Kyphosis

Kyphosis is a curving of the spine that causes a bowing or rounding of the back, which leads to a hunchback or slouching posture.

Alternative Names

Scheuermann disease; Roundback; Hunchback; Postural kyphosis

Causes

Kyphosis can occur at any age, although it is rare at birth.

A type of kyphosis that occurs in young teens is known as Scheuermann disease. It is caused by the wedging together of several bones of the spine (vertebrae) in a row. The cause of this condition is unknown.

In adults, kyphosis can be caused by:

Degenerative diseases of the spine (such as arthritis or disk degeneration)
Fractures caused by osteoporosis (osteoporotic compression fractures)
Injury (trauma)
Slipping of one vertebra forward on another (spondylolisthesis)

Other causes of kyphosis include:

Certain endocrine diseases
Connective tissue disorders
Infection (such as tuberculosis)
Muscular dystrophy
Neurofibromatosis
Paget disease
Polio Scoliosis
Spina bifida
Tumors

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Symptoms

Symptoms may include any of the following:

Difficulty breathing (in severe cases)
Fatigue
Mild back pain
Round back appearance
Tenderness and stiffness in the spine

Exams and Tests

Physical examination by a health care provider confirms the abnormal curve of the spine. The doctor will also look for any nervous system (neurological) changes (weakness, paralysis, or changes in sensation) below the curve.

Tests that may be ordered include:

Spine x-ray
Pulmonary function tests (if kyphosis affects breathing)
MRI (if there may be a tumor, infection, or nervous system symptoms)
Bone density test (if there may be osteoporosis)

Treatment

Treatment depends on the cause of the disorder:

Congenital kyphosis requires corrective surgery at an early age.
Scheuermann disease is treated with a brace and physical therapy. Sometimes surgery is needed for large (greater than 60 degrees), painful curves.
Compression fractures from osteoporosis can be left alone if there are no nervous system problems or pain. But the osteoporosis needs to be treated to help prevent future fractures. For severe deformity or pain from osteoporosis, surgery is an option.
Kyphosis caused by infection or tumor needs prompt treatment, often with surgery and medicines.

Treatment for other types of kyphosis depends on the cause. Surgery is needed if nervous system symptoms or persistent pain develop.

Outlook (Prognosis)

Young teens with Scheuermann disease tend to do well, even if they need surgery. The disease stops once they stop growing. If the kyphosis is due to degenerative joint disease or multiple compression fractures, surgery is needed to correct the defect and improve pain.

Possible Complications

Untreated kyphosis can cause any of the following:

Decreased lung capacity
Disabling back pain
Nervous system symptoms, including leg weakness or paralysis
Round back deformity

Prevention

Treating and preventing osteoporosis can prevent many cases of kyphosis in the elderly. Early diagnosis and bracing for Scheuermann disease can reduce the need for surgery, but there is no way to prevent the disease.

References

Spiegel DA, Dormans JP. The spine. In: Kliegman RM, Stanton BF, St. Geme JW III, et al., eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 671.

Warner WC, Sawyer JR, Kelly DM. Scoliosis and kyphosis. In: Canale ST, Beaty JH, eds. Campbell's Operative Orthopaedics. 12th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 41.