Definition

Kyphosis is a curving of the spine that causes a bowing of the back, which leads to a hunchback or slouching posture.

Symptoms

Difficulty breathing (in severe cases) Fatigue Mild back pain Round back appearance Tenderness and stiffness in the spine

Causes & Risk Factors

Causes of kyphosis depend on the different types of kyphosis. Types of kyphosis in children and adolescents For children or adolescents, the most common types include:

Postural kyphosis. This type mainly becomes apparent in adolescence. The onset of postural kyphosis generally is slow. It's more common in girls. Poor posture or slouching may cause stretching of the spinal ligaments and abnormal formation of the bones of the spine (vertebrae). Postural kyphosis often is accompanied by an exaggerated inward curve (hyperlordosis) in the lower (lumbar) spine. Hyperlordosis is the body's way of compensating for the exaggerated outward curve in the upper spine. Scheuermann's kyphosis. Like postural kyphosis, Scheuermann's kyphosis typically appears in adolescence, often between ages 10 and 15, while the bones are still growing. Also called Scheuermann disease, it's slightly more common in boys. Scheuermann's kyphosis may deform the vertebrae so that they appear wedge shaped, rather than rectangular, on X-rays. There may be another finding, known as Schmorl's nodes, on the affected vertebrae. These nodes are the result of the cushion (disk) between the vertebrae pushing through bone at the bottom and top of a vertebra (end plates). The cause of Scheuermann's kyphosis is unknown, but it tends to run in families. Some people with this type of kyphosis also have scoliosis, a spinal deformity that causes a side-to-side curve. Adults who developed Scheuermann's during childhood may experience increased pain as they get older.

Congenital kyphosis. A malformation of the spinal column during fetal development causes kyphosis in some infants. Several vertebrae may be fused together or the bones may not form properly. This type of kyphosis may worsen

as the child grows. In some cases, congenital kyphosis eventually leads to paralysis of the lower body (paraplegia). Causes in adults Disorders that may cause a curvature of the spine in adults, resulting in kyphosis, include:

Osteoporosis, a bone-thinning disease that's associated with fractures of the vertebrae, which cause compression of the spine and contribute to kyphosis Degenerative arthritis of the spine, which can cause deterioration of the bones and disks of the spine Ankylosing spondylitis, an inflammatory arthritis that affects the spine and nearby joints Connective tissue disorders, such as Marfan syndrome, that may affect the connective tissue's ability to hold joints in their proper position Tuberculosis and other infections of the spine, which can result in destruction of joints Cancer or benign tumors that impinge on bones of the spine and force them out of position Spina bifida, a birth defect in which part of the spine doesn't form completely, and which causes defects of the spinal cord and vertebrae Conditions that cause paralysis, such as cerebral palsy and polio, and that stiffen the bones of the spine

Certain groups of people are at higher risk of kyphosis:

Adolescent girls with poor posture are at greater risk of postural kyphosis. Boys between the ages of 10 and 15 are at greater risk of Scheuermann's kyphosis. Older adults with osteoporosis are at greater risk of spinal fractures that can contribute to kyphosis. People who have connective tissue disorders, such as Marfan syndrome, also are at greater risk.

Tests & Diagnostics

Physical examination by a health care provider confirms the abnormal curve of the spine. The doctor will also look for any nervous system (neurological) changes (weakness, paralysis, or changes in sensation) below the curve.

Other tests may include:

Spine x-ray Pulmonary function tests (if kyphosis affects breathing) MRI (if there may be a tumor, infection, or neurological symptoms)

Treatments
Treatment depends on the cause of the disorder:

Congenital kyphosis requires corrective surgery at an early age. Scheuermann's disease is treated with a brace and physical therapy. Occasionally surgery is needed for large (greater than 60 degrees), painful curves. Multiple compression fractures from osteoporosis can be left alone if there are no nervous system problems or pain. However, the osteoporosis needs to be treated to help prevent future fractures. For debilitating deformity or pain, surgery is an option. Kyphosis caused by infection or tumor needs to be treated more aggressively, often with surgery and medications.

Treatment for other types of kyphosis depends on the cause. Surgery may be necessary if neurological symptoms develop.

Complications

Body image problems. Adolescents, especially, may develop a poor body image from having a rounded back or from wearing a brace to correct the condition. Deformity. The hump on the back may become prominent over time. Back pain. In some cases, the misalignment of the spine can lead to pain, which can become severe and disabling. Breathing difficulties. In severe cases, the curve may cause the rib cage to press against your lungs, inhibiting your ability to breathe. Neurological signs and symptoms. Although rare, these may include leg weakness or paralysis, a result of pressure on the spinal nerves.