Kyphosis refers to a condition where the back is curved beyond normal. This condition occurs when the spine bends abnormally forward, curving more than it should at the thoracic level. The normal structure of the spine creates three natural curves when viewed from the side. The neck and lower back are characterized by "C-shaped" curves, while the thoracic region exhibits an "inverted C-shaped" curve.

Normally, the spine in the thoracic region should have a curve between 20 and 45 degrees. However, this curve can deviate from normal for various reasons. Doctors often refer to an excessively curved upper back in the thoracic region as "kyphosis." The natural curvature of the spine is important for balance and helps the body maintain an upright posture. If these curves are too large or too small, it can be difficult to stand upright, and posture may appear abnormal.

Kyphosis can occur in any age group, but it's more common during adolescence, a period of rapid bone growth. The severity of kyphosis varies from person to person. The greater the curve, the more serious the condition can be. Mild kyphosis can often cause back pain or no symptoms at all, while severe kyphosis can lead to a pronounced back curvature and spinal deformity.

What are the types of kyphosis?

There are different types and causes of kyphosis. The three main types, particularly common in children and adolescents, are:

• Postural kyphosis: Postural kyphosis, one of the most common types of kyphosis, usually becomes apparent during adolescence. This type of kyphosis is often clinically noticeable as poor posture or a hunchback. However, serious structural abnormalities of the spine are rare. The curvature caused by postural kyphosis is usually round and smooth. This curvature can usually be corrected when the person stands upright. It may be more common in girls than boys. It is rarely painful and may not cause problems in adulthood because the curve may not progress.
• Scheuermann's kyphosis: Scheuermann's kyphosis is named after the radiologist who first described the condition. Like postural kyphosis, it usually becomes apparent in adolescence. However, Scheuermann's kyphosis can cause a more pronounced deformity than postural kyphosis, especially in thin patients. Scheuermann's kyphosis is caused by structural abnormalities in the spine. In this condition, several consecutive vertebrae appear triangular on a spinal X-ray instead of the normal rectangular shape. The curve caused by Scheuermann's kyphosis is usually sharp and pronounced. Unlike a person with postural kyphosis, a person with Scheuermann's kyphosis cannot correct the curve by standing upright. Scheuermann's kyphosis usually affects the thoracic spine and can sometimes develop in the lumbar (lower) spine. It is more common in males and generally does not progress once growth is complete. While pain is rare, if present, it is usually felt at the highest point of the curve or in the lower back. Activity, such as prolonged standing or sitting, can worsen the pain.
• Congenital kyphosis: This type of kyphosis is present at birth, and the spine doesn't develop normally while the baby is in the womb. The bones may not form normally, or several vertebrae may fuse together. Congenital kyphosis usually worsens as the child ages.

Patients with congenital kyphosis often require surgery to stop the curve from progressing. These patients often have additional birth defects affecting other parts of the body, such as the heart or kidneys.

What are the symptoms of kyphosis?

Signs and symptoms of kyphosis can vary depending on the level of curvature and its cause. These symptoms may include:

• Rounded shoulders: When the spine curves, the shoulders can take on a rounded appearance, and this may be noticeable to the eye.
• A visible hump: In particularly severe cases of kyphosis, a noticeable hump may appear in the posterior part of the back.
• Mild back pain: In some cases, mild back pain may be felt.
• Fatigue: Kyphosis can cause a feeling of fatigue in a person because it affects body posture.
• Spinal stiffness: Curvature in the spine can restrict mobility and create a feeling of stiffness.
• Tight hamstrings: A feeling of tightness may occur in the muscles at the back of the thigh.

Rarely, cases of kyphosis that progress over time can cause the following symptoms:

• Weakness, numbness, or tingling in the legs: This can put pressure on spinal nerves, causing weakness, numbness, or a tingling sensation in the legs.
• Loss of sensation: If it puts pressure on the spinal nerves, loss of sensation may occur.
• Shortness of breath or breathing difficulties: Excessive curvature of the spine can affect the normal function of the lungs and breathing difficulties may occur.

Apart from these, certain causes of kyphosis can lead to the following symptoms:

• Fractures: Vertebral fractures can cause spinal curvature. Mild fractures often don't cause noticeable symptoms.
• Osteoporosis: When bone density decreases, weakened vertebrae can contribute to kyphosis, leading to compression fractures. This is particularly common in older women and those taking corticosteroids for extended periods.
• Disc degeneration: The drying and shrinkage of discs with age can often worsen kyphosis.
• Syndromes: Certain syndromes, especially in children, can be associated with kyphosis, such as Ehlers-Danlos syndrome and Marfan syndrome.
• Cancer and cancer treatments: Cancer in the spine or cancer treatments can weaken the spine and cause compression fractures.

How is kyphosis diagnosed?

Doctor's examination:

• First, a doctor will take a medical history and assess your symptoms. A physical exam will include examining your back and identifying areas of tenderness by applying pressure.
• The doctor may also direct the patient to examine their back by leaning forward. This helps identify the degree of spinal curvature and any deformities.
• He or she may also ask the patient to lie in certain positions to observe the patient's ability to straighten their back.

X-ray:

• Your doctor may request X-rays from different angles to identify the spinal structure and potential bone abnormalities. This allows you to measure the degree of the kyphotic curve. A curve greater than 50 degrees is typically considered abnormal.

Pulmonary function tests:

• If the severity of kyphosis affects breathing, your doctor may order pulmonary function tests. These tests evaluate whether the chest cavity is narrowed and breathing is restricted.

Other tests:

• Patients with congenital kyphosis may experience symptoms of spinal cord compression. If the patient experiences symptoms such as pain, tingling, numbness, or weakness in the lower back, the doctor may order neurological tests or a magnetic resonance imaging (MRI) scan. These tests can help evaluate spinal cord compression.

These tests and examinations help determine the type, severity, and potential effects of kyphosis so that the appropriate treatment plan and approach can be determined.

How is kyphosis treated?

Kyphosis treatment aims to halt the progression of the curve and prevent deformity. The treatment method depends on factors such as the patient's age, general health, type of kyphosis, and severity of the curve. Some of the treatment methods used include:

Non-surgical treatment:

• Observation: If it can be assured that kyphosis is not progressing, the doctor may recommend follow-up with regular check-ups.
• Physical therapy: Specific exercises can relieve back pain and improve posture by strengthening the back and abdominal muscles.
• NSAIDs: Medications such as aspirin and ibuprofen can be used to relieve back pain.
• Support: In cases of Scheuermann's kyphosis, a kyphosis brace may be recommended for growing children. This brace is adjusted regularly as the curve improves and is generally worn until skeletal maturity.

Surgical treatment:

• Spinal fusion: In this common surgical procedure, the spinal curvature is reduced and the vertebrae are fused together.
• Surgery: This involves straightening the vertebrae to realign the spine and then fusing them together using bone grafts (small pieces of bone). Metal screws, plates, and rods may also be used to stabilize the spine.

After surgery, the bones fuse together, making the spine more stable. Fusion can reduce spinal motion and alleviate back pain. This procedure aims to reduce the degree of curvature, prevent its progression, and alleviate any significant back pain.

The choice of treatment depends on the individual situation and the characteristics of the curvature. The doctor's recommended treatment method and process are customized to the patient's condition and needs.