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Kyphosis

Overview:

The vertebral column, also known as the spinal column or simply spine, is a column of 26 bones in an adult body (24 vertebrae interspaced with cartilage in addition to the sacrum and coccyx). In adolescents, the column consists of 33 bones as the sacrum’s five bones and the coccyx’s four do not fuse together until after adolescence. The spine is further divided into regions: cervical (the neck), thoracic (upper back), lumbar (lower back), sacral, and coccygeal. In between the vertebrae are thin regions of cartilage known as intervertebral discs, which are made of a fibrous outer shell (annulus fibrosus) and a pulpy center (nucleus pulpous).

Some rounding of the spine is normal, but in some cases, severe rounding of the spine can lead to other problems. This unnatural rounding of the spine is called kyphosis of the spine. Kyphosis can occur at any age; however, it is more common in older women, typically after osteoporosis has weakened the bones in the spine to the point where they crack and compress. Kyphosis in children occurs due to malformation of the spine.

Symptoms:

Individual who have kyphosis may experience some pain in the back associated with stiffness along with the abnormally curved spine that is visible to the naked eye. Mild cases of kyphosis may result in no obvious signs or symptoms. If an individual notices an increased curve in their upper back, a consultation with a physician is highly recommended.

Diagnosis:

Kyphosis is diagnosed with a combination of physical examination and imaging studies and possible nerve testing.  After discussing the individual's symptoms, the physician will check their height and instruct them to pend forward from the waist while the physician vies the spine from the side to identify any clear signs of kyphosis. The physician may then order an X-ray, CT scan, or MRI scan to determine the degree of curvature to help identify the type of kyphosis. The CT and MRI scan will help the physician rule out other possible causes such as tumors or infections.

The most common types of kyphosis are as follows:

  • Postural Kyphosis – This is the most common form of kyphosis is often linked to slouching, representing an increase in the natural curve of the spine. Specific exercises and postures may help in relieving some discomfort, but it’s unlikely to significantly correct the postural kyphosis.
  • Scheuermann's Kyphosis – This type mostly affects the upper spine, but can also affect the lower spine, and is a more severe deformity than postural kyphosis. Activity and long period of time sitting or standing can aggravate the pain. Specific exercises aimed at strengthening the spine along with over-the-counter anti-inflammatory medication such as ibuprofen and naproxen can help ease discomfort.
  • Congenital Kyphosis – This type occurs in infants where the spinal column doesn’t develop fully while the fetus is in the womb. The bones may not have formed properly or were fused together because of the position of the fetus in the womb. These abnormal situations can lead to progressive kyphosis as the child grows.

Treatment:

Treatment for kyphosis will vary depending on the reason for the deformity as well as the type of kyphosis. Individuals that have postural kyphosis typically don’t require treatment and have no permanent issues. Kids and teens that are still developing and have Scheuermann's kyphosis may be able to wear a brace until they reach skeletal maturity to prevent further curving of the spine. Surgery is typically recommended when the degree of curvature caused by kyphosis exceeds 75. The main objectives of surgery are to reduce the degree of curvature that will be maintained over time and to alleviate other associated symptoms.

Recovery:

Recovery will vary based on the type of kyphosis and the severity of the symptoms. Each patient is unique, so the therapy program will vary based on his/her level of pain, extent of damage, and desired level of activity they would like to return to. Based on the treatment approach, the physician will discuss the appropriate recovery timeline.