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Kyphosis
What is kyphosis of the back?
When we look at the spine from the side, we can identify three natural curves. There is a lordosis in the cervical spine (neck), a kyphosis in the thoracic spine (mid-back), and a lordosis in the lumbar spine (lower back).
It is normal for the spine to have these curves and to form an S-shape when viewed from the side. In some cases, these curves become more pronounced, and when thoracic kyphosis exceeds 50°, it is considered pathological.
What are its types and symptoms?
The most common type is postural kyphosis (also called roundback), which is flexible and can be corrected if the patient makes an effort.
The second, rarer type is Scheuermann’s kyphosis, which results from degeneration of the intervertebral discs at a young age. It can be distinguished from postural kyphosis because it becomes more prominent when the patient bends forward and the back is observed from the side. The exact cause of Scheuermann’s disease is unknown, but it is likely hereditary, as it often appears in multiple members of the same family. It typically manifests between the ages of 12 and 14.
There is also kyphosis caused by fractures (from trauma or cancer) or by infections.
How is kyphosis diagnosed?
It can be diagnosed by having the patient bend forward while the doctor observes the spine from the side. In cases of acute kyphosis (such as from fractures or infections), the curvature is even more visible (known as a Gibbus deformity).
The doctor may also assess tightness in the hamstrings and any spinal pain. The main imaging test is a plain X-ray, which allows for the measurement of the curvature angle.
What are the treatment and management options?
Conservative treatment
Physical exercise is the recommended therapy for postural kyphosis.
For Scheuermann’s kyphosis, a brace is often prescribed to prevent the condition from worsening, provided that the child is still growing. The brace must be combined with physical therapy and exercise to maintain spinal mobility and muscle strength.
Surgical treatment
If kyphosis continues to progress despite conservative measures, or if it is already severe, surgery may be necessary.
Surgical intervention is typically considered when thoracic kyphosis exceeds 80–90°, whereas the normal thoracic curve ranges from 20° to 40°.
Spinal fusion is the standard procedure, and often requires spinal osteotomies (surgical cuts in the bones) to correct the deformity.
Frequently Asked Questions about Kyphosis
Can kyphosis be corrected?
It depends on the type of kyphosis. Postural kyphosis is a flexible form and can be corrected with physical exercise, physiotherapy and conscious correction of posture. In Scheuermann’s kyphosis, as long as growth is not complete, a brace can prevent it from getting worse, but it does not fully correct it. When the deformity is extensive, the correction is done surgically with spinal fusion, and in many cases osteotomies are also needed.
How is kyphosis treated in adults?
In adults, kyphosis usually develops as a result of osteoporotic fractures, inflammatory conditions or tumors, so treatment also targets the cause. In osteoporotic fractures of the spine, treatment includes pain relief until the fracture heals and treatment of osteoporosis, while if the pain persists, vertebroplasty and kyphoplasty may be considered. Surgery with spinal fusion is indicated when kyphosis progresses despite conservative treatment, or when the deformity is extensive and causes serious functional problems, such as chronic pain or difficulty breathing.
Can kyphosis be related to spinal disorders and not to bad posture?
In children, kyphosis is due either to bad posture or to abnormal growth, called Scheuermann’s disease. In adults, it usually develops as a result of osteoporotic fractures, inflammatory conditions or tumors.
Can kyphosis cause pain in the back or elsewhere?
Yes. Although postural kyphosis usually does not cause pain, progressive or pathological kyphosis can lead to chronic spinal pain, stiffness or even pressure on nerve roots.
Is there a way to prevent postural kyphosis?
Good posture, regular exercise and early monitoring in childhood and adolescence help prevent progressive postural kyphosis.
Does a brace fully correct kyphosis?
In mild to moderate Scheuermann’s kyphosis, and as long as growth is not complete, a brace can prevent the curve from getting worse. It does not fully correct it, but it works preventively.
What are the osteotomies used in kyphosis surgery?
Osteotomies are special cuts in the bones of the spine that make it easier to correct the deformity. They are often used in severe deformities for better alignment.
Can kyphosis come back after treatment?
If treatment is applied correctly and completed before the end of growth, the results are stable. However, long-term follow-up is needed.