Kyphosis

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at June 27, 2016
StartDiseasesKyphosis

Kyphosis is an exaggerated rounding of the forward curvature of the spine. The condition is most common in older women, but it can occur at any age. Kyphosis is sometimes referred to as a dowager’s hump, hunchback, or humpback

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Definition & Facts

When viewed from the side, the thoracic spine has a normal forward curvature of approximately 20 to 50 degrees. This forward curvature is offset by a reverse curve called lordosis in the cervical spine and lumbar spine. This combination of curvatures allows an individual to stand or sit in an upright position. The kyphotic curve is considered excessive when it exceeds 50 degrees.

There are several different types of kyphosis. Postural kyphosis, as the name implies, is related to poor posture. The thoracic hump will normally be smooth and round. A person can typically correct postural kyphosis by adjusting their sitting or standing position. Congenital kyphosis is the result of a spinal defect that causes it to curve too much. Congenital kyphosis is often associated with heart problems and kidney problems since these organs develop at the same time as the spine.

Scheuermann’s kyphosis is most often seen among adolescents. It occurs when the front of the vertebrae grows slower than the back of the vertebrae. This causes the vertebrae to become wedge-shaped, leading to excessive curvature. Secondary structural kyphosis occurs when another condition weakens the spine to the point of fracturing. The structural defects then cause the spine to curve forward. 

Symptoms & Complaints

Mild cases of kyphosis often do not cause any symptoms. As the spinal curvature becomes more pronounced, however, it can cause a variety of symptoms, including:

  • A bent or hunched forward appearance, especially when viewed from the side. 
  • Back pain ranging from mild to severe.
  • A decrease in height.
  • Fatigue.
  • Problems sitting or standing upright that may worsen throughout the day.

Severe cases of kyphosis can be disfiguring, painful, and even cause breathing problems and difficulty eating due to the compression of the various organs.

Causes

Kyphosis that is unrelated to congenital defects or spinal growth during adolescence can be caused by a number of factors, including:

Diagnosis & Tests

To diagnose abnormal kyphosis, the doctor will typically start with a physical examination to assess any changes in height and to evaluate spinal curvature. The doctor will evaluate the curve of the spine with the patient standing upright and while the patient is bent forward at the waist since kyphosis is most obvious in this position.

The doctor will also perform a neurological examination to test reflexes, strength, sensation, and flexibility in the arms and legs. Standard X-rays are used to detect spinal deformities and to determine the specific degree of spinal curvature, which can help identify the type of kyphosis.

A CT scan may also be used if a more detailed picture of the spinal structures is required. A CT takes pictures from multiple angles and compiles them to form a cross-sectional image. An MRI may be used to rule out tumors and infections and to determine if there is any compression of the nerves or spinal cord. A MRI uses radio waves in conjunction with a powerful magnet to create detailed pictures of soft tissue and bone.

The doctor may also order nerve conduction tests if a patient is experiencing muscle weakness or numbness in the arms or legs. These tests measure the strength of nerve impulses traveling between the spinal cord and the extremities

Treatment & Therapy

The treatment of kyphosis depends on the cause as well as the type and severity of the symptoms. Over-the-counter and prescription pain relievers may be used to ease discomfort. Post-menopausal women suffering from kyphosis are often prescribed bone-strengthening drugs, such as bisphosphonates, calcitonin, denosumab, teriparatide, and raloxifene, to slow bone loss and build bone mass.

Exercises that build abdominal strength and increase spinal flexibility can improve postural kyphosis. Back braces can stop the progression of kyphosis in children with Scheuermann’s kyphosis who are still growing. A diet rich in calcium and vitamin D can strengthen bones and prevent compression fractures that can cause kyphosis. A healthy lifestyle that includes maintaining a healthy body weight can help alleviate kyphosis-related back pain symptoms.

Severe curvatures which compress the spinal cord or nerve roots typically require surgery. The most common surgery for kyphosis is a spinal fusion. This procedure involves inserting a small piece of bone between the affected vertebrae and then connecting them together using metal rods and screws until they heal together in the desired position. Congenital kyphosis typically requires surgery while the child is quite young to keep the condition from progressing.

Prevention & Prophylaxis

Patients with kyphosis generally respond well to exercise, physical therapy, and medications. Even patients requiring surgery are often able to return to their normal activities following a sufficient recovery time. There is no way to prevent congenital or Scheuermann’s kyphosis; however, bracing and exercise can prevent the progression of Scheuermann’s kyphosis.

Postural kyphosis can be corrected through physical therapy and exercises to strengthen back muscles and abdominal muscles. Post-menopausal women should talk to their doctor about getting periodic bone density tests to detect early bone loss. Weight-bearing exercise and medications can often reverse or prevent osteoporosis-related bone loss and subsequent kyphosis. 

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