stretch tight hamstrings and strengthen areas of the body that may be impacted by misalignment of the spine.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
NSAIDs, including aspirin, ibuprofen and naproxen, can help relieve back pain.
The specific type of brace and the number of hours per day it should be worn will depend upon the severity of the curve. Your doctor will adjust the brace regularly as the curve improves.
Spinal fusion is the surgical procedure most commonly used to treat kyphosis.
The goals of spinal fusion are to:
• Reduce the degree of the curve
• Prevent any further progression
• Maintain the improvement over time
• Alleviate significant back pain, if it is present
Spinal fusion is essentially a “welding” process. The basic idea is to fuse together the affected vertebrae so that they heal into a single, solid bone. Fusing the vertebrae will reduce the degree of the curve and, because it eliminates motion between the affected vertebrae, may also help alleviate back pain.
During the procedure, the vertebrae that make up the curve are first realigned to reduce the rounding of the spine. Small pieces of bone—called bone graft—are then placed into the spaces between the vertebrae to be fused. Over time, the bones grow together—similar to how a broken bone heals.
Before the bone graft is placed, your doctor will typically use metal screws, plates and rods to increase the rate of fusion and further stabilize the spine.
Exactly how much of the spine is fused depends upon the size of the curve. Only the curved vertebrae are fused together. The other bones in the spine can still move and assist with bending, straightening, and rotation.