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Kyphosis: Causes, Symptoms and Treatment

Kyphosis is an excessive outward curvature of the spine, most commonly affecting the thoracic region. It can cause a rounded back, pain, and in severe cases, breathing difficulties.

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Things worth knowing about "Kyphosis"

Kyphosis is an excessive outward curvature of the spine, most commonly affecting the thoracic region. It can cause a rounded back, pain, and in severe cases, breathing difficulties.

What is Kyphosis?

Kyphosis refers to an abnormal forward rounding of the upper back. While a slight natural curve in the thoracic spine is normal, kyphosis is considered pathological when the curvature angle (Cobb angle) exceeds 45 degrees. Affected individuals often appear hunchbacked or have a visibly stooped posture.

Causes

Kyphosis can result from a variety of causes, depending on age and underlying conditions:

Postural kyphosis: Common in adolescents due to prolonged poor posture; usually reversible.
Scheuermann disease: A structural spinal condition in growing adolescents, where vertebral bodies become wedge-shaped.
Osteoporotic kyphosis: Vertebral compression fractures due to bone loss, particularly in older women.
Congenital kyphosis: Malformation of vertebral bodies present at birth.
Inflammatory conditions: Such as ankylosing spondylitis (Bechterew disease).
Tumors or spinal infections can also lead to kyphosis.

Symptoms

Symptoms vary depending on the severity of the curvature:

Visibly rounded upper back (hunchback or gibbous deformity)
Back and neck pain
Muscle tension and weakness
Reduced range of motion
In severe cases: breathing difficulties due to chest compression
Neurological deficits if the spinal cord is compressed

Diagnosis

Kyphosis is diagnosed through:

Physical examination: Assessment of posture and spinal curvature.
X-ray imaging: Measurement of the Cobb angle to quantify the degree of curvature.
MRI or CT scan: To evaluate structural changes, nerve involvement, or tumors.
Bone density scan (DXA): If osteoporosis is suspected.

Treatment

Treatment depends on the underlying cause and severity of the kyphosis:

Conservative Treatment

Physiotherapy: Strengthening of back muscles and improvement of posture.
Pain management: Use of analgesics or anti-inflammatory medications for significant pain.
Bracing: Particularly in adolescents with Scheuermann disease to prevent further progression.
Osteoporosis therapy: Calcium, vitamin D, and bisphosphonates to strengthen bone density.

Surgical Treatment

Surgery is rarely needed but may be indicated in cases of severe curvature (Cobb angle above 75 degrees), neurological deficits, or pain that does not respond to conservative treatment. The procedure typically involves realigning the vertebrae and stabilizing them with screws and rods (spinal fusion / spondylodesis).

References

Niethard, F. U., Pfeil, J., Biberthaler, P. (2014). Orthopädie und Unfallchirurgie. Thieme Verlag, 7th edition.
Lowe, T. G. et al. (2007). Etiology of idiopathic scoliosis: current trends in research. Journal of Bone and Joint Surgery, 89(Suppl 1), 93-98. PubMed PMID: 17272194.
World Health Organization (WHO). Musculoskeletal conditions. Retrieved from https://www.who.int/news-room/fact-sheets/detail/musculoskeletal-conditions

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