Kyphosis is a term used to describe both a normal spinal condition and several abnormal spinal conditions. All people have some degree of kyphosis, a C curvature in the thoracic spine. In some cases, though, this C curvature is exaggerated, causing problems in posture, affecting range of motion, and often causing pain. In sufferers of abnormal kyphosis, the shoulders are hunched and the face is slightly forward, although in early development of some forms, this posture may not be particularly evident.
Abnormal kyphosis can be postural, as often seen in teen boys. Hunching the upper back and jutting the chin forward is corrected by teaching appropriate posture. This is the least dangerous of the different types of kyphosis, because it can be easily addressed and solved. Other types of kyphosis result from structural abnormalities, such as congenital defects, osteoporosis, Gibbous deformity, or Scheuermann’s Disease. In each case, early treatment significantly improves outcome, but treatment differs depending upon the cause.
Gibbous deformity is congenital and results in an angled curve in the lower spine, which should have a smooth curve. The result to the upper spine is a hunched back, which is generally more evident when a person bends forward.
Sheuermann’s Disease is more common in girls and generally develops at onset of puberty. The spaces between the discs in the vertebrae begin to decrease. The result is a stiff excessive C curve which can be painful.
Osteoporosis, because it also affects disc space and bone density, can result in a pronounced hunch. Since osteoporosis is progressive, this can be the most difficult type of kyphosis to treat. The outlook for improvement of osteoporosis is not favorable.
Kyphosis is diagnosed by palpation of the spine, neurological evaluation, a series of x-rays, and examination of range of motion. Magnetic resonance imaging may also be required if the physician suspects damage to the spinal column. In some cases, the treatment of kyphosis is simply to observe the progression of the curve. Since kyphosis is normal, a slightly advanced C curve may never progress to the point at which it creates problems. Any curve that measures between 55 and 60 degrees is usually treated in this manner.
When the curve is 60 to 80 degrees, physicians generally recommend using a brace, worn 23 hours a day, to keep the spine from curving further. This treatment is commonly used with Sheuermann’s disease. Anti-inflammatory medications may also be used to address discomfort and swelling. The physician may also recommend physical therapy, or alternative therapies like Pilates or yoga to increase the flexibility of the spine.
When children are born with spine abnormalities, they often need to be corrected surgically soon after birth. Spinal surgery is the treatment of last resort, given the complications of paralysis and infection that may occur. However, surgery can offer the possibility of normal growth and development for a child with structural kyphosis. Also, some adults choose spinal surgery for cosmetic reasons, since kyphosis can cause a pronounced hunch that is cosmetically distasteful.
For abnormal kyphosis caused by osteoporosis, bracing and corrective shoes may provide some relief but will not correct the curve. Other treatment focuses on slowing the progression of osteoporosis through hormone replacement therapy, increased calcium supplementation, and promoting exercise and weight loss for those patients who are overweight.
