Kyphosis

Overview

Kyphosis is an excessive forward rounding of the upper back.

In older people, kyphosis is often due to weakness in the spinal bones that causes them to compress or crack. Other types of kyphosis can appear in infants or teens. These types are due to malformation of the spine or wedging of the spinal bones over time.

Mild kyphosis causes few problems. Serious kyphosis can cause pain and be disfiguring. Treatment for kyphosis depends on your age, and the cause and seriousness of the curvature.

Symptoms

Mild kyphosis may not cause any noticeable symptoms. It is typical for the upper back to have a slight curve. However, too much curvature can lead to back pain and difficulty standing upright.

When to see a doctor

Make an appointment with your healthcare professional if you notice that the curve in your upper back is getting worse. Contact your child's healthcare professional if you see an increased curve in your child's spine.

Causes

In a healthy spine, each vertebra is shaped like a cylinder, with the front and back about the same height. This allows the spine to stack evenly and stay upright.

In kyphosis, the vertebrae become wedge-shaped. This means the front of the bone becomes shorter than the back, forming a triangle shape. When several vertebrae take on this shape, the spine may tilt forward. Over time, this causes the back to curve and appear rounded.

The shape of vertebrae can be changed by:

• Fractures. Broken vertebrae can cause the spine to curve forward.
• Compression fractures. These are the most common type of fracture. They often happen in weakened bones and can happen with no known injury. Mild compression fractures may not cause noticeable symptoms.
• Osteoporosis. Osteoporosis weakens bones. This can lead to spinal curvature, especially when compression fractures happen. Osteoporosis is most common in older women and in people who have used corticosteroids for a long time.
• Disk degeneration. Soft, round disks between the vertebrae act as cushions. As you age, these disks can flatten and shrink, which may worsen kyphosis.
• Scheuermann disease. Also called Scheuermann kyphosis, this condition typically appears during adolescence.
• Other issues. Vertebrae that do not form properly before birth can cause kyphosis. In children, kyphosis also may be linked to certain medical conditions.

Risk factors

The risk of developing kyphosis in adulthood increases with age. As people get older, bone strength lessens and spinal disks wear down. In children, certain conditions can raise the risk of kyphosis. These include osteogenesis imperfecta, cerebral palsy, Scheuermann's disease, Ehlers-Danlos syndrome and Marfan syndrome.

Complications

In addition to causing back pain, kyphosis may cause:

• Limited physical function. Kyphosis can weaken back muscles and make everyday activities harder. The condition can make walking or standing up from a chair difficult. The spinal curve also may make it hard to look upward, drive or lie flat without pain.
• Digestive problems. Serious kyphosis can press on the digestive tract. This can lead to problems such as acid reflux or trouble swallowing.
• Back pain. Some people with serious kyphosis have ongoing back pain.
• Body image issues. People with kyphosis, especially teenagers, may feel self-conscious about having a rounded back.

Diagnosis

To diagnose kyphosis, your healthcare professional typically starts with a physical exam. You may be asked to bend forward at the waist so your spine can be seen from the side. You also may have a neurological exam to check your reflexes and muscle strength.

Your healthcare professional may order one or more of the following tests:

• X-rays. X-rays show the amount of spinal curvature and can reveal changes in the vertebrae.
• CT scan. A CT scan may be used if more detailed images are needed.
• MRI. An MRI uses radio waves and a strong magnetic field to look for recent fractures in the spine.
• Nerve tests. If you have numbness or muscle weakness, nerve tests check how well signals travel between your spinal cord and the rest of your body.
• Bone density test. This test checks bone strength. Low bone density raises the risk of compression fractures and often can be treated with medicine.

Treatment

Treatment for kyphosis depends on the cause and how severe the condition is.

Medicines

Kyphosis treatment may include:

• Pain relievers. If medicines available without a prescription — such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve) — aren't enough to manage pain, your healthcare professional may prescribe stronger pain medicine.
• Osteoporosis medicines. Some medicines can help strengthen the spinal bones and lower the risk of future fractures that could make kyphosis worse.

Therapy

Some types of kyphosis may improve with:

• Exercises. Stretching and strengthening exercises may improve spinal flexibility and relieve back pain.
• Bracing. Children who have Scheuermann disease may wear a back brace during periods of rapid growth to help slow the worsening of the curve.

Surgical and other procedures

Severe kyphosis can cause serious symptoms. In rare cases, the spinal curve can press on the spinal cord or nerves. This is more likely with kyphosis present at birth or kyphosis that develops after spine surgery.

You may need surgery to correct severe kyphosis. The most common surgery is spinal fusion. In this procedure, the surgeon uses rods and screws to hold the spinal bones in a straighter position while they fuse together.

Compression fractures typically are treated without surgery.

Preparing for an appointment

You may be referred to a doctor who specializes in diagnosing and treating spine conditions.

What you can do

• Ask if there are any instructions to follow before your appointment, such as changes to your diet.
• Write down your symptoms, even those that may not seem related to why you made the appointment.
• Make a list of all medicines, vitamins and supplements you take.
• Write down your medical history, including other health conditions.
• Note important personal information, such as recent life changes or stress.
• Prepare a list of questions for your healthcare team.
• Consider bringing a family member or friend to help you remember the information you get.

Questions to ask your doctor

• What tests do I need? Do I need to prepare for them?
• Will I need treatment? What are my options, and what are the risks and benefits of each?
• I have other health conditions. How can I manage them along with kyphosis?

You also can ask any other questions that come up during your visit.

What to expect from your doctor

Your healthcare professional will likely ask several questions. Being ready to answer them can help make the most of your appointment. You may be asked:

• When did your symptoms start, and how bad are they?
• Do your symptoms happen all the time or only sometimes?
• What makes your symptoms better or worse?