The spine has a normal curvature that allows weight to be supported in an upright posture. An exaggeration of this curvature is known as kyphosis. This curvature causes the top of the back to appear more rounded than normal. While some degree of curvature is normal, an evaluated curve of more than 50 degrees is considered diagnostic at The Center for Spinal Disorders. Kyphosis is most common in the thoracic spine, though it can also affect the cervical and lumbar spine.
Sometimes kyphosis does not cause any symptoms other than the back appearing abnormally curved or hunched. However, in some cases the condition results in back pain and stiffness, tenderness of the spine and fatigue.
Back pain can be particularly problematic in adults with kyphosis because the body has to compensate for the spinal abnormality. If you have severe kyphosis, your symptoms may get worse over time. This may lead to additional symptoms, such as having difficulty breathing and eating.
There are three main types of abnormal kyphosis:
Postural Kyphosis: Postural kyphosis is caused by poor posture and a weakening of the muscles and ligaments in the back. This can occur with slouching and carrying heavy bags, which can stretch the back ligaments and muscles, pulling the thoracic vertebrae out of their normal position.
Scheuermann’s Kyphosis: Most common in the upper back (the thoracic spine), Scheuermann’s kyphosis is the result of a structural deformity of the vertebrae and occurs when the front sections of the vertebrae grow slower than the back sections. This results in wedge-shaped vertebrae rather than rectangular-shaped vertebrae. In this condition, an x-ray shows a wedge in at least three vertebral bodies. The first signs appear in adolescence and it affects boys more often than girls.
Congenital Kyphosis: Congenital kyphosis is the least common type of abnormal kyphosis. It is caused in the first six to eight weeks of embryonic life as a result of a genetic mistake. This defect causes a failure of formation or failure of segmentation on the front part of one or more vertebral bodies and disc. As a result, the spine develops on a sharp forward angle as it grows, which is kyphosis.
- Poor posture with a hump appearance of the back or “hunchback”
- Back pain
- Muscle fatigue
Over time, kyphosis can lead to:
- Compression of the spinal cord with neurological symptoms including:
- Loss of sensation
- Loss of bowel and bladder control
- The amount of diminished space in the chest can cause cardiac and pulmonary problems leading to:
- Chest pain
- Shortness of breath
- Eventual pulmonary and/or heart failure.
- Poor posture (postural kyphosis)
- Osteoporosis (thinning of the bones) resulting in compression fractures in the vertebrae (the most common cause in adults)
- Degenerative arthritis
- Spine injury, infections or tumors
- Ankylosing spondylitis, an arthritic condition causing chronic inflammation of the spine and sacroiliac joints
- Genetics due to the fact some types of kyphosis tend to run in families
Anyone who develops signs or symptoms of kyphosis should be evaluated by a qualified physician, particularly if the symptoms worsen. A medical history is followed by a physical examination, which will allow the physician to assess the curve of the spine as well as strength and flexibility in the extremities (arms and legs), reflexes and motor skills. At the Center for Spinal Disorders, diagnosis is usually made following a physical examination and X-rays of the spine to measure the “kyphotic angle” (a kyphotic angle greater than 50 degrees is considered diagnostic). The possible indication for an MRI prescription is made if there is a suspicion of a neurological injury.
Bracing & physical therapy are indicated for some types of kyphosis.
Surgery is sometimes recommended for Scheuermann’s kyphosis, such as when the curve is severe and a patient suffers from uncontrolled pain and neurological, cardiac or breathing problems.
Surgery may be indicated for congenital kyphosis during infancy to correct kyphosis before it worsens. If all non-invasive means fail, surgery for kyphosis caused by osteoporosis is used as a last resort.
An appointment with an experienced spine expert such as Dr. Jonathan Lewin is important to assess this condition for the earliest possible treatment. After all non-surgical means are considered and/or used and if surgery is required, early surgical intervention generally produces the best results and can halt progression of the curve. The type of surgical procedure will depend on the nature of the abnormality.