Kyphosis (Roundback)

There are three main types of abnormal kyphosis: postural kyphosis, Scheuermann's kyphosis (Scheuermann's disease), and congenital kyphosis.

There are three main types of kyphosis: postural, Scheuermann's, and congenital.

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 inward curvature that health care professionals call lordosis or lordotic curvature by which the spine is bent backward. The thoracic spine (upper back) has a normal outward curvature that is health care providers call

Kyphosis or the kyphotic curve by which the spine is bent forward. The official medical term for an abnormal curvature of the thoracic spine is hyperkyphosis. However, abnormal kyphosis and hyperkyphosis are commonly referred to as kyphosis by the medical community, so in this discussion, the term kyphosis will be used to discuss abnormal kyphosis. In other words, kyphosis is a deformity of the spine of the upper back causing an exaggerated outward curve.

The spine is normally straight when looking 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 with adolescence, degenerative spinal changes in adulthood, or abnormal twisting of the vertebrae because of muscle spasm after an injury.

The normal curves of the spine allow the head to balance directly over the pelvis. If one or more of these curves is either too great or too small, the head may not properly balance over the pelvis. This can lead to back pain, stiffness, and an altered gait or walking pattern.

There are three main types of abnormal kyphosis: postural kyphosis, Scheuermann's kyphosis (Scheuermann's disease), and congenital kyphosis.

Postural kyphosis is the most common type of kyphosis. This is more common in girls than in boys and typically appears during adolescence. Poor posture (slouching) and a weakening of the muscles and ligaments in the back (paraspinous muscles) cause postural kyphosis. Typically, the vertebrae are a normal shape in postural kyphosis. It is often slow to develop and usually does not continue to become progressively worse with time. These patients can have symptoms of pain and muscle fatigue. This is commonly mild kyphosis. This type of kyphosis does not lead to a severe curve, and there is little risk of neurologic, cardiac, or pulmonary problems.

Scheuermann's kyphosis also first appears during adolescence. This type of kyphosis is the result of a structural deformity of the vertebrae. It is more common to develop scoliosis (kyphoscoliosis) with Scheuermann's kyphosis than with the other types of kyphosis. The diagnosis requires X-rays to show a wedge of at least 5 degrees at the front of at least three neighboring vertebral bodies. Physicians do not understand the reason for this abnormal wedging of the vertebrae.

Congenital kyphosis is the least common type of abnormal kyphosis. Abnormal development of the vertebrae during development prior to birth causes congenital kyphosis. This can lead to several of the vertebrae growing together (fusing) in kyphosis.

There are other disorders that can lead to different types of kyphosis in adults. Each of these disorders can lead to a collapse of the front of the vertebrae and the development of kyphosis. The most common of these is from sustaining multiple compression fractures of the bony building blocks of the spine (vertebrae) from osteoporosis (thinning of the bones). Multiple wedge-shaped deformities resulting from compression fractures in the thoracic spine can lead to severe kyphosis. Other causes include degenerative arthritis, spine infections, and spine tumors. Ankylosing spondylitis can lead to spinal fusion and severe kyphosis.

The most common symptom of scoliosis is the curvature of the spine. Source: Getty Images

The most common symptoms for patients with an abnormal kyphosis are the appearance of poor posture with a hump appearance of the back or "roundback." Symptoms may include back pain, muscle fatigue, and stiffness in the back. Most often, these symptoms remain constant and do not become progressively worse with time.

In more severe situations, the patient may notice their symptoms worsening with time. The kyphosis can progress, causing a more exaggerated hunchback. In rare cases, this can lead to compression of the spinal cord with neurologic 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 cardiac and pulmonary problems leading to chest pain or shortness of breath with eventual pulmonary and/or heart failure.

Your doctor will likely begin by obtaining your medical history, including when you first noticed your symptoms, any history of family members with similar problems, and other history of back or neck problems. A doctor will perform a physical examination. This will assess the curve of your spine both standing upright and while bending forward. A health care professional will test your strength, sensation, reflexes, and flexibility in your arms and legs.

Based on the results of the history and physical examination, your physician may order X-rays of your spine. This can help differentiate postural kyphosis (normal shaped vertebrae) from Scheuermann's kyphosis (wedged-shaped vertebrae). If your doctor finds any evidence of neurologic injury, you may also obtain 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 physician may order additional tests to evaluate your heart and lungs.

Postural changes cause most cases of kyphosis, and it rarely progresses to cause serious complications. However, a physician should evaluate any patient who develops signs or symptoms of kyphosis to rule out a more serious cause. A referral to an orthopedist may be necessary for proper evaluation and treatment. Additionally, a physician should evaluate any patient with worsening of symptoms or who develops any weakness, numbness, or tingling in the legs or chest pain and shortness of breath.

Treatment options depend on the type of kyphosis. Nonsurgical treatment is most common. Physical therapy strengthens the back muscles and corrects the posture of individuals with postural kyphosis. Mild pain relievers and anti-inflammatory medications can also help with symptoms. These curves do not continue to worsen with time or lead to complications that are more serious. Surgery is unnecessary for postural kyphosis.

Initially, health care 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. Physicians often recommend braces for more severe kyphosis with curves of at least 45 degrees and can be continued until the patient is no longer growing. X-rays are frequently used to monitor the degree of kyphosis over time. Bracing is not typically recommended for adults who are no longer growing.

In some cases, physicians recommend surgery for Scheuermann's kyphosis. The goals of surgery are to partially correct the deformity of the kyphosis, relieve pain, and improve your overall spinal alignment. Indications for surgery include a curve greater than 75 degrees, uncontrolled pain, and neurologic, cardiac, or pulmonary complaints.

There are various types of surgical procedures available depending on the specifics 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 health care professional may obtain X-rays bending forward and backward to determine how flexible the spine is. If it is flexible, a posterior approach may be adequate. If the spine is less flexible, an anterior or combined approach may be used. Regardless of the approach, the surgery involves partially straightening your spine and using rods and screws in the vertebrae to hold the spine while a bony fusion occurs (spinal fusion).

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 continues to worsen.

Sometimes, a procedure called kyphoplasty treats kyphosis from the painful collapse of vertebrae due to osteoporosis. With kyphoplasty, a balloon is inserted into the affected vertebra and filled with a liquid (methyl methacrylate) that hardens to restore the vertebral height. This procedure is a last resort after the failure of noninvasive treatment.

The most common complications from surgery for kyphosis include infection and failure of the bones to heal (failure of fusion, also known as pseudoarthrosis). Other more serious complications are much less common, including injury to the nerves or blood vessels, complications related to anesthesia, or blood clots in lower extremities or lungs.

Most patients with kyphosis do not require continued care by a physician. After the initial diagnosis and initiating physical therapy and exercises, the patient will often not need routine follow-up care. Patients that notice a progression of their curve or a worsening of their symptoms should see their doctor for further evaluation.

The majority of patient with kyphosis respond very well to a combination of physical therapy, exercises, and medications. Even in more severe cases that eventually require surgery, patients are able to return to normal activities without restrictions, in most cases, after they have fully recovered from surgery.

Scheuermann's and congenital kyphosis are both the result of a structural problem with the vertebrae. As a result, there is nothing that people can do to prevent these types of kyphosis. Bracings and exercises can help slow the progression of Scheuermann's kyphosis. It's possible to prevent postural kyphosis or lessen the severity with physical therapy and exercises to strengthen the back muscles.