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Some degree of rounded curvature of the spine is normal. The term kyphosis is used to describe the spinal curve that results in an abnormally rounded back.
A visit to the doctor is typically brought on by a scoliosis screening examination at school, a child's or parent's concern about the cosmetic deformity of a rounded back, or pain.
The doctor may ask the child to bend forward so that the slope of the spine can be assessed. X-rays of the spine will show if there are any bony abnormalities. X-rays will also help measure the degree of the kyphotic curve. A kyphotic curve that is more than 50° is considered abnormal.
Postural kyphosis is the most common type of kyphosis. It is often attributed to slouching. It represents an exaggerated, but flexible, increase of the natural curve of the spine.
Postural kyphosis usually becomes noticeable during adolescence. It is more common among girls than boys. It rarely causes pain.
Although exercise to strengthen the abdomen and stretch the hamstrings may help relieve associated discomfort, it is unlikely to result in significant correction of the postural kyphosis. With occasional exceptions, postural kyphosis does not lead to problems in adult life.
Scheuermann's kyphosis is named after the Danish radiologist who first described the condition.
As with postural kyphosis, Scheuermann's kyphosis often becomes apparent during the teen years; however, patients with Scheuermann's kyphosis have a significantly more severe deformity, particularly thin individuals.
Scheuermann's kyphosis usually affects the upper (thoracic) spine. It can also occur in the lower (lumbar) back area. If pain is present, it is usually felt at the apex of the curve.
Activity can aggravate the pain, as can long periods of standing or sitting. Exercise and anti-inflammatory medication can help ease associated discomfort.
When x-rays of patients with kyphosis are examined, the vertebrae and disks will appear normal in those with postural kyphosis, but they will appear irregular and wedge-shaped in those with Scheuermann's kyphosis.
In some infants, the spinal column does not develop properly while the fetus is still in the womb. The bones may not form as they should. Several vertebrae may be fused together. Either of these abnormal situations may cause progressive kyphosis as the child grows.
Surgical treatment may be needed at a very young age. Surgery can help maintain a more normal spinal curve. Consistent follow-up is required to monitor any changes.
Treatment will depend on the reason for the deformity. Most teens with postural kyphosis will do well throughout life. The posture of some patients with postural kyphosis may improve over time. An exercise program may help relieve any associated back pain.
An initial program of conservative treatment that includes exercises and anti-inflammatory medications (for discomfort) is recommended for patients with Scheuermann's kyphosis. If the patient is still growing, the doctor may prescribe a brace. The patient typically wears the brace until skeletal maturity is reached.
Surgery may be recommended if the kyphotic curve exceeds 75°. The goals of surgery are:
- To reduce the degree of curvature by straightening and fusing the abnormal spinal segments together
- To maintain the improvement over time
- To alleviate significant back discomfort, if present preoperatively
Reviewed by members of POSNA (Pediatric Orthopaedic Society of North America)
The American Academy of Orthopaedic Surgeons
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