Kyphosis Causes - Mayo Clinic By Mayo Clinic Staff The individual bones (vertebrae) that make up a healthy spine look like cylinders stacked in a column. Kyphosis occurs when the vertebrae in the upper back become more wedge-shaped. This deformity can be caused by a variety of problems, including: Osteoporosis. This bone-thinning disorder can result in crushed vertebrae (compression fractures). Osteoporosis is most common in older adults, particularly women, and in people who have taken high doses of corticosteroids for long periods of time. Disk degeneration. Soft, circular disks act as cushions between spinal vertebrae. With age, these disks dry out and shrink, which often worsens kyphosis. Scheuermann's disease. Also called Scheuermann's kyphosis, this disease typically begins during the growth spurt that occurs before puberty. Boys are affected more often than are girls. The rounding of the back may worsen as the child finishes growing. Birth defects. If a baby's spinal column doesn't develop properly in the womb, the spinal bones may not form properly, causing kyphosis. Syndromes.

Kyphosis in children can also be associated with certain syndromes, such as Marfan syndrome or Prader-Willi disease. Cancer and cancer treatments. Cancer in the spine can weaken vertebrae and make them more prone to compression fractures, as can chemotherapy and radiation cancer treatments. An increased curve in the upper spine also can be caused by slouching. Called postural kyphosis, this condition doesn't involve any deformities in the spine. It's most common in teenagers. Frontera WR, et al. Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation. 2nd ed. Philadelphia, Pa.: Saunders Elsevier; 2008. Accessed July 11, 2013. Kyphosis (roundback) of the spine. American Academy of Orthopaedic Surgeons. Accessed April 10, 2012. Kado DM. Overview of hyperkyphosis in older persons. Accessed July 11, 2013. Kliegman RM, et al. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa.: Saunders Elsevier; 2011.

Accessed July 11, 2013. Canale ST, et al. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa.: Mosby Elsevier; 2008. Accessed July 11, 2013. Neurological diagnostic tests and procedures. National Institute of Neurological Disorders and Stroke. Accessed July 11, 2013. Larson AN (expert opinion). Mayo Clinic, Rochester, Minn. Dec. 9, 2013. Wybier M, et al. Musculoskeletal imaging in progress: The EOS imaging system. Joint Bone Spine. 2013;80:238. Six years and more than 60 lifesized anatomic models to help plan complex surgeries. Mayo Clinic. Accessed Jan. 7, 2014. Golden AK. Decision Support System. Mayo Clinic, Rochester, Minn. Nov. 5, 2013.

Products and Services Kyphosis Conditions Treated | Spine Institute of San Diego Kyphosis Symptoms Symptoms of kyphosis can range from unattractive posture, to pain, to severe problems of pressure on the lungs and abdomen. The pain occurs primarily in the area of the kyphosis. A severe curve can also begin to put pressure on the spinal cord and spinal nerve roots, which may cause weakness in the lower extremities. Eventually there can be pressure on the lungs and abdomen, affecting breathing and appetite. General Overview The mid (thoracic) spine naturally has some kyphosis or “C”-shaped curve. A kyphotic spinal deformity means there is too much forward curve in the spine resulting in a rounded or hunch/hump back appearance. Postural Kyphosis Postural kyphosis-sometimes called “round back”-is the result of poor posture. This condition is most common in adolescents and young adults. Slouching when standing or sitting causes the spine to curve forward. Postural kyphosis is often accompanied by hyperlordosis of the lumbar (lower) spine. The lumbar spine naturally has a lordosis or inward curve.

Hyperlordosis means the lumbar spine compensates for too much thoracic kyphosis by curving too far in the inward direction. A postural kyphosis corrects itself when lying down on a flat surface, or when the spine is hyper-extended. There are no noticeable vertebral abnormalities on X-rays because structural damage or deformity does not cause this kyphosis. Postural kyphosis is easily corrected with education about proper posture, including some retraining on how to sit and stand correctly. Special bracing or casting is usually not necessary. Strengthening exercises for the back muscles can be helpful in correcting posture. Scheuermann’s Kyphosis Scheuermann’s kyphosis affects the shape of the vertebral bodies in the mid back. The front of several vertebral bodies becomes narrow. The affected bones appear wedge-shaped, producing forward rounding (kyphosis) in the thoracic spine.Researchers are unsure what causes Scheuermann’s kyphosis. Genetics appear to have a role, meaning it runs in families. Spine specialists suspect the problem may have to do with damage in the area where growth occurs in the vertebral body.

Others suggest mild osteoporosis or muscle abnormalities could contribute to the deformity. Congenital Kyphosis Congenital kyphosis means a person is born with some sort of defect, such as incomplete formation of the spine. This can lead to a severe abnormal kyphosis. Extreme kyphosis is the most common cause of paralysis in the lower part of the body, other than trauma or infection. With congenital kyphosis, there is a strong (20-30 percent) association of congenital abnormalities with the body’s urinary collecting system. If this type of kyphosis is suspected, your doctor may suggest that you have a special X-ray that looks at the kidneys (called an IVP), an ultrasound of the kidneys, a myelogram, or an MRI. The myelogram and the MRI can show whether or not the parts of the spine have developed normally. A 3-D CT scan gives a three dimensional view of the misshapen vertebrae. Severe congenital kyphosis deformities are usually treated surgically. Conservative treatment plans are less successful at correcting this type of kyphosis. Early surgical intervention generally produces the best results and can prevent progression of the curve.

The type of surgical procedure will depend on the nature of the abnormality. If nonsurgical treatment is chosen, there is a critical need for observation and close medical follow-up to prevent possible problems later. Paralytic Disorders Conditions that cause paralysis can lead to kyphosis. Paralysis can be caused by disorders such as Polio, muscular dystrophy, and Cerebral Palsy (paralysis caused by trauma at birth or developmental defects in the brain). The development of kyphosis in these cases is gradual rather than sudden. Post-Traumatic Kyphosis Injury to the spine can lead to progressive kyphosis and nerve problems in the spine. A vertebral fracture in the thoracic or lumbar spine will almost always cause some degree of kyphosis. Post-traumatic kyphosis is sometimes treated with either bracing or surgery. The choice will depend on the severity of the condition. Post-Surgical Kyphosis Kyphosis can develop after spine surgery has been done to correct other problems. This usually occurs when the procedure does not heal as intended. For example, a spine fusion may not heal, and the unstable fusion may cause the spine to collapse into kyphosis.

The ligaments of the spine may not heal strongly enough to support the vertebrae, and a kyphosis develops. A second operation might be needed. Degenerative Kyphosis There are cases of kyphosis that are caused by degeneration (wear and tear of the spine). Over time, the degenerative process can result in collapse of the intervertebral disc, changes in the shape of the vertebrae, and weakening of the ligaments that support the spine. This can result in the gradual development of a kyphosis over many years. Once the kyphosis begins to form, it gets worse because the imbalance of the forces continually increases the wear and tear. Other Causes Different types of systemic (whole body) diseases can cause a kyphosis to develop over time. These conditions include infection in the spine, cancer or tumors that involve the spine, and different types of systemic arthritis. These conditions affect the bones and soft tissues of the mid back and may produce kyphosis. Children with cancer sometimes need radiation treatment. Radiation of the spine in childhood can alter the strength of the spinal vertebrae, leading to kyphosis later in life.

Kyphosis Treatment Non-surgical Treatment Non-surgical treatments are chosen first whenever possible and commonly include medications, exercise, and certain types of braces to support the spine. If osteoporosis is present, treatment of the condition may also slow the progression of the degenerative kyphosis. This can be accomplished in several ways. The current recommendations include increasing calcium and vitamin D intake, hormone replacement therapy, and weight-bearing exercises. Physical Therapy: Adolescents and adults with kyphosis may work with a physical therapist. A well-rounded rehabilitation program assists in calming pain and inflammation, improving mobility and strength, and helping you do your daily activities with greater ease and ability. Exercise has not proven helpful for changing the kyphotic curve in the back. However, it can be helpful in providing pain relief. Therapy sessions may be scheduled two to three times each week for up to six weeks. The goals of physical therapy are to help you learn correct posture and body movements to counteract the effects of kyphosis, maintain appropriate activity levels, maximize your range of motion and strength and learn ways to manage your condition. Bracing: Bracing is the standard treatment to control curve progression in adolescents if the patient is still growing and the curve is likely to get bigger.

It is important that the patient wear the brace daily for the number of hours prescribed by the doctor. Sometimes an adolescent might feel self-conscious about wearing a brace. Though the brace can help the curve from getting worse, it may take some time for the patient (and caregiver) to get used to it. Adults tend to be less concerned about what their peers think, but adolescence is a time when appearance is often of great importance. Listen to the child’s concerns and look for ways to help overcome feelings about appearance. A spinal brace may provide some pain relief. In adults, it will not cause the spine to straighten. Once you have reached skeletal maturity, bracing is used for pain relief rather than prevention. Surgical Treatment The most common reason for kyphosis surgery is pain relief for chronic discomfort that keeps getting worse. Most cases of adult kyphosis surgeries are done to relieve severe pain. However, if the pain is manageable through conservative treatments, surgery will probably not be recommended. Progression of the kyphosis deformity is another reason for considering surgery. If the curvature continues to worsen, surgery may be suggested. Surgery is recommended in this situation to prevent the problems that come from severe kyphosis.

When adult kyphosis requires surgery, doctors may choose many different procedures. Each case of kyphosis is somewhat different and may require a very specialized approach for optimal results. Surgery is suggested to solve the problems brought on by the kyphosis, not just to straighten the spine. The goals of most surgical procedures for adult kyphosis are to: reduce the deformity (straighten the spine as much as possible) stop the progression of the deformity remove any pressure from the nerves and spinal cord protect the nerves and spinal cord from further damage To achieve these goals, your surgeon may suggest an operation on the back of the spine, the front of the spine-or both. The goal is to first straighten the spine and then to fuse the vertebrae together into one solid bone (fusion). Nearly all surgeons will use some type of instrumentation metal screws, plates, or rods, in order to help straighten the spine and hold the vertebrae in place while the fusion heals and becomes solid. The screws are placed into the vertebrae. The rods or plates then attach to the screws to connect everything together. Tightened together, they form an internal brace to hold the vertebrae in alignment while the fusion heals.

Kyphosis Case Study This 28 year old male has a profound roundback (increased kyphosis in the thoracic spine measuring 95 degrees - Image A). His posture has progressively worsened. He suffers from low back pain which is most likely due to compensation of the lumbar spine into hyperlordosis. Postoperatively, the patient has undergone anterior fusion with placement of allograft wedges for anterior support. He also has undergone posterior instrumentation. Note the markedly improved posture and alignment (Image B). Adult Kyphosis | University of Maryland Medical Center A Patient's Guide to Adult Kyphosis Introduction The word "kyphosis" describes a type of curve in the spine. A kyphotic curve is normally present in the thoracic spine (the part of the spine in the chest area). A kyphotic curve looks like the letter "C" with the opening of the C pointing towards the front. Though the thoracic spine is supposed to be curved, if the curve in a person's thoracic spine is more than 40 to 45 degrees, it is considered abnormal - or a spinal deformity.

Adult kyphosis can have varying symptoms and degrees of severity, from minor changes in the shape of your back, to severe deformity, nerve problems, and chronic pain. Kyphosis is most common in the thoracic spine, though it can also affect the cervical and lumbar spine. There are several causes of kyphosis in adults. The first is congenital, which means it is a condition present from birth. A congenital spine problem affects the development of the spine. The second cause is traumatic, which means it is caused by a trauma or injury to the spine. Third are "iatrogenic factors"; these are from the effects of medical treatment or surgery. Finally, osteoporosis can cause kyphosis in adults. Osteoporosis is a condition that leads to major losses of bone mass, leaving the bones brittle and prone to fractures. Osteoporosis is the most common cause of kyphosis in adults. It is much more common in women than men, due to losses of estrogen in menopausal and postmenopausal women. Kyphosis can be effectively treated. Methods of treatment have evolved over time. Originally, body casts were used to treat kyphosis. Later, treatment turned to surgery.

Today there are numerous effective treatment options for correcting a severe kyphotic deformity. This website will provide information about: The normal anatomy of the spine Different types of adult kyphosis Treatment of adult kyphosis Anatomy As mentioned above, the thoracic spine naturally has some kyphosis. A kyphotic spinal deformity really means there is too much kyphotic curve in the spine. The thoracic spine is made up of the middle 12 vertebrae of your spine. The normal amount of curve in the thoracic spine is considered to be from 20 to 40 degrees within the entire thoracic spine. There is a range because the amount of "normal" curve varies from person to person. In order to understand your symptoms and treatment choices, you should start with some basic understanding of the general anatomy of your spine. This includes becoming familiar with the various parts that make up the spine and how they work together. Please review the document, entitled: Anatomy and Function of the Spine Different types of Kyphosis There are many types of adult kyphosis. This section will discuss the major types and causes of kyphosis.

Postural Kyphosis Postural kyphosis, or "round back", is the result of poor posture. This condition is most common in adolescents and young adults, as they often slouch when standing and sitting, causing the spine to curve forward. Postural kyphosis is often accompanied by "hyperlordosis" of the lumbar (lower) spine. The lumbar spine naturally has a "lordosis", a backward "C"-shape. Hyperlordosis means the lumbar spine compensates for the excessive thoracic kyphosis by curving more in the opposite direction. A postural kyphosis corrects itself when lying down on a flat surface, or when the spine is hyper-extended. On X-rays, there will not be any vertebral abnormalities, because structural damage or deformity does not cause this kyphosis. In fact, postural kyphosis is rather easily corrected with education about proper posture and some retraining on how to sit and stand correctly. Treatment does not need to include casting, bracing, or exercise. However, strengthening the back muscles can help with proper posture.

Scheuermann's Kyphosis With Scheuermann's kyphosis, the thoracic curve is usually 45 and 75 degrees. There will also be vertebral wedging of greater than five degrees of three or more vertebrae that are next to each other. The vertebrae in these cases have a triangular appearance, so they wedge together and cut down the normal space between vertebrae. With Scheuermann's disease, there is also the presence of Schmorl's nodes at the ends of the affected (wedged) vertebrae. These nodes are small herniations of intervertebral disc (the cushion between each vertebra) in the vertebra's endplates. A herniated disc is when a disc's outer fibers (the annulus) are damaged and the soft inner material of the nucleus pulposus ruptures out of its normal space. With Scheuermann's, there are also thickened anterior longitudinal ligaments, and the tightness of these ligaments may contribute to the spinal deformity. Ligaments connect bones together, including spinal vertebrae. The cause of Scheuermann's kyphosis has not been discovered, but there are many possible theories about its development.

Scheuermann, the Danish radiologist for whom the disease is named, was the first to notice the problem. He proposed that the problem was a result of a process of "avascular necrosis" of the cartilage ring of the vertebral body. This means the cartilage of the spinal bone's ring died because it lacked the necessary blood supply. Scheuermann believed that this interrupted bone growth during development, leading to wedge-shaped vertebrae. Most researchers think that some sort of damage to the growth area of the vertebrae starts the process. The abnormal growth that follows is what causes the excessive kyphosis. For instance, there may be a vertebral disorder during the rapid growth spurts of adolescence, which then leads to abnormal bone growth. Many spine specialists also suspect that problems with the mechanics of the spine (the way it is put together and functions) play a part in Scheuermann's kyphosis. Others suggest mild osteoporosis could contribute to the deformity. Muscle abnormalities have been considered as a possible cause. There also seems to be a high genetic predisposition to this disease, which means that it runs in families.

To learn more about Scheuermann's kyphosis, you may wish to review the document, entitled: Scheuermann's Kyphosis Congenital Kyphosis Congenital kyphosis refers to abnormal development of the spine that is inherited. This means a person is born with some sort of defect, such as incomplete formation of the spine, which can lead to a severe abnormal kyphosis. This kyphosis is also the most common non-traumatic, non-infectious cause of paraplegia (paralysis of the lower part of the body). With congenital kyphosis, there is a strong (20-30%) association of congenital abnormalities with the body's urinary collecting system. If this type of kyphosis is suspected, your doctor may suggest that you have an IVP (a type of X-ray that looks at the kidneys), a myelogram, or an MRI done. The myelogram and the MRI scan are done to make sure that the parts of the spine have developed normally. Treatment for severe congenital kyphosis deformities is usually surgery. If necessary, early surgical intervention generally produces the best results and can prevent progression of the curve.

The type of surgical procedure will depend on the nature of the abnormality. Conservative (non-surgical) treatment plans are less successful at correcting this type of kyphosis. If non-surgical treatment is chosen, there is a critical need for observation and close medical follow-up to prevent serious problems later. Paralytic Disorders Conditions that cause paralysis can lead to kyphosis. The kyphosis that results is a secondary result of the paralysis. The causes of the paralysis can include disorders such as Polio, spinal muscle atrophy (a deterioration that leads to paralysis), and Cerebral Palsy (paralysis caused by trauma at birth or developmental defects in the brain). The development of kyphosis in these cases is gradual rather than sudden. Post Traumatic Injury to the spine can lead to both progressive kyphosis and nerve problems in the spine. When the trauma is a vertebral fracture in the thoracic or lumbar spine, 90% of the time some degree of kyphosis will result. Treatment for post-traumatic kyphosis can include either bracing or surgery. The choice will depend upon the severity of the condition. Post-Surgical Kyphosis Kyphosis can develop after surgery of the spine to correct other problems.

This usually occurs when the surgery performed does not heal as intended. For example, a spine fusion may not heal. The unstable fusion may cause the spine to collapse into a kyphosis. The ligaments of the spine may not heal strong enough to support the vertebrae and allow the spine to form a kyphotic curve. These conditions may require a second operation to try to correct the problem. Degenerative Kyphosis There are also cases of kyphosis that are caused by degeneration, or wear and tear of the lumbar (lower) spine. Over time, the degenerative process can result in: collapse of the intervertebral disc, changes in the shape of the vertebrae, and weakening of the ligaments that support the spine. This can result in the gradual development of a kyphosis over many years. Once the kyphosis begins to form, it gets worse because the imbalance of the forces continually increase the wear and tear. Other Causes of Kyphosis Different types of systemic diseases can cause a kyphosis to develop over time. These conditions include: infection in the spine, cancer or tumors that involve the spine, and different types of systemic arthritis.

This type of kyphosis is caused by changes in the spine brought on by inflammation of the tissue in the area surrounding the thoracic spine. Kyphosis can also develop in people who were treated for a malignant (cancerous) childhood disease by radiation to the axial skeleton. Symptoms The symptoms of kyphosis can range from causing pain to severely affecting the function of the lungs and heart. Kyphosis can be painful and cause pain primarily in the area of the kyphosis. If the curve is severe it can begin to put pressure on the spinal cord and cause problems due to the compression of the nerves of the spinal cord. This can cause weakness in the lower extremities. Finally if the kyphosis is in the thoracic spine the curve can make it difficult to breath and affect the function of the heart as well. Diagnosis If kyphosis is suspected in an adult, a diagnosis must be made before an appropriate treatment plan can be developed. History In order to make a proper diagnosis and rule out other possible conditions, the first step is to take a history. The provider may ask about the following: Family History - Some types of kyphosis tend to run in families, so it may have a genetic cause.

Your provider will want to know if anyone else in your family has the problem. Date of Onset - When did you first notice the appearance of your spinal condition? Measured Curve Progression - If X-rays have been taken of your spine in the past, the doctor will want to see if the curve is getting worse. This can be measured comparing new x-rays with old ones, measuring the size of the curve, or measuring changes in your height. The Presence or Absence of Pain - Not all cases of kyphosis produce pain. However, if there is pain, your doctor needs to know where it is, what brings on or intensifies the pain, and if there is any radicular pain - pain that radiates away from the spine itself. This usually comes from irritation of the nerves as they leave the spine. Bowel or Bladder Dysfunction - Are you having problems knowing when you have to urinate or have a bowel movement? This is extremely important because it could signal the presence of serious nerve damage. Motor function - Has there been a change in how your muscles work? This may be the result of pressure on the nerves or spinal cord itself.

Previous surgery - If you have had any surgery on your spine, it may have caused the kyphosis due to weakened muscles or other problems. In order to evaluate your condition properly, it is important that your physician knows about any spinal surgery you have had in the past. Physical Exam The spine specialist will then perform a physical examination. During the exam, the provider will try get an understanding of the curve in your back and how it is affecting you. This mean first trying to get a "mental picture" of how the spine is curved from examining your back and watching you move about. Your doctor will look at the flexibility you have bending in certain directions. Finally, your nerves will be tested by checking: your sensation, your reflexes, and the strength of your muscles. Additional Tests Usually, after the examination, X-rays will be ordered that allow the provider to see the structure of the spine and measure the curve. During the X-rays, you will be asked to hold certain positions while standing or lying on a table. You will need to hold very still while pictures are taken of your spine. With kyphosis the following images may be taken: Front view - These are X-rays of the entire spine taken from the front.

Lateral view - These are X-rays of the entire spine taken from the side. Lateral bend - These are X-rays taken while you are bending sideways. Traction films - Traction is when your spine is pulled and held in a particular position to take X-rays. These films are only taken occasionally. Depending on the outcome of your history, physical examination, and initial X-rays, other tests may be ordered to look at specific aspects of the spine. The most common tests that are ordered are: the MRI scan - to look at the nerves and spinal cord; the CAT scan - to get a better picture of the vertebral bones; and special nerve tests - to determine if any nerves are being irritated or pinched. To learn more about these tests, you may wish to review the document, entitled: Diagnostic Tests for Spine Problems Treatment for Adult Kyphosis Adult kyphosis has a variety of treatment options. Whenever possible, the first choice of treatment for adult kyphosis is always going to be conservative. Spinal surgery will always be the last choice of treatment due to the risks involved. Conservative treatment that is commonly recommended includes: medications, exercise, and certain types of braces to support the spine.

If osteoporosis is present, then treatment of the osteoporosis may slow the progression of the degenerative kyphosis as well. This can be accomplished in several ways. The current recommendations include: increasing your calcium and vitamin D intake, hormone replacement therapy, and weight-bearing exercises. For more information on osteoporosis, you may wish to review the document, entitled: A Patient's Guide to Osteoporosis The use of a spinal brace may provide some pain relief. However, in adults, it will not cause the spine to straighten. Once you have reached skeletal maturity, bracing is used for pain relief rather than prevention. If there is a difference in the length of your legs (or if the scoliosis causes you to walk somewhat crooked), special shoe inserts, called orthotics, or a simple shoe lift may reduce your back pain. To learn more about the different types of braces available for the spine, you may wish to review the document, entitled: A Patient's Guide to Back and Neck Braces Physical Therapy Physical therapy and exercise is an important part of treating adult kyphosis. A well-designed exercise program can also provide pain relief in many patients. A physical therapist will develop an appropriate exercise routine for your case.

It is essential that you stick to the plan. Typical advice includes: Learning correct body mechanics to maintain erect posture that counteracts the effects of the kyphosis Doing regular non-jarring exercises, such as swimming Maintaining high levels of activity Doing your daily stretching exercises Surgery Surgery for adult kyphosis carries with it some risks. For this reason, surgery is only recommended when the risks are far outweighed by the expected benefits. Surgery will not be recommended for most cases of kyphosis. Surgery may be recommended in the following situations: Pain - The most common reason for surgery is pain relief for increasing, chronic discomfort. Most cases of adult kyphosis surgeries are done to relieve severe pain. However, if the pain is manageable through any conservative way, surgery will not usually be recommended. Progression of Curve - Progression of the kyphosis deformity is another reason for considering surgery. If the curvature continues to worsen, surgery may be suggested. Surgery is recommended in this situation to prevent the problems that come from severe kyphosis. Cosmetics - In most cases of kyphosis, surgery will not be recommended simply for the sake of appearances.

However, in some cases, the kyphosis causes physical deformity that is unbearable to the patient. In these cases, surgery is the only option for correcting the condition. Most cases of cosmetic kyphosis surgery are in young adults that have very noticeable curves. Surgical Procedures When adult kyphosis requires surgery, many different procedures may be suggested. Each case of kyphosis is somewhat different and each may require a very specialized approach for optimal results. Surgery is suggested to solve the problems brought on by the kyphosis - not just to straighten the spine. The goals of most surgical procedures for adult kyphosis are to: Reduce the deformity (straighten the spine as much as possible) Stop the progression of the deformity Remove any pressure from the nerves and spinal cord Protect the nerves and spinal cord from further damage To succeed at doing these things, the spine surgeon may suggest an operation on the back of the spine, the front of the spine - or both. The goal is to first straighten the spine and then fuse the vertebrae together into one larger bone.

Nearly all surgeries will use some type of metal screws, plates, or rods, in order to help straighten the spine and hold the vertebrae in place while the fusion heals and becomes solid. The screws are placed into the vertebra. The rods or plates then attach to the screws to connect everything together. When everything is tightened together, the "construct" forms a sort of internal brace to hold the vertebrae in alignment while the fusion heals. To better understand the types of procedures that are used to treat adult kyphosis, please review the document, entitled: Spinal Fusion Using Intervertabral Cages Possible Complications/Problems with Surgery With any surgery, there is a risk of complications. When surgery is done near the spine and spinal cord these complications (if they occur) can be very serious. Complications could involve subsequent pain and impairment and the need for additional surgery. You should discuss the complications associated with surgery with your doctor before surgery. The list of complications provided here is not intended to be a complete list of complications and is not a substitute for discussing the risks of surgery with your doctor. Only your doctor can evaluate your condition and inform you of the risks of any medical treatment he or she may recommend.

Please review the document entitled: In addition, the surgical treatment of adult kyphosis may result in two special complications. Flat-back Deformity The lumbar (lower) spine naturally has a "C"-shaped curve called lordosis. When the vertebrae in the lumbar spine are fused together, this lordosis curve may be lost, leaving the patient with a "flat-back" deformity. However, the loss of curve may not appear right after surgery. In fact, if the surgery it is done in a young person, the loss of lordosis may not appear until sometime between the ages of 30 to 50. Pseudoarthrosis The term "pseudo" means false and "arthrosis" refers to joint. The term "pseudoarthrosis" then means false joint. A surgeon uses this term to describe either a fractured bone that has not healed or an attempted fusion that has not been successful. A pseudoarthrosis usually means that there is motion between the two bones that should be healed, or fused, together. When the vertebrae involved in a surgical fusion do not heal and fuse together, there is usually continued pain. The pain may actually increase over time.

The spinal motion can also stress the metal hardware used to hold the fusion. The screws and rods may break, leading to an increase in pain. A pseudoarthrosis may require more surgery to try to get the bones to heal. Your surgeon may add more bone graft, replace the metal hardware, or add an electrical stimulator to try to get the fusion to heal. Copyright © 2003 DePuy Acromed. Scheuermann's Disease | Orthogate Scheuermann's Disease Published: 20 July 2006 Introduction The section of spine from below the neck to the bottom of the rib cage is called the thoracic spine. From the side, the thoracic spine appears slightly rounded. Its shape is like the letter C with the opening facing the front of the body. This normal curve is called kyphosis. With excessive kyphosis, the thoracic spine takes on a hunchbacked appearance. Scheuermann's disease (also called Scheuermann's kyphosis) is a condition that starts in childhood. It affects less than one percent of the population and occurs mostly in children by the age of 11. It affects boys and girls equally.

Those who do not get proper treatment for the condition during childhood often experience back pain from the spinal deformity as adults. This guide will help you understand how the problem develops how doctors diagnose the condition what treatment options are available Anatomy What parts of the spine are involved? A healthy human spine has three gradual curves . From the side, the neck and low back curve gently inward. This is called lordosis. The thoracic kyphosis (outward curve) gives the mid back its slightly rounded appearance. These normal curves help the spine absorb forces from gravity and daily activities, such as lifting. The angle of normal kyphosis in the thoracic spine varies. During the growth years of adolescence, a normal curve measures between 25 and 40 degrees. If the curve angles more than 40 degrees, doctors consider the kyphosis a deformity. In general, kyphosis tends to be more exaggerated in girls. The angle increases slightly throughout life both in women and men. Scheuermann's disease causes the thoracic kyphosis to angle too far (more than 45 degrees). The 12 thoracic vertebrae are known as T1 to T12.

The main section of each thoracic vertebra is a round block of bone, called a vertebral body. A ring of bone attaches to the back of the vertebral body. This ring surrounds and protects the spinal cord. In Scheuermann's disease, the front of the vertebral body becomes wedge-shaped, possibly from abnormal growth. This produces a triangular-shaped vertebral body, with the narrow, wedged part closest to the front of the body. The wedge puts a bigger bend in the kyphosis of the thoracic spine. The vertebral bodies are separated by a cushion, called an intervertebral disc. Between each disc and vertebral body is a vertebral end plate. Sometimes one or more discs in patients with Scheuermann's disease squeeze through the vertebral end plate, which is often weaker in patients with Scheuermann's disease. This forms pockets of disc material inside the vertebral body, a condition called Schmorl's nodes . A long ligament called the anterior longitudinal ligament connects on the front of the vertebral bodies. This ligament typically thickens in patients with Scheuermann's disease. This adds to the forward pull on the spine, producing more wedging and kyphosis.

The disease usually produces kyphosis in the middle section of the thorax (the chest), between the shoulder blades. The condition sometimes causes kyphosis in the lower part of the thoracic spine, near the bottom of the rib cage. Causes Why do I have this problem? Famed for discovering this disease, Scheuermann himself thought a lack of blood to the cartilage around the vertebral body caused the wedging. Though scientists have since disproved this theory, the root cause of the disease is still unknown. Mounting evidence suggests wedging develops as a problem vertebral body grows . During normal growth, the cartilage around the vertebral body turns evenly and completely to bone. If the change from cartilage to bone doesn't happen evenly, one side of the vertebral body grows at a faster rate. By the time the entire vertebral body turns to bone, one side is taller than the other. This is the wedge shape that leads to abnormal kyphosis. Other theories of how Scheuermann's kyphosis starts include genetics Researchers have suggested that this disease can be passed down in families.

Childhood osteoporosis One medical study found that some patients with Scheuermann's disease had mild osteoporosis (decreased bone mass) even though they were very young. Other studies did not show problems with osteoporosis. More research is needed to confirm the role of osteoporosis in Scheuermann's disease. Mechanical Reasons These include strains from bending, heavy lifting, and using poor posture. This theory makes sense because the back braces used in treating kyphosis work. If a back brace can straighten a bent spine, then perhaps mechanical forces could cause more kyphosis than naturally occurs in the spine. (Back braces are discussed in more detail later.) Scientists are not convinced that mechanical reasons cause the disease; rather, these factors likely aggravate the condition. Symptoms What does the condition feel like? Hunched posture in children usually alerts parents or teachers to the need for a doctor visit. Children don't typically complain of back pain or other symptoms. This is not the case in adolescents who are nearing puberty and have kyphosis in the lowest part of the thorax, near the bottom of the rib cage. In these patients, back pain is the overriding problem. This happens most often to young, active males.

Doctors suspect this unique form of the disease occurs because the condition is overlooked during childhood, delaying treatment. Adults who've lived with the hunched posture for many years may note worsening pain. The pain typically causes them to seek medical help. Patients of all ages who experience pain generally report feeling discomfort along the sides of the spine, slightly below the main part of the abnormal curve. Exaggerated kyphosis can lead to an increased lordosis (inward curve) in the low back. This puts extra strain on the tissues of the low back. Over many years, this added wear and tear may produce low back pain. This mainly occurs in adults who have extra lumbar lordosis from years of untreated Scheuermann's disease. In rare cases, the spinal cord is affected. A severe kyphosis stretches the spinal cord over the top of the curve. This can injure the spinal cord. Also, patients with Scheuermann's disease have a greater chance of having a herniated thoracic disc. This is where the disc material from inside the disc begins to squeeze out and press on the spinal cord. Spinal cord symptoms for both situations include sensations of pins and needles and numbness. The leg muscles may feel weak.

Symptoms from an injured spinal cord can also include changes in bowel and bladder function. When the kyphosis angle exceeds 100 degrees, the sharply bent spine puts pressure on the heart, lungs, and intestines. When this occurs, patients may tire quickly, suffer shortness of breath, feel chest pain, and lose their appetite. Diagnosis How do doctors diagnose the problem? Doctors start with a complete history and physical examination. However, X-rays are the main way to diagnose Scheuermann's kyphosis. Taken from the side, an X-ray may show vertebral wedging, Schmorl's nodes, and changes in the vertebral end plates. Doctors use X-ray images to measure the angle of kyphosis. Doctors diagnose Scheuermann's disease when three vertebrae in a row wedge five degrees or more and when the kyphosis angle is greater than 45 degrees. A side-view X-ray can also show if the spine is flexible or rigid. Patients are asked to bend back and hold the position while an X-ray is taken. The spine straightens easily when it is flexible. In patients with Scheuermann's disease, however, the curve stays rigid and does not improve by trying to straighten up.

From the front, X-rays show if the spine curves from side to side. This sideways curve is called scoliosis and occurs in about one-third of patients with Scheuermann's kyphosis. X-rays can show signs of wear and tear in adults who have extra lumbar lordosis from years of untreated Scheuermann's disease. Computed tomography (a CT scan) may be ordered. This is a detailed X-ray that lets doctors see slices of the body's tissue. Myelography is a special kind of X-ray test. For this test, dye is injected into the space around the spinal canal. The dye shows up on an X-ray. This test is especially helpful if the doctor is concerned whether the spinal cord is being affected. Magnetic resonance imaging (MRI) uses magnetic waves rather than X-rays to show the soft tissues of the body. This machine creates pictures that look like slices of the area the doctor is interested in. The test does not require special dye or a needle. Treatment combined fusion Posterior Fusion In a fusion operation, two or more bones are joined into one solid bone.

Surgeons perform posterior fusion for Scheuermann's disease on the rare patient who prefers not to use a brace and whose spine is still growing, is mildly flexible, and has a kyphosis of less than 65 degrees. This surgery is done through the back (posterior) of the spine. After making an incision in the back, the surgeon applies pressure to straighten the kyphosis. Small strips of bone graft are then laid over the back of the spinal column. These strips encourage the bones to grow together. Metal rods are attached along the spine to prevent the vertebrae from moving. The rods hold the spine in better alignment and protect the bone graft so it can heal better and faster. Combined Fusion Combined fusion is actually two fusion surgeries, one from the back (posterior) and one from the front (anterior) of the spine. In the past, two separate operations were needed, but now some surgeons do both fusions in the same operation. This surgery is commonly used if the spine is finished growing and the kyphosis angle is more than 75 degrees. The surgeon starts with anterior fusion.

With the patient on his or her side, the surgeon cuts away a piece of rib to make a small opening on the side of the thorax. The rib opening is spread apart so the surgeon can reach the spine better. The surgeon operates on the front of the spine through the chest cavity. A section of the anterior longitudinal ligament is cut. This makes it easier to straighten the hunched spine. The intervertebral discs in the problem area are taken out, and the spaces between the wedged vertebrae are filled with bone graft. One method is to take a graft of bone from the pelvis and tamp it into the place of each removed disc. This requires another incision over one side of the pelvis. A second method is to grind up the piece of rib that was removed and place it in the disc spaces. As the grafts heal, the vertebrae become fused into solid bone. The second part of surgery is an involved form of posterior fusion using special rods and hooks. This part of the operation can be done right after the anterior fusion or scheduled for one week later. First, the surgeon makes an incision over the back of the spine. The skin and muscles are spread apart.

Then strips of bone graft are laid across each vertebra to be fused. Long rods are inserted along the sides of the spine. The rods have hooks attached on both ends. Wire is wrapped between the top and bottom hooks. Tightening the wires causes the spine to straighten. The rods help hold the spine steady as the bone grafts heal. The rods are usually left in permanently. Rehabilitation What should I expect as I recover? Nonsurgical Rehabilitation Children and adolescents treated nonsurgically sometimes work with a physical therapist. Certain exercises are beneficial when used in combination with a brace. Upper back exercises, such as gentle back bends (extension) can improve posture and prevent the spine from slouching forward. Hamstring stretches and pelvis exercises improve posture by preventing extra lordosis in the low back. Aerobic exercise improves heart and lung health and combats pain. Pain is also addressed by the physical therapist. The therapist may apply heat, cold, ultrasound, and massage treatments. Adults who've had kyphosis for many years (and the resulting low back pain from too much lordosis) benefit from postural exercises to reduce the lumbar curve, followed by stabilization exercises to help them keep better posture.

Patients benefit most when these exercises are done regularly and for a lifetime. After Surgery Rehabilitation after surgery is more complex. Although some patients leave the hospital shortly after surgery, some surgeries require patients to stay in the hospital for a few days. Soon after surgery, a physical therapist may visit patients who stay in the hospital. The treatment sessions help patients learn to move and do routine activities without putting extra strain on the back. During recovery from surgery, patients should follow their surgeon's instructions about wearing a back brace or support belt. They should be cautious about overdoing activities in the first few weeks after surgery. Many surgical patients also need physical therapy outside of the hospital. Patients normally wait up to three months before beginning a rehabilitation program after fusion surgery for Scheuermann's disease. They typically need to attend therapy sessions for eight to 12 weeks. Full recovery may take up to eight months. Upon completing physical therapy, patients are in charge of doing their exercises as part of an ongoing home program. All content provided by eORTHOPOD® is a registered trademark of Medical Multimedia Group, L.L.C. . Content is the sole property of Medical Multimedia Group, LLC and used herein by permission.

Details Kyphosis Kyphosis Cifosis Your spine (backbone) curves forward gently as it runs up your back. This is normal, and it helps your spine support your head and upper body. Sometimes, though, a person's back can be rounded too far forward. This condition is known as kyphosis, and it can sometimes lead to problems. What Is Kyphosis? Kyphosis is a fairly common condition for teens and adults. Often, when someone has kyphosis, you won't be able to notice it and it won't cause any problems. In some cases, though, people with kyphosis can develop a hump on their back, feel uncomfortable, or have trouble breathing properly. The backbone is made up of a column of small disc-shaped bones, called vertebrae, that are held together by ligaments. The vertebrae in the middle and upper part of the back are called the thoracic vertebrae. They're attached to the ribs. The thoracic vertebrae are the ones that are rounded forward too much when someone has kyphosis.

Different types of kyphosis can affect teens, and each has its own cause: Postural kyphosis is the most common type of kyphosis. It typically appears during the teen years and is more common in girls than boys. Postural kyphosis can happen when bones and muscles develop in an abnormal way as they grow, possibly because of slouching or poor posture. Postural kyphosis can cause mild discomfort but rarely leads to problems later in life. Scheuermann's kyphosis usually appears during adolescence, especially during a growth spurt. No one knows what causes it, but it can run in families. Scheuermann's kyphosis causes the vertebrae to look like wedges, rather than rectangles, when viewed from the side on X-rays. It is slightly more common among boys than girls. Congenital kyphosis happens when the spine develops abnormally while a baby is still in the mother's womb. Several vertebrae can be fused together or the bones can form improperly. This type of kyphosis can get worse as a child grows. It is important to check a baby or child with congenital kyphosis for other orthopedic problems and heart or kidney defects.

continue How Is Kyphosis Diagnosed? Sometimes kyphosis will be easy to see. A person might have a hump or the back might look more rounded than it should. Other cases of kyphosis will be harder to notice and may not be visible at all. To check you for kyphosis, a doctor will examine your spine and might ask you to do a forward-bending test, which involves simply bending forward at the waist. This can sometimes make kyphosis easier to see. The doctor also might ask you to lie down, which can help in diagnosing postural kyphosis. If it looks like someone has kyphosis, doctors will usually order X-rays of the spine. Looking at the X-rays can help determine the type of kyphosis. To check if kyphosis is affecting breathing, doctors may ask a person to breathe in so they can listen to the lungs. If a doctor thinks kyphosis isn't the problem, he or she may call for an MRI scan of the back. What Do Doctors Do? Often, doctors don't need to do anything for kyphosis.

Cases in which it appears that the rounding isn't going to cause any problems might only require regular checkups to ensure the rounding doesn't become worse. Most cases will stop getting worse once someone is fully grown. Sometimes, a doctor may refer someone with kyphosis to an orthopedist, who will examine the spine to determine the cause and extent of the kyphosis. Congenital kyphosis sometimes requires surgery at an early age to fix (if you have this type, you may have already had surgery). The types of kyphosis that appear during a person's teens can generally be treated with simpler methods. Treatment varies depending on the type of kyphosis and how severe it is: Postural kyphosis. A doctor may recommend physical therapy or strength training to decrease pain and improve posture. You may be given exercises to strengthen the back muscles so they can help support the spine better. Sleeping on a firm bed can also help. Scheuermann's kyphosis. With moderate cases, an orthopedist may recommend a brace to help correct the condition and provide back support as you grow. If you need a brace, an orthopedist will help you determine which one is right for you.

You might hear an orthopedist mention something called a Cobb angle. The Cobb angle is a measure of the curvature of the spine in degrees, and the number of degrees helps the doctor decide what type of treatment is necessary. If the rounding of the spine is especially pronounced (75 degrees or more), or if it causes pain or makes breathing difficult, an orthopedist may recommend surgery. Surgery might also be a last resort if someone's back doesn't respond to other treatments. Most of the roundedness from Scheuermann's kyphosis will be gone after surgery. previous continue Braces Some braces are designed to help correct posture. Others are stiffer body jackets designed to help straighten the spine as a person grows. One common brace used for treating Scheuermann's kyphosis is a thoracolumbosacral orthosis (pronounced: tho-ra-ko-lum-bo-SAY-krul or-THOH-sus), or TLSO for short. It can be worn under clothes. Some people with kyphosis wear a brace at night; others will need to wear a brace for 18-20 hours a day. It all depends on the type of kyphosis and what the brace is designed to do.

Most teens wear back braces until they stop growing and the kyphosis is unlikely to progress. As with orthodontic braces , back braces can be a little uncomfortable at first. But people get used to them, and — like braces on the teeth — they really need to be worn as prescribed or they won't work. Usually, back braces won't restrict a person's activities, and researchers are coming up with lighter and better ones all the time. Surgery Kyphosis rarely requires surgery. If it does, the surgeon will likely do a spinal fusion. This procedure joins two or more of the affected vertebrae together to reduce the amount of rounding in the spine. Spinal fusion involves attaching new pieces of bone to the vertebrae by using metal rods and screws, placed deep under the spine muscles to correct the kyphosis. After a few months to a year, the bones grow together, or "fuse." The metal pieces are usually left in place as they are not noticeable or uncomfortable. Doctors will often prescribe physical therapy after surgery to help the back recover more quickly. Every situation is different, but most teens who've had surgery to correct their kyphosis are up and walking within a day or two.

After kyphosis surgery, people can generally go home from the hospital within a week. Most teens return to school within a month of the surgery and can resume some activities in 3 to 4 months. Most people will be able to resume all routine activities 6 to 12 months after surgery, and the bones should be fully fused by about 1 year. It's important for teens who have had surgery to talk with their doctor and parents about which activities are OK as their backs heal. There's no need to let kyphosis slow you down. People with kyphosis can lead active, normal lives and usually won't have any restrictions on their activities. So if you have kyphosis, do the things you enjoy doing and play your favorite games and sports (as long as you're not still recovering from any surgery!). Learn more: All About Thoracic Kyphosis: Forward Curvature of the Upper Back Such problems occur at a young age with Scheuermann's disease, also called Scheuermann's kyphosis. It can lead to a rounded upper back, sometimes called a hump back, in otherwise healthy adolescents.

Scheuermann's disease is among the most frequent sources of back pain in young people, with pain more likely to follow either exertion or long periods of inactivity. See Back Pain in Kids and Teens The number of terms used for the condition, named after the doctor who first described it, can be confusing. Patients and their parents may hear the name Scheuermann used for other conditions, such as changes in the disc spaces of the lumbar spine, usually called juvenile disc disorder (or juvenile discogenic disorder). Other terms sometimes used are Calvé disease and juvenile osteochondrosis. Surgery is usually not needed except in the most advanced cases. Effective treatments often include braces and a supervised program of exercises to increase flexibility and ease pain. Article continues below Abnormal Bone Growth To understand how Scheuermann's disease develops, it’s helpful to understand the structure of the upper spine. The vertebrae are more or less cylindrical in shape, and stacked to keep the spine in an upright position. See Vertebrae in the Vertebral Column With Scheuermann's disease, an abnormality causes parts of the vertebrae to grow at different rates during a child’s growth spurt.

This variance causes some of the vertebrae to become wedge-shaped, and the stack to look more like a tower that is leaning forward. These changes result in the exaggerated forward curvature of the upper back. Scheuermann's disease occurs most often in the upper back, also called the thoracic spine, but occasionally develops in the lower back, or lumbar spine. When the disease is in the lumbar spine, the deformity is usually not as obvious, but the lumbar deformity usually causes greater pain, more limitation on movement, and an increased likelihood of the condition continuing into adulthood. See Lumbar Spine Anatomy and Pain Scheuermann's disease begins before puberty. It is not known what triggers the abnormal growth, but there are theories that the bone may have been injured at some point, or that the area was weak before puberty. Heredity is thought to play a role, but the connection is not straightforward. The condition is connected to skeletal growth, and the curvature does not usually increase after growth is completed. It is estimated that 1 to 8 percent of people develop the condition. In This Article: Kyphosis Video: What is Kyphosis?

Concerns About Appearance If a young person shows symptoms of Scheuermann’s disease, medical help should be sought as soon as possible. In addition to the physical health challenges, the psychological impact can be significant, since the condition strikes at an especially self-conscious stage of life. Delaying medical care can have long-term cost; those who do not receive treatment as adolescents may encounter significant pain as adults. Sometimes delays in diagnosis and treatment are caused by the mistaken belief that the deformity is due to poor posture. Such cases are known as postural kyphosis, a condition that involves weak muscles. People with Scheuermann’s disease have a skeletal deformity, however, and simply cannot straighten their spine. Kyphosis - NHS Choices Kyphosis Kyphosis Treatment Introduction Kyphosis is curvature of the spine that causes the top of the back to appear more rounded than normal. Everyone has some degree of curvature in their spine. However, a curve of more than 45 degrees is considered excessive. Sometimes kyphosis doesn't cause any symptoms other than the back appearing abnormally curved or hunched.

However, in some cases the condition causes: tenderness of the spine tiredness Back pain can be particularly problematic in adults with kyphosis because the body has to compensate for the spinal abnormality. If you have severe kyphosis, your symptoms may get worse over time. You may also have difficulty breathing and eating. What causes kyphosis? In kyphosis, the normal curve in the middle section of vertebral column (the thoracic vertebrae) is more curved than normal. There are a number of reasons why this might happen, including: poor posture (postural kyphosis) – slouching, leaning back in chairs and carrying heavy bags can stretch supporting muscles and ligaments, which can increase spinal curvature abnormally shaped vertebrae (Scheuermann’s kyphosis) – if the vertebrae don't develop properly, they can end up being out of position abnormal development of the spine in the womb (congenital kyphosis) – if something disrupts the spine's normal development, two or more vertebrae sometimes fuse together age – as people get older, their spinal curvature can be expected to increase Kyphosis can also develop as a result of a spinal injury.

Read more about the causes of kyphosis . Treating kyphosis If you have kyphosis, your treatment depends on how curved your spine is, whether you have any additional symptoms such as back pain, and the underlying causes. Children with kyphosis may be able to be treated using non-surgical methods, such as bracing, to limit the progression of kyphosis as they grow. Treatment for mild kyphosis may not be necessary. Kyphosis rarely requires surgical treatment. It's only needed in some severe cases to correct the curvature of the spine. Read more about treating kyphosis . Emotional issues Older children with kyphosis may become concerned or embarrassed about the effect the condition has on their appearance, or having to wear a back brace. These concerns can affect different children in different ways. Some children can become socially withdrawn and they may be reluctant to take part in activities, such as PE, where their condition may be exposed. There are no easy answers to these problems, but it can sometimes help to reassure your child that their feelings will improve with time. Complications Complications of kyphosis usually only occur in more severe cases.

They include: persistent pain that can't be controlled with medication breathing difficulties caused by the spine compressing the lungs and airways Occasionally, people with kyphosis can have difficulties when the nerves running through the spine become compressed or pinched. This can disrupt nerve signals and cause symptoms such as: numbness or weakness in the arms and legs problems with sense of balance loss of normal bladder or bowel control These serious complications require urgent medical attention and surgery would usually be recommended. Can kyphosis be prevented? Postural kyphosis can be prevented by being aware of your posture and by taking care of your back. You should encourage your child to: avoid slouching sit correctly – sit upright, ensuring that the small of the back is supported avoid carrying heavy schoolbags that can pull on the back muscles and ligaments; the best schoolbags are well-designed backpacks take regular exercise (see below) to help strengthen the back and keep it flexible; activities such as swimming , running , walking , yoga and pilates are ideal for helping to prevent back problems Further information: Kyphosis: Causes, Treatments, and Risks Your message has been sent. OK We're sorry, an error occurred. We are unable to collect your feedback at this time.

However, your feedback is important to us. Please try again later. Close Kyphosis, also known as roundback or hunchback, is a condition in which the spine in the upper back has an excessive curvature. The upper back, or thoracic region of the spine, is supposed to have a slight natural curve. The spine naturally curves in the... Read more Kyphosis, also known as roundback or hunchback, is a condition in which the spine in the upper back has an excessive curvature. The upper back, or thoracic region of the spine, is supposed to have a slight natural curve. The spine naturally curves in the neck, upper back, and lower back to help absorb shock and support the weight of the head. Kyphosis occurs when this natural arch is larger than normal. If you have kyphosis, you may have a visible hump on your upper back. From the side, your upper back may be noticeably rounded or protruding. In addition, people with hunchback appear to be slouching and have noticeable rounding of the shoulders. Kyphosis can lead to excess pressure on the spine, causing pain. It may also cause breathing difficulties due to pressure put on the lungs.

Kyphosis in elderly women is known as dowager’s hump. Common causes of kyphosis Kyphosis can affect people of any age. It rarely occurs in newborns because it’s usually caused by poor posture. Kyphosis caused by poor posture is called postural kyphosis. Other potential causes of kyphosis include: aging, especially if you have poor posture muscle weakness in the upper back Scheuermann’s disease, which occurs in children and has no known cause arthritis or other bone degeneration diseases osteoporosis , the loss of bone strength due to age injury to the spine Much of our bodily movement depends on the health of the spine, including our: flexibility mobility activity Getting treatment to help correct the curvature of your spine may help you reduce the risk of complications later in life, including arthritis and back pain. Treating kyphosis Treatment for kyphosis will depend on its severity and underlying cause. Here are some of the more common causes and treatments: Scheuermann’s disease: A child may receive physical therapy, braces, or corrective surgery. Infection: Your doctor will probably prescribe antibiotics for you. Tumors: Typically, tumors are only removed if there’s concern for spinal cord compression.

If this is present, the surgeon may try to remove the tumor, but frequently this destabilizes the bone. In such cases, a spinal fusion is often also necessary. Osteoporosis: It’s essential to treat bone deterioration to prevent kyphosis from worsening. Poor posture: You will not need aggressive treatments. The following treatments may help relieve the symptoms of kyphosis: medication, to relieve pain, if necessary physical therapy, to help build strength in the core and back muscles yoga, to increase body awareness and build strength, flexibility, and range of motion weight loss, to relieve excess burden on the spine braces, especially in children and teens surgery, in severe cases Risks of untreated kyphosis For most people, kyphosis does not cause serious health problems. This is dependent on the cause of the kyphosis. If kyphosis is caused by poor posture, you may suffer from pain and breathing difficulties. These will only get worse later in life. You can treat kyphosis early by: strengthening the muscles of the back seeing a physical therapist Your goal will be to improve your posture long-term to decrease pain and other symptoms.

Written by Amber Erickson Gabbey Medically Reviewed on October 26, 2016 by Timothy Schmidt, MD Article Sources: Kyphosis | definition of kyphosis by Medical dictionary Kyphosis | definition of kyphosis by Medical dictionary Kyphosis is the extreme curvature of the upper back also known as a hunchback. Description The upper back bone (thoracic region), is normally curved forward. If the curve exceeds 50° it is considered abnormal (kyphotic). Causes and symptoms Kyphosis can be divided into three ages of acquisition—birth, old age, and the time in between. Spinal birth defects can result in a fixed, exaggerated curve. Vertebrae can be fused together, shaped wrong, extraneous, or partially missing. Congenital and hereditary defects in bone growth weaken bone and result in exaggerated curves wherever gravity or muscles pull on them. Dwarfism is such a defect. During life, several events can distort the spine. Because the natural tendency of the thoracic spine is to curve forward, any weakness of the supporting structures will tend in that direction.

A diseased thoracic vertebra (a spine bone) will ordinarily crumble its forward edge first, increasing the kyphotic curve. Conditions that can do this include cancer , tuberculosis, Scheuermann's disease, and certain kinds of arthritis. Healthy vertebra will fracture forward with rapid deceleration injuries, such as in car crashes when the victim is not wearing a seat belt. Later in life, kyphosis is caused from osteoporosis , bone weakness, and crumbling forward. The stress caused by kyphosis produces such symptoms as an increase in musculoskeletal pains, tension headaches, back aches, and joint pains. Diagnosis A quick look at the back will usually identify kyphosis. X rays of the spine will confirm the diagnosis and identify its cause. Treatment Congenital defects have to be repaired surgically. The procedures are delicate, complicated, and lengthy. Often orthopedic hardware must be placed to stabilize the back bone. At other times, a device called a Milwaukee brace can hold the back in place from the outside. Fitting Milwaukee braces comfortably is difficult because they tend to rub and cause sores. Kyphosis acquired during the younger years requires treatment directed at the cause, such as medications for tuberculosis.

Surgical reconstruction or bracing may also be necessary. Kyphosis induced by osteoporosis is generally not treated except to prevent further bone softening. Prognosis Congenital kyphosis may be alleviated to some extent by surgery and bracing. Kyphosis occurring later in life may worsen over time. Prevention Preventing osteoporosis is within the grasp of modern medicine. Menopausal women must start early with estrogen replacement, calcium supplementation, and appropriate exercise . The treatment must continue through the remainder of life. Evidence suggests that a high calcium intake even during younger years delays the onset of symptomatic osteoporosis. Dairy products are the major dietary sources of calcium. Resources Arthritis Foundation.1300 W. Peachtree St., Atlanta, GA 30309. (800) 283-7800. National Osteoporosis Foundation. 1150 17th St., Suite 500 NW, Washington, DC 20036-4603. (800) 223-9994. Osteoporosis and Related Bone Diseases-National Resource Center.

1150 17th S. NW, Ste. 500, Washington, DC 20036. (800) 624-2663. Key terms Causes of Kyphosis Causes of Kyphosis There are many possible causes of kyphosis, and narrowing down the curve's cause starts with narrowing down what type of kyphosis you have. Remember, there are 2 types: postural kyphosis and structural kyphosis. Cause of Postural Kyphosis The cause of postural kyphosis is easy to understand: Poor posture leads to an excessive rounding of the upper back. If you try, you can correct postural kyphosis, just by making a conscious effort to stand up straight and have good posture. Causes of Structural Kyphosis The second type of kyphosis, structural kyphosis, can't be corrected with postural work, and its causes are much more varied. The causes of structural kyphosis relate to problems with various structures in the spine. One type of structural kyphosis is congenital kyphosis.

"Congenital" means present at birth, so people with this type of structural kyphosis are born with either missing or incompletely formed parts of the spine. Congenital kyphosis is called a primary kyphosis because it's not related to another cause. During a growth period, a person with a vertebra that has not formed correctly may develop a pronounced kyphotic curve because of the underlying structural problems. Then there's Scheuermann's kyphosis, also known as Scheuermann's disease. It's also considered a primary kyphosis because it's not caused by another condition. Right now, the medical community isn't exactly sure what causes Scheuermann's kyphosis, but they believe that it has something to do genetics. The condition seems to run in families. Other possible causes of Scheuermann's kyphosis include interrupted bone growth, height, and weight. Scheuermann's kyphosis occurs when the front of the spine doesn't grow as fast as the back of the spine. Doctors have found that some children begin to develop this type of kyphosis between the ages of 12 and 15—generally a period of bone growth.

Structural kyphosis can develop because of another spinal problem. This is known as secondary kyphosis; the kyphosis is "secondary to another medical condition" in doctor-speak. Some conditions that can cause secondary kyphosis are: Connective tissue disorders Some other causes of secondary kyphosis are: Degenerative Conditions Over time, parts of our bodies can wear out or degenerate. When that happens, those body parts don't work as well, and this degeneration can lead to kyphosis. Two common degenerative conditions that can cause secondary kyphosis are: arthritis: Inflammation of the spinal joints can create spinal instability as your spine loses its ability to move as it should. If you have arthritis in your spine, you may develop kyphosis. degenerative disc disease: This spinal condition is generally considered to be age-related; over time, our intervertebral discs can wear out because our spines have to work so hard to cushion our movements. When the discs wear out, other problems can develop. DDD can lead to kyphosis because as the discs thin, the front of the vertebrae begin to tip forward.

That makes the spine unstable and as more discs wear out and thin, more vertebrae start to tip, and you'll develop a hyperkyphotic curve. osteoporosis: When the bones in the spine weaken because of osteoporosis, you can get vertebral compression fractures. The vertebrae can fracture because of a sudden movement—even a cough can damage osteoporosis-weakened vertebrae—or they can collapse. Several vertebral fractures can cause kyphosis because if it's fractured, the spine can no longer support itself. Vertebrae may lose their normal shape and may begin to look like wedges, causing the vertebrae to collapse on one another and creating a curve in the spine. Iatrogenic In Greek, "iatro-" means medicine or physician; "genic" relates to the cause of something. So iatrogenic means that the physician's actions caused something to happen—and that's usually taken in a negative way. Certainly without intending to and with no malice involved, surgeons can sometimes cause a patient to develop an abnormal kyphotic curve following a surgery. This is very, very rare.

Post-laminectomy kyphosis: If the surgeon is trying to open up more room for your spinal cord or spinal nerves, he or she may do a laminectomy. That's a form of decompression surgery because it takes pressure off—decompresses—the nerves or cord. Perhaps the nerves are being compressed by a herniated disc, a tumor, or a bone spur (osteophyte). The surgeon will remove what's causing your pain and any related structures that could compress the nerve. In a laminectomy, the surgeon removes part of the lamina, which is somewhat like the roof of your spine. The lamina is located on the posterior side (the backside) of the vertebrae. Usually, the surgeon also has to remove part of the ligament that's on the back of the spine, and that can cause the patient to lose spinal stability. Also, the surgery can weaken the muscles that support the spine. Without strong supporting structures, the spine may start to bend forward—abnormal kyphosis. Trauma If you experience a traumatic event—a car accident, a fall, a serious sports injury, etc—the injuries to your vertebrae and supporting soft tissues may cause secondary kyphosis.

The following is a list of injuries that, in combination, can cause significant spinal instability and kyphosis. Fractures of the posterior (back) elements: The back part of your vertebra is crucial in stabilizing and controlling your movements. If you fracture the lamina (the roof of the vertebrae) or a facet joint (very central to control your vertebral movements), your spine could become so unstable that it will curve forward. Torn posterior (back) ligaments: Ligaments on the backside of your vertebrae provide a lot of stability. If they're torn, your spine may start to curve forward too much. Loss of supporting muscles: The muscles in your back also have an important job in supporting the spine. If they're torn or injured, they won't be able to provide as much support to the vertebrae. The spine can then start to curve forward too much. Compression fractures: These were covered in the osteoporosis section above. In addition to being caused by osteoporosis, compression fractures can happen during a traumatic event that places too much strain and stress on your spine. Additionally, without the strong supporting structures on the posterior (back) side—the ligaments and muscles—the spine may develop compression fractures.

It may collapse on the front side of the spinal column (the anterior side) as it adjusts to the strain. When too many vertebrae collapse (and then start to tip forward because the front part is compressed), you can develop an abnormal kyphotic curve. Updated on: 09/08/15

Question: In humans, the medical condition kyphosis affects which part of the body?
Answer: Spine