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Kyphosis

Kyphosis is a spinal disorder in which an excessive forward curve of the spine results in an abnormal rounding of the upper back. While kyphosis can occur at any age, it is more prevalent in adolescents and older women.

Kyphosis: What it is, Symptoms, and Treatment

Southwest Scoliosis Institute is North Texas’ premier practice treating scoliosis and other complex spinal issues, including kyphosis.

“What’s unusual at the Southwest Scoliosis Institute is that we treat both children and adults,” explains Dr. Hostin. “What we provide here is a continuum of care, and our commitment really is to be able to care for you throughout your life.”

In most cases, kyphosis causes few problems and does not require surgical treatment. Some patients may need to use a back brace or do specific exercises to improve their posture and strengthen their spine. However, severe cases of kyphosis can be painful, cause significant spinal deformity, and even lead to breathing problems. Patients with severe kyphosis may require surgery to reduce their excessive spinal curve and improve their symptoms.

Types of Kyphosis:

  • Developmental (Postural and Scheuermann’s) kyphosis – Developmental kyphosis is usually classified as either postural or structural in origin. Both are most commonly seen in children and adolescents, but they may occur at any age.
  • Congenital kyphosis – Congenital kyphosis is present at birth and occurs when the spinal column fails to develop normally while the baby is in utero.
  • Post-Traumatic kyphosis – Most often the result of an accident, post-traumatic kyphosis occurs due to an injury to the spine and is commonly seen in the thoracolumbar and lumbar regions (mid- to lower-back).

Postural Kyphosis

Postural kyphosis is the most common type of kyphosis and usually becomes noticeable during childhood. Postural kyphosis is more commonly seen in girls than in boys, is rarely painful, and doesn’t normally lead to problems as an adult because the curve is rarely progressive.

Testing for Postural Kyphosis

Mild postural kyphosis often goes unnoticed until a scoliosis screening at school, which then prompts a visit to the doctor. In more severe cases of kyphosis, the rounding of the upper back may be clearly visible.

During an exam, Dr. Kishan or Dr. Hostin will ask your child to bend forward with both feet together, knees straight, and arms hanging free. This test, known as the Adam’s forward bend test, allows the doctor to better observe the curve of the spine and spot any spinal deformity.

The doctor may also ask your child to lay down to see if this straightens the curve, which is a sign that the curve is flexible and may be representative of postural kyphosis. They may also order X-rays to determine if there are changes in the vertebrae or any other bony abnormalities using the EOS imaging system, which scan the full spine in seconds.

In patients with postural kyphosis who do not have any abnormalities in the shape of the vertebrae, the forward curve is typically flexible and can be corrected simply by encouraging proper posture.

Structural Kyphosis

Structural kyphosis, also known as Scheuermann’s kyphosis, occurs when the structure of the spine develops abnormally, with the front sections of the vertebrae growing slower than the back sections. Instead of normal, rectangular vertebrae with ideal alignment, structural kyphosis results in more triangular, wedge-shaped vertebrae that cause misalignment.

Structural kyphosis usually develops during periods of rapid bone growth (typically between the ages of 12 and 15 in males or a few years earlier in females). The curve caused by structural kyphosis is usually sharp and angular, as well as stiff and rigid. Unlike postural kyphosis, structural kyphosis cannot be corrected by standing up straight.

Treating Developmental Kyphosis

Nonoperative Management

Observation is typically recommended for:

  • Postural kyphosis (rounded back straightens with proper posture)
  • Curves that are less than 60° in patients who are growing
  • Curves 60° – 80° in patients who are finished growing

X-Rays and Exercise. Full-spine X-rays are usually taken every six months as the child grows using our advanced in-house imaging system that scans the entire spine in just seconds while delivering an extremely low dose of radiation.

Bracing. With a moderately severe curve (60° – 80°) and a patient who is still growing, brace treatment in conjunction with a tailored exercise program may be recommended. Full-time use of a brace (20 hours/day) is usually required in the beginning until maximum correction has been achieved.

During the last year of treatment prior to skeletal maturity, part-time brace wear (12-14 hours/day) may be proposed. Brace wear must be continued for a minimum of 18 months in order to maintain a significant, permanent correction of the deformity.

Operative Treatment

At Southwest Scoliosis Institute, we consider surgery only when it is absolutely necessary. Our orthopedic surgeons use the most advanced treatment options to ensure that patients can return to normal daily activities as soon as possible.

Spinal Fusion. If kyphosis has become severe (greater than 80°) and causes frequent back pain, surgical treatment may be recommended. Surgery can significantly correct the deformity without the need for postoperative bracing. Pedicle screws, hooks, or sublaminar cables are placed, two per level, and connected with two rods. Thanks to Southwest Scoliosis Institute’s enhanced recovery after spine, pelvic and hip procedures, hospital stays for spine fusions performed here are shorter than most.

While most surgeries are performed from the back, your physician may recommend additional surgery on the front of the spine. Patients are usually able to return to normal daily activities within four to six months following surgery.

Spine Osteotomy. Spine osteotomy is a surgical procedure in which a section of the spinal bone is cut and removed to allow for correction of spinal alignment. The Smith-Peterson Osteotomy is one of the most common procedures and involves removing sections of bone from the back of the spine, as well as the posterior ligament and facet joints. This causes the spine to lean more toward the back, correcting the kyphotic curve.

Long-Term Prognosis

When kyphosis is diagnosed early, the majority of patients can be treated successfully without surgery and go on to lead active, healthy lives. If kyphosis is left untreated, however, progression of the curve could potentially lead to problems in adulthood.

For patients with kyphosis, regular checkups are necessary to monitor the condition and check for any progression of the curve.

Age-Related Kyphosis

Age-related kyphosis is usually the result of weakened vertebrae that compressed or cracked over time, leading to an increased kyphotic curve.

This form of kyphosis affects between 20 – 40% of older adults (mostly women) and is usually the result of several factors, including:

  • Poor posture
  • Difficulty breathing
  • Increased stress on the spine
  • Poor gait (which can lead to falls)

Treating Age-Related Kyphosis

Exercise programs, spinal orthotics, and other interventions may help delay the progression of age-related kyphosis. However, stronger evidence is needed to support widespread clinical use.

Pharmaceutical interventions mainly rely on antiresorptive or bone-building medication due to the fact that most patients with age-related kyphosis have low bone density or spine fractures (often due to conditions such as osteoporosis).

There are two surgical options: vertebroplasty and kyphoplasty, which involve reinforcing the damaged vertebrae with a specially designed bone cement. These surgeries mainly help to relieve pain and increase range of motion and mobility, but in some cases, surgery can reduce the kyphosis angle as well.

Congenital Kyphosis

While congenital kyphosis is uncommon, it can be quite debilitating. The bones may develop in an unusual shape (failure of formation), or several vertebrae may be fused together (failure of segmentation).

Unfortunately, casting and/or bracing is often not effective for patients with congenital kyphosis. Patients with congenital kyphosis often need surgical treatment at a very young age to stop the progression of the curve.

Treating Congenital Kyphosis

Nonoperative Treatment

Observation and serial examination with x-rays to monitor curvature is recommended. Unfortunately, casting/bracing is not usually effective for congenital kyphosis. While it may delay progression, there is limited evidence available at this time.

Operative Treatment

The primary surgical option for progressive congenital kyphosis is a solid fusion of the deformed vertebrae. In addition, the surgeon may recommend separate approaches from the front and the back of the spine.

Prognosis

Should your child require surgery to correct kyphosis, the expert surgeons and caregivers at Southwest Scoliosis Institute can provide the care and attention they deserve. In addition, Dr. Richard Hostin and Dr. Shyam Kishan have been treating children and adolescents for more than 10 years.

Because the skeleton grows quite rapidly in the first year of life, the chances of progression are high and there is the potential for spinal cord compression. A failure of separation (segmentation) deformity has a lower chance of worsening and may not require surgery until the child reaches adolescence.

Post-Traumatic Kyphosis

Post-traumatic kyphosis occurs following an injury such as a fall from a height, a motor vehicle accident, or a horseback riding accident. The impact from these kinds of injuries can lead to fractures and/or dislocation of the vertebrae, which can lead to a kyphotic curve of the spine, especially if the injury is not treated promptly.

Treating Post-Traumatic Kyphosis

Traumatic kyphosis can be even worse if the injury is allowed to heal without treatment. Treatment options are dependent on a variety of factors, including the type and site of fracture, the degree of spine curvature, and the size of the patient.

Nonoperative treatment includes bracing to support the spine and keep it in a more ideal position as it heals, as well as physical therapy, which can help lessen pain, strengthen muscles, and improve posture.

Operative treatments for traumatic kyphosis include spinal fusion (posterior or anterior-posterior) with instrumentation and osteotomy (bone removal) to restore proper alignment.

If you or a loved one suffers from spinal pain, you owe it to yourself to call Southwest Scoliosis Institute at 214-556-0565 to make an appointment.