Kyphosis, also referred to as either hunchback, flat back, round back or gibbous deformity, is an excessive curve of the spine noticeable when looking at the patient from the side and results in an exaggerated rounding of the upper back. Normally, there is a gentle curve but in kyphosis the curve is excessive.
The spine is made up of 24 bones, called vertebrae, which are stacked on top of one another. These bones connect to protect the spinal cord and form the natural curves of your back. The seven small vertebrae that begin at the base of the skull and form the neck comprise the cervical spine.
Your spinal cord and nerves travel through the spinal canal carrying messages between your brain and muscles. The intervertebral discs between your vertebrae are flexible, flat and round discs and are about a half-inch thick. They act as shock absorbers when you walk or run and allow motion between the vertebrae.
The natural curves of the spine allow us to stand upright and the curves should balance each other. The cervical and lumbar spine is balanced in lordosis (excessive inward curvature of the spine). The thoracic spine is balanced in kyphosis. Together, the curves balance each other into an “S” shape. If there is too much kyphosis, or alternately, not enough lordosis, our posture is pitched forward, with abnormal appearance, abnormal body posture and mechanics resulting in increased work needed to stand upright. The following list is only the most common types:
Types of Kyphosis
- Postural: Posture is easily correctable by just changing positions. Long-term solutions include parental and peer coaching, self-awareness, training with full length mirrors and sometimes physical therapy. There is no medical evidence that shows “bad postures” are associated with future adult problems.
- Scheuermann’s kyphosis: This is a stiff, fixed and rigid deformity and the most common adolescent kyphosis deformity. Because this is a true deformity it is not correctable simply with changes in posture and the teenager cannot simply “stand up straight” when asked.This is a growth disturbance of the vertebra bones where three or more vertebrae grow wedge shaped in the front of the spine rather than rectangle shaped. Mild to moderate Scheuermann’s kyphosis is very common and may not need any treatments. The condition becomes more severe after 75 degrees. Unlike scoliosis (spine curve when looking at the patient from the back) Scheuermann’s kyphosis can progress even as an early adult. Interventions for more severe Scheuermann’s kyphosis may include brace or surgery.
- Congenital: This stiff, rigid and fixed deformity is noticeable at six to eight years and sometimes earlier. The child is born with malformed bones or there is a bone bar that tethers the vertebrae, preventing normal growth. Surgery is commonly recommended for this type of congenital deformity, which may be progressive and disfiguring.
- Post-traumatic(PTK): This stiff, rigid and fixed deformity occurs after a vertebrae fracture from major trauma such a car accident, sudden fall or from the common osteoporotic vertebrae fractures in the elderly. Treatments may include brace, surgery or bone cement injection (kyphoplasty) especially in the elderly who may not tolerate surgery.
- Pathologic fracture: This stiff, rigid and fixed deformity may result from radiation therapy to treat bone tumors, or as a result of bone tumors which weaken the vertebrae enough to fracture.
- Post laminectomy: May result from necessary spine laminectomy microsurgery especially when necessary to remove spinal cord tumors in the growing child.
- Dwarfism: This is a stiff, rigid and fixed deformity associated with more rare types of skeletal dwarfism.
- Mild back pain
- Rounded shoulders
- A visible hump on the back
- Spine stiffness
- Tight hamstrings
- Loss of sensation
- Weakness or numbness in the legs
- Shortness of breath
Kyphosis is often noticed during scoliosis screening at school, which causes a parent to make an appointment with a spine specialist for their child. To determine whether your child has kyphosis, your physician will ask you for a complete medical history, have your child describe symptoms and conduct a physical examination. The physical examination will include having the child bend forward with both feet together, knees straight and arms hanging free. An X-ray or MRI is usually necessary to confirm the diagnosis.
Treatments may include a series of X-rays to document progression or spontaneous stabilization of the deformity, back brace or surgery. The decision for surgery depends on the patient’s age, the expected progression of the deformity, the amount of deformity, the risk of nerve damage if left untreated, knowledge of the patient’s overall health, and the quality of vertebral bone or presence of osteoporosis. Poor bone quality, chronic obstructive pulmonary disease (COPD), respiratory or heart problems, or poor overall health may not allow the patient to undergo surgery.
Surgery is tailored to the individual needs of the patient and may include one of many types of bone vertebral bone stabilizing surgeries. This may include surgery from the front of the spine, the back of the spine or from the side of the spine. Most commonly, surgery from the front and back of the spine may be recommended.
An osteotomy may be recommended for severe deformity. With an osteotomy, the vertebral bone is cut and reset to the normal angle and then stabilized in the corrected position with spine rods. Modern spine rods are made from either titanium or cobalt chrome alloy. These rods are MRI safe. Additionally, modern spine rods will not set off airport metal detectors.
In early diagnosis, kyphosis is treated successfully without surgery and children lead active and healthy lives. If left untreated, curve progression could lead to pain or problems during adulthood.
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