Kyphosis

What is kyphosis?

Kyphosis is a condition where your spine curves outward more than it should. This causes your upper back around the thoracic region (the part of your spine between your neck and ribs) to bend forward. The curvature can make it look like you’re hunched over or slouching. People sometimes call it “hunchback” or “roundback.”

Your spine has natural curves. These curves support your posture and help you stand straight. But excessive curvature can affect your body and make standing difficult.

Most of the time, kyphosis doesn’t cause health problems or need medical treatment. But it may make you feel self-conscious about how you look. In severe cases, kyphosis can cause pain or breathing issues. Severe kyphosis may require surgery.

What are the types of kyphosis?

There are several types of kyphosis. Some of the most common include:

• Postural kyphosis: This is the most common type of kyphosis. It usually happens during your teenage years. Slouching or poor posture stretches the ligaments and muscles holding your vertebrae (spinal bones) in place. Stretching pulls your vertebrae out of their normal position, causing a rounded shape in your spine. It affects more children assigned female at birth than children assigned male at birth. It doesn’t usually cause pain.
• Scheuermann’s kyphosis: This type happens when vertebrae have a different shape than expected. Instead of being rectangular, your vertebrae have a wedge shape. The wedge-shaped bones curve forward, making your spine look rounded. It affects children assigned male at birth more than children assigned female at birth. Scheuermann’s kyphosis can be painful, especially during activity or when standing or sitting for a long time. Changing your position or posture doesn’t change the curve, as your vertebrae aren’t flexible.
• Congenital kyphosis: Congenital means a condition present at birth. Congenital kyphosis occurs when your spine doesn’t properly develop or develop completely in the uterus. It can increase in severity as you grow. Surgery can correct the spine curvature during childhood to prevent it from worsening. It can happen in addition to other congenital growth defects like those that affect your heart and kidneys.
• Cervical kyphosis (military neck): This type occurs when your cervical spine, or the part of your spine at the bottom of your head to your upper back), curves toward your front instead of its natural curve to your back.
• Hyperkyphosis: Hyperkyphosis is a severe forward curvature of the spine. The curve measures more than 50 degrees. This type is common after age 40.

How common is kyphosis?

Less than 8% of school-aged children in the United States experience Scheuermann’s kyphosis.

Hyperkyphosis (severe kyphosis) affects an estimated 20% to 40% of adults over age 60. On average, the forward angle of your upper spine increases about 3 degrees each decade (10 years).

What are the symptoms of kyphosis?

The main symptoms of kyphosis include:

• Rounded shoulders.
• A curve or hump in your upper back.
• Tight hamstrings (muscles in the back of your thighs).

Severe kyphosis may cause the following symptoms:

• Pain or stiffness in your back and shoulder blades.
• Numb, weak or tingling legs.
• Extreme fatigue.
• Balance issues.
• Bladder incontinence or bowel incontinence.
• Shortness of breath or difficulty breathing.

If you have difficulty breathing, contact 911 or your local emergency services number.

What causes kyphosis?

The cause of kyphosis varies depending on the type but could include:

• Poor posture.
• Structural abnormalities of the bones in your spine.
• Bone growth abnormalities (shape of the bone).
• Spinal injury.
• Your age.

Can kyphosis turn into scoliosis?

No. Kyphosis and scoliosis are both conditions that affect your spine. They can happen together, but one doesn’t cause the other. Kyphosis is the abnormal curvature of the spine, from front to back. Scoliosis is the abnormal curvature of the spine, from left to right or sideways.

What are the risk factors for kyphosis?

A kyphosis diagnosis is common between ages 13 and 16 for postural and Scheuermann’s kyphosis. This is because teenagers’ bones are growing rapidly. But it can develop in anyone at any age. As humans age, the vertebrae lose flexibility, and the spine may begin to tilt forward.

You can also be born with the congenital form of kyphosis. This can happen in addition to other underlying health conditions that affect your growth and development in the uterus.

What are the complications of kyphosis?

Complications aren’t common for mild cases of kyphosis but they can happen when you have a severe spine curve. Complications may include:

• Back pain.
• Difficulty walking.
• Lung compression (difficulty breathing).
• Neurological issues (pinched nerves).

How is kyphosis diagnosed?

Among children, you (your child’s caregiver) or a school physician (nurse) may notice symptoms of kyphosis, especially at school during a scoliosis screening. Your child’s school may recommend your child visit a primary care physician for an exam to confirm a diagnosis.

At any age, your healthcare provider will diagnose kyphosis after a physical exam. During the physical, your provider will ask you or your child to perform a bending test. You’ll stand with your feet together, knees straight and your arms hanging at your side. Then, you’ll gently bend forward, looking toward your feet. This test helps your provider see the spine curve or any other spine problems.

What tests diagnose kyphosis?

A spine X-ray helps your healthcare provider measure the curve of your spine to diagnose the condition. The natural curve is between 20 and 45 degrees. Your provider will diagnose kyphosis if the curve is greater than 50 degrees.

In addition, your healthcare provider will offer tests to determine if your symptoms are the result of an underlying condition or if the curve in your spine affects other parts of your body. Tests may include:

• A pulmonary function test to measure how well your lungs are working.
• An MRI to determine if your spine curve causes pressure on your spinal nerves.

How is kyphosis treated?

Treatment for kyphosis varies but could include:

• Physical therapy: Exercises can strengthen abdominal and back muscles to relieve pain and improve posture. Exercise can also stretch tight hamstrings and strengthen other areas of your body.
• Pain medication: Anti-inflammatory medications relieve back pain.
• Back brace: Your provider may recommend that you wear a brace. It’s most common when children who are still growing have Scheuermann’s kyphosis. Your provider will discuss the type of brace and how many hours a day to wear it.
• Surgery: A surgical procedure can reduce spine curvature. The most common kyphosis surgery is spinal fusion surgery. During this procedure, your surgeon lines up your vertebrae in a straighter position. They’ll fuse them together by using small pieces of bone to fill the spaces between your vertebrae. As your vertebrae heal, they fuse or join together. This procedure reduces the severity of the curve.

How will my healthcare provider decide what kyphosis treatment I need?

A healthcare provider will examine your spine and offer treatment options based on your:

• Age.
• Medical history.
• General health.
• Kyphosis type.
• Curve severity.
• Difficulty breathing.

You may qualify for spine surgery if you have:

• Congenital kyphosis.
• Scheuermann’s kyphosis with a curve of more than 75 degrees.
• Severe back pain, even after trying nonsurgical or conservative treatment.

Are there side effects of the treatment?

Each type of treatment comes with possible side effects. Talk to your healthcare provider before treatment begins to understand the risks and side effects. For example, side effects of surgery could include infection and bleeding at the incision site.

Can kyphosis be prevented?

You can’t prevent all types of kyphosis. You can take steps to prevent postural kyphosis by:

• Maintaining good posture.
• Strengthening abdominal and back muscles.
• Maintaining a healthy weight.
• Carrying bags or schoolbooks and supplies in a sturdy backpack or roller bag.
• Exercising to strengthen your muscles and stay flexible.

What can I expect if I have kyphosis?

Kyphosis is a treatable spine condition. The curve may or may not cause you pain and you might not even notice it until a healthcare provider mentions it during an exam. The goal of treatment is to stop the curve from getting worse. In severe cases, you may need surgery. But most people with kyphosis don’t need surgery.

Does kyphosis come back?

Kyphosis can return, even after treatment. You may need to make lifestyle changes to adjust your posture. This means being more aware of how you sit, stand and move throughout the day. For example, you might choose to use a roller bag instead of carrying schoolbooks in a backpack. Talk to your healthcare provider about what you can do to prevent kyphosis from coming back.

What’s the outlook for kyphosis?

An early kyphosis diagnosis leads to the best outcome. Most people who receive an early diagnosis don’t need surgery and can manage the condition with nonsurgical options. Kyphosis can get worse if left untreated. This can cause health problems like difficulty breathing.

It’s important to monitor kyphosis regularly with a healthcare provider throughout your life, even after treatment.

When should I see a healthcare provider?

Talk to a healthcare provider if you notice a curve in your or your child’s spine that affects your or their posture. A healthcare provider can evaluate your symptoms and help you improve your posture, if necessary.

Visit the emergency room if you have difficulty breathing.

What questions should I ask my healthcare provider?

If you or your child have kyphosis, ask your provider:

• How severe is the curve?
• Will I need surgery?
• What nonsurgical treatments can help?
• Should I do physical therapy?
• How can I stop the curve from getting worse?
• Are there side effects of treatment?