What Is Kyphosis?
Kyphosis is a condition in which your upper spine curves forward more than usual. Your spine is made up of three sections: the cervical spine, lumbar spine, and thoracic spine. When you look at a spine from the side, you can see three natural curves in these sections. These curves are necessary for you to stay upright and balanced.
Typically, the C-shaped curve in your thoracic spine — the section in your upper and mid-back — curves about 20 to 45 degrees. But with kyphosis, it curves more than 50 degrees. This will make you look slouched or hunched over. This is why doctors sometimes call kyphosis "round back," or in serious cases, "hunchback."
If you have mild kyphosis, this may not cause any problems aside from your upper back looking more rounded. But it can get worse over time, which can cause symptoms such as back pain, trouble keeping your balance, or breathing problems.
If the curve gets worse, hurts, or makes you uncomfortable with your appearance, your doctor can fix it. The type of treatment you need depends on your age, the kind of kyphosis you have, and how it affects you.
Kyphosis vs. scoliosis
Types of Kyphosis
Experts divide kyphosis into a few different kinds based on who's most affected, which part of your spine is most affected, and how much curvature you have.
Some common types include:
Postural kyphosis
Postural kyphosis is the most common type of kyphosis. It's usually diagnosed in teens, but it's not associated with abnormalities in your spine. It's most likely caused by poor posture or "slouching." This stretches the ligaments and muscles holding your spine in place. This can pull your vertebra out of position, causing the rounded shape.
With postural kyphosis, the curve in your spine generally looks smooth and round, and you can correct it by standing up straight. It doesn't usually cause any pain or worsen over time.
This type is more common in girls and people assigned female at birth (AFAB) than boys and people assigned male at birth (AMAB).
Scheuermann's kyphosis (also called Scheuermann's disease, juvenile kyphosis, and juvenile diskogenic disease)
This type is also usually diagnosed in teens aged 12-17. It generally causes more curve in your thoracic spine, which is the part of your spine in your upper and middle back that connects to your rib cage. Sometimes, it may affect your thoracolumbar/lumbar spine. Your thoracolumbar spine is the part of your thoracic spine that transitions to your lumbar spine (lower back).
Typically, your vertebrae are rectangular. But with Scheuermann's kyphosis, at least three vertebrae next to each other are wedge-shaped. This unusual shape of several vertebrae in a row pushes the bones together toward the front of your spine, which makes your spine curve forward. This curve tends to look sharp and angular and isn't fixed when you stand up straight. It may get worse over time as you continue to grow. It tends to stop getting worse once you stop growing.
Scheuermann's kyphosis may rarely cause pain, which you may feel at the most obvious part of the curve in your back. Sometimes, it causes pain in your lower back, too, as you round your lower back to try to make up for the rounding in your upper or mid-back. Long periods of sitting or standing and activity can worsen your pain.
Scheuermann's kyphosis tends to affect boys and people assigned male at birth about twice as often as girls and people AFAB.
Congenital kyphosis
You are born with this type of kyphosis. It often happens when your spine doesn't form correctly while you're developing in your mother's uterus. For instance, the bones may not be of the right shape or may fuse together. Usually, the curve will get worse as you grow. Children with congenital kyphosis may be more likely to develop symptoms of spinal cord compression. Many children with congenital kyphosis need surgery at a very young age to prevent the curve in their spine from getting worse.
Some infants with congenital kyphosis will also have other congenital abnormalities, such as heart and kidney disorders.
Age-related hyperkyphosis (also sometimes called a Dowager's hump)
After age 40, the curve in your back gets more obvious. Studies show the angle of this curve increases by about 3 degrees every 10 years after about age 50.
About 20%-40% of people older than 60 have hyperkyphosis, which is when your back curves forward more than 50 degrees. This tends to happen a bit faster in women and people AFAB than in men and people AMAB.
It's most likely caused by:
- Weakening of back muscles as you get older
- Degenerative disk disease
- Osteoporosis
- Fracturesor small breaks in the vertebrae of your back
Age-related kyphosis can make it harder for you to get around, increasing your risk for falls and fractures from falling.
Kyphosis Symptoms
Your symptoms depend on which type of kyphosis you have and how severe the curve is. For instance, postural kyphosis may not cause any symptoms other than a slight rounding in your back when you slouch.
In addition to a visible rounding or hump in your back, you may also have:
- Rounded shoulders or one shoulder higher than the other
- Back pain, which is usually mild but may be severe and get worse with movement
- Your head further forward than usual
- Stiffness in your spine
- Fatigue
- Tight hamstrings, which are the muscles in the back of your thighs (more common with Scheuermann's kyphosis than with other types)
Some types of kyphosis get worse over time, such as Scheuermann's kyphosis and age-related kyphosis. It's rare, but in this case, you may also develop other symptoms that suggest spinal cord compression, such as:
Kyphosis Causes
What is the main cause of kyphosis?
This depends on the type of kyphosis. The most common type is postural kyphosis, which is generally caused by slouching or poor posture.
Other causes may include:
- Structural differences in the bones of your spine, either present at birth or developed over time. For instance, with Scheuermann's or juvenile kyphosis, you may be born with several wedge-shaped vertebrae that cause your spine to curve more than usual.
- Injury or fractures to your spine.
- Changes in your spine as you age from muscle weakness or conditions such as degenerative disk disease.
- Disorders that affect your connective tissues, such as Ehlers-Danlos syndrome and Marfan syndrome.
Osteoporosis and kyphosis
Osteoporosis weakens your bones by making them thinner, less dense, and more fragile than healthy bones. This can increase your risk for fractures, especially in your wrists, hips, and spine. Fractures in your spine can make you more likely to develop kyphosis.
Osteoporosis doesn't usually cause many signs or symptoms, so you may not know you have it until you suddenly break a bone after a minor injury. This is why it's important to get your bone density checked, especially if you are a woman or AFAB and postmenopausal.
Kyphosis Diagnosis
Kids and teens with mild kyphosis may not know they have it until they get screened for scoliosis at school. Kids with a more obvious curve in their back may be worried about their appearance and may ask to go to the doctor, or you may notice it and decide to take them in for a check-up.
When you see your doctor, they will usually start by asking about your or your child's medical and family history and do a physical exam. The physical exam may involve having you or your child bend forward at the waist to see how your or your child's spine slopes. They may also press on some areas to see if you or your child have areas of tenderness or pain. They may have you or your child lie down to see if this straightens the curve.
They will likely also send you for tests, such as:
- X-rays, which can show if your vertebrae are shaped abnormally or if you have fractures or other spinal abnormalities.
- Pulmonary function tests, if the curve in your back is severe. This can help your doctor see if you're having trouble breathing because of compression in your chest.
- Neurologic tests and MRI, if you've had symptoms such as weakness, numbness, or tingling. These tests can help them see if you're having signs and symptoms of spinal cord compression.
Kyphosis Treatment
You or your child may not need treatment for mild kyphosis that doesn't cause other symptoms. If the curve is large or causes other symptoms, your doctor may recommend nonsurgical or surgical treatment, depending on your age, overall health, type of kyphosis you have, and how severely your spine curves. For children, they will also consider how many years they have left to grow.
Doctors usually recommend nonsurgical treatment for postural kyphosis and Scheuermann's kyphosis with a curve less than 70-75 degrees. Nonsurgical options include:
Observation for mild kyphosis
If you have a mild curve without other symptoms, your doctor may suggest observation. This is when you have periodic tests to make sure the curve doesn't get worse.
Physical therapy for kyphosis
Your physical therapist can give you specific exercises to help:
Ease your back pain.
Improve your posture by strengthening the core muscles in your back and belly that support your spine.
Stretch your hamstrings
Strengthen other areas of your body that may be affected by the curve in your spine.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Your doctor may suggest you take NSAIDs, such as ibuprofen (Advil) or naproxen (Aleve), to help ease your back pain and reduce any swelling.
Bracing for kyphosis
Your child's doctor may recommend this if they have Scheuermann's kyphosis and are still growing. The type of brace their doctor recommends and the amount of time they need to wear it per day will depend on how severe the curve in their back is. They will generally use this brace until they stop growing.
Surgery for kyphosis
Your doctor may recommend surgical treatment for:
- Congenital kyphosis
- Scheuermann's kyphosis with a curve of more than 70-75 degrees
- Lower back kyphosis (also called lordosis)
- Serious back pain
The most common surgery for kyphosis is spinal fusion, which can reduce the curve in your back, keep it from getting worse over time, and help relieve your pain. During spinal fusion, your surgeon will fuse together any affected vertebrae so they form one solid bone. This reduces movement between these vertebrae, which should help ease your pain and reduce the amount of curve in your back. The more severe the curve in your back, the more of your vertebrae are likely affected. This may mean a more extensive surgery.
If you have age-related kyphosis due to osteoporosis, your doctor may recommend a procedure called a kyphoplasty or a vertebroplasty. Both kyphoplasty and vertebroplasty are minimally invasive procedures to treat compression fractures in your vertebra. During the procedure, your surgeon will use imaging to help guide them as they inject bone cement into your vertebrae through a small cut in your skin.
This strengthens and stabilizes the bones in your spine, which can help relieve pain and keep the curve in your back from getting worse. These procedures differ in where the bone cement is injected. In kyphoplasty, the bone cement is usually injected into the center of the vertebra. In vertebroplasty, the bone cement is injected right where your bone is broken and needs strengthening.
Kyphosis Complications
If you have mild kyphosis, you probably won't have any complications. But if you have a severe curve in your spine, you may have complications such as:
- Back pain
- Trouble walking
- Trouble breathing if your chest is compressed. A serious spine curve can compress organs in your chest and abdomen. That can make it hard to breathe and cause acid reflux or trouble swallowing. It can even affect your heart function.
- Neurological issues from pinched nerves. This can include numbness, weakness, or tingling in your legs and feet, loss of balance, or even loss of control of your bladder and bowels.
- Physical limitations that negatively affect your quality of life. Serious kyphosis can make it hard to walk, lie down, or get out of a chair. You may not be able to sit normally or tilt your head to look up.
- Feelings of self-consciousness over your body image
Kyphosis Outlook
Mild kyphosis shouldn't have any impact on your life and can generally be managed with NSAIDs, physical therapy, and the use of a brace. Severe kyphosis can cause deformity, pain, and breathing problems, but surgery can correct it. Once you or your child gets treatment, it's important to follow up with your doctor regularly to check for changes in the spine.
Takeaways
Kyphosis is when your upper spine curves forward more than usual. It's generally mild and doesn't cause any symptoms. In some cases, the curve may be enough to cause symptoms, such as back pain, trouble balancing, or even trouble breathing. If you need treatment, there are lots of options, such as NSAIDs, physical therapy, back bracing, surgery, or a combination.
Kyphosis FAQs
How can I fix kyphosis quickly?
The treatment for kyphosis varies depending mainly on what type you have and how severe it is. For instance, if you have postural kyphosis, you can likely fix it by strengthening your core muscles and working to improve your posture. However, if you have Scheuermann's kyphosis or congenital kyphosis, you may need physical therapy or surgery. But regardless, all treatments will take some time to achieve results.
Is kyphosis fully reversible?
This depends on the type of kyphosis you have and how severe it is. Most people with postural kyphosis can completely reverse their condition by working to improve their posture. Scheuermann's kyphosis may not be completely reversible because it is caused by differences in the shapes of the bones in your spine. But all types of kyphosis are treatable. Work with your doctor to plan your treatment strategies.
