Kyphosis

People diagnosed with kyphosis typically have the appearance of poor posture. Often, as with Schuerreman’s disease, the rounded appearance of their back is not the result of poor posture but of a congenital condition. An orthopedist specializing in spinal disorders will help diagnose kyphosis, order tests to determine what kind you have, and determine the best treatments.

Kyphosis Definition

Kyphosis is a spinal disorder where the spine curves more than it should. A normal spine will have a forward curve measuring 20 degrees to 45 degrees. A patient with kyphosis will present an excessive outward curve of the upper back that is greater than 50 degrees.

Unlike scoliosis, kyphosis refers only to a forward curvature of the spine.

Types of Kyphosis

Kyphosis can affect both adults and children, and is most often seen in one of the following three forms:

• Age-associated hyperkyphosis results from generative conditions like osteoporosis, muscle weakness, and disc disease. Symptoms include:
  • Pain
  • Difficulty with movement and performing activities of daily life
  • Stiffness
  • Reduced height
• Scheurrmann’s kyphosis develops in children whose vertebrae are abnormally wedge-shaped, causing the forward curvature in the spine. Symptoms include:
  • Poor posture
  • Back pain
• Post-traumatic kyphosis typically affects the mid- to lower-back of people who have fractured one or several of their vertebrae in a traumatic injury. Symptoms include:
  • Spinal muscle fatigue
  • Chronic swelling
  • Progressive degeneration of the spine
  • Pinched nerve(s)
  • Problems with sitting balance with severe kyphosis
  • Skin alterations in paraplegic patients

Diagnosing Kyphosis

• Standing X-rays are usually the gold standard in diagnosing kyphosis, but elderly patients can be X-rayed laying on their backs
• MRI looks for compression of the nerves that could affect motor function Learn more about magnetic resonance scans
• CT scan provides enhanced imaging when X-ray is not adequate. Learn more about computed tomography imaging
• Biopsy can rule out underlying conditions like tumors or infection

Treatment for Kyphosis

Treatment goals entail pain relief, curve correction, spine stability, and improved neurologic function. Osteoporosis presents a challenge in that many of the indicated treatments for kyphosis don’t help the osteoporotic patients, although several medications—like teriparatide—can decrease the pain.

With Scheurmann’s kyphosis, early intervention is key. When treatment is initiated ahead of puberty while a child is still growing, an orthotic brace can straighten the spine and allow bone to grow in the vertebral spaces created by the bracing process.

Nonsurgical Treatments

• Non-steroidal anti-inflammatory medications (NSAIDs)
• Bracing or other orthotic devices
• Physical therapy and/or targeted daily exercise as directed by a clinician

Surgical Treatments

When conservative measures do not help, surgery is a viable option for controlling pain, correcting deformity, or decompressing nerve roots.

Surgical options for treating kyphosis include:

Spinal Fusion

This surgery is typically recommended for severe kyphosis with a forward curvature greater than 80° to 90° accompanied by chronic back pain. During this operation, vertebrae are connected, or fused, with two screws per vertebra and two rods. In most cases, spinal fusion surgery provides significant correction without the need for postoperative bracing. Patients are usually able to return to normal daily activities within four to six months following surgery.

Smith-Peterson Osteotomy

If Schuermann’s kyphosis is not corrected by orthotics before puberty is reached, the vertebral deformities become rigid and fixed. Bracing is not a corrective option post-puberty—but the Smith-Peterson osteotomy is. This procedure entails removing the bone in the back of the spine that connect the facet joint, enabling the spine to move to more of an upright position.