Kyphosis

Definition

Kyphosis is an excessive forward curvature of the thoracic spine, resulting in a rounded or hunched back appearance. While a certain degree of thoracic curvature (20°–50°) is normal, kyphosis refers to a curvature exceeding the normal range, potentially leading to structural changes, pain, and impaired function.

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Types of Kyphosis

1. Postural Kyphosis

   • Most common type, particularly in adolescents.

   • Flexible curvature that improves with posture correction.

   • Not usually associated with structural vertebral changes.

2. Scheuermann’s Kyphosis

   • Structural deformity due to wedge-shaped vertebrae.

   • Typically develops during adolescence.

   • Often accompanied by tight hamstrings and mild scoliosis.

3. Congenital Kyphosis

   • Present at birth due to abnormal spinal development.

   • May progress rapidly and require early surgical intervention.

4. Age-related/Degenerative Kyphosis

   • Associated with osteoporosis, vertebral fractures, and degenerative disc disease.

   • Common in older adults, especially postmenopausal women.

5. Secondary Kyphosis

   • Caused by other conditions such as ankylosing spondylitis, neuromuscular disorders, spinal infections, tumors, or trauma.

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Causes and Risk Factors

Causes

• Poor posture over time (postural).

• Structural vertebral anomalies (Scheuermann’s).

• Osteoporotic vertebral compression fractures.

• Congenital malformations of the spine.

• Chronic inflammatory spinal diseases.

• Spinal infections (e.g., tuberculosis).

• Spinal tumors or metastases.

Risk Factors

• Osteoporosis.

• Female sex (especially postmenopausal).

• Family history of spinal deformity.

• Low bone mineral density.

• Neuromuscular disorders.

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Clinical Presentation

Symptoms

• Visible rounded upper back or hump.

• Back pain and stiffness.

• Fatigue due to muscle strain.

• In severe cases: breathing difficulty (due to reduced thoracic cavity volume).

Signs

• Exaggerated thoracic curve on inspection.

• Reduced spinal flexibility.

• Forward head posture and rounded shoulders.

• In structural types: curvature remains when bending forward.

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Diagnosis

Clinical Evaluation

• Physical examination: assessment of curvature, flexibility, and neurological status.

• Adam’s forward bend test (flexibility assessment).

Imaging

• X-ray spine: Measures Cobb angle to quantify curvature severity.

  • Normal: 20°–50°

  • Kyphosis: >50°

• MRI: Evaluates spinal cord involvement, tumors, or soft tissue pathology.

• Bone density scan: If osteoporosis suspected.

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Management

1. Conservative Management

Appropriate for mild to moderate cases without significant neurological compromise.

Postural Kyphosis

• Physical therapy: Strengthening of back extensors, stretching of chest muscles, core stability training.

• Postural training: Ergonomic correction and awareness.

Scheuermann’s Kyphosis (mild/moderate)

• Bracing: Especially effective in skeletally immature patients with curves 50°–75°. Thoracolumbosacral orthosis (TLSO) worn for 16–20 hours/day until skeletal maturity.

• Exercise programs: Hamstring stretches, back extension exercises.

Osteoporotic Kyphosis

• Osteoporosis treatment:

  • Alendronic acid: 70 mg orally once weekly.

  • Risedronic acid: 35 mg orally once weekly.

  • Ibandronic acid: 150 mg orally once monthly or 3 mg IV every 3 months.

  • Zoledronic acid: 5 mg IV once yearly.

  • Calcium carbonate: 500–600 mg orally twice daily.

  • Vitamin D3 (cholecalciferol): 800–1,000 IU orally daily.

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2. Pharmacological Pain Management

• Paracetamol: 500–1,000 mg orally every 4–6 hours as needed (max 4 g/day).

• Ibuprofen: 200–400 mg orally every 6–8 hours as needed (max 1,200 mg/day OTC; up to 2,400 mg/day under supervision).

• Naproxen: 250–500 mg orally twice daily with food.

• Topical NSAIDs (diclofenac gel) for localized pain.

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3. Surgical Management

Indications:

• Cobb angle >75° with symptoms.

• Progressive curvature despite bracing.

• Severe pain or neurological compromise.

Procedures:

• Spinal fusion with instrumentation to correct and stabilize the spine.

• Vertebroplasty/kyphoplasty for osteoporotic vertebral fractures.

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Complications

• Chronic back pain.

• Reduced lung capacity.

• Nerve compression symptoms (in severe cases).

• Psychological effects due to appearance changes.

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Prognosis

• Postural kyphosis: Good prognosis with posture correction and exercise.

• Scheuermann’s kyphosis: Progression possible; early intervention improves outcomes.

• Osteoporotic kyphosis: Progressive without osteoporosis management.

• Congenital kyphosis: Often requires surgery; prognosis depends on early detection and correction.