What is kyphosis?
A normal spine, when viewed from behind appears straight. A spine affected by kyphosis, however, shows evidence of a forward curvature of the back bones (vertebrae) in the upper back area, giving a "humpback" appearance.
The Scoliosis Research Society defines kyphosis as a curvature of the spine measuring 45 degrees or greater on an x-ray. The normal spine typically has 20 to 45 degrees of forward curvature in the upper back area. Kyphosis is a type of spinal deformity and should not be confused with poor posture.
What causes kyphosis?
Most commonly, kyphosis is postural and represents an exaggerated but flexible curve. Usually postural kyphosis is noted during adolescence and is more common in girls than boys. It rarely causes pain, but exercises to strengthen the abdominal muscles and stretch the hamstrings may improve associated discomfort. Postural kyphosis rarely causes problems into adult life.
Other types of kyphosis can be congenital (present at birth), or due to acquired conditions that may include the following:
- metabolic problems
- neuromuscular conditions
- osteogenesis imperfecta - also called "brittle bone disease." A condition that causes bones to fracture with minimal force.
- spina bifida
- Scheuermann's disease - a condition that causes the vertebrae to curve forward in the upper back area. The cause of Scheuermann's disease is unknown and is commonly seen in males.
What are the symptoms?
The following are the most common symptoms of kyphosis. However, each individual may experience symptoms differently. Symptoms may include:
- difference in shoulder height
- the head bends forward compared to the rest of the body
- difference in shoulder blade height or position
- when bending forward, the height of the upper back appears higher than normal
- tight hamstrings (back thigh) muscles
Back pain, pain down the legs, and changes in bowel and bladder habits are not commonly associated with kyphosis. A person experiencing these types of symptoms requires further medical evaluation by a physician.
The symptoms of kyphosis may resemble other spinal conditions or deformities, or may be a result of an injury or infection. Always consult your physician for a diagnosis.
How is kyphosis diagnosed?
The physician makes the diagnosis of kyphosis with a complete medical history, physical examination, and diagnostic tests. If the patient is a child, the physician obtains a complete prenatal and birth history of him/her and asks if other family members are known to have kyphosis.
The physician also will ask about developmental milestones since some types of kyphosis can be associated with other neuromuscular disorders. Developmental delays may require further medical evaluation.
Diagnostic procedures may include the following:
- x-ray - a diagnostic test which uses invisible energy beams to produce images of bones onto film.
- computed tomography scan (Also called a CT or CAT scan.) – a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs.
- magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body; can often determine damage or disease in an intervertebral disc, vertebral body, spinal cord, nerve roots, ligaments, and muscle.
- radionuclide bone scan - a nuclear imaging technique that uses a very small amount of radioactive material, which is injected into the patient's bloodstream to be detected by a scanner. This test shows blood flow to the bone and cell activity within the bone.
- blood tests
Early detection of kyphosis is important for successful treatment. Pediatricians or family physicians, and even some school programs, routinely look for signs that kyphosis may be present.
Treatment of kyphosis
Specific treatment for kyphosis will be determined by your physician based on:
- your age, overall health, and medical history
- extent of the condition
- your tolerance for specific medications, procedures, and therapies
- expectation for the course of the disease
- your opinion or preference
The goal of treatment is to stop the progression of the curve and prevent deformity. According to the Scoliosis Research Society, treatment may include:
- observation and repeated examinations
Observation and repeated examinations for curves that measure less than 60 degrees on an x-ray. Progression of the curve depends upon the amount of skeletal growth, or how skeletally mature, the child is. Curve progression slows down or stops after the child reaches puberty.
Bracing may be used when the curve measures between 60 to 80 degrees on an x-ray, but skeletal growth remains. The type of brace and the amount of time spent in the brace will be determined by your physician.
In rare instances, surgery is recommended when the curve measures 80 degrees or more on x-ray and bracing is not successful in slowing down the progression of the curve.