Kyphosis (Greek - kyphos, a hump)also called "hunch back", in general terms, is a common condition of a curvature of the upper (thoracic) spine. It can be either the result of bad posture (slouching) or a structural, muscular abnormalty in the spine.
In the sense of a deformity, it is the pathological curving of the spine, where parts of the spinal column lose some or all of their lordotic profile. This causes a bowing of the back, seen as a slouching posture. Symptoms of kyphosis, that may be present or not, depending on the type and extent of the deformity, include mild back pain, fatigue, appearance of round back and breathing difficulties. Severe cases can cause great discomfort and even lead to death.
There are several kinds of kyphosis (ICD-10
codes are provided):
- Postural kyphosis (M40.0), the most common type, normally attributed to slouching can occur in both the old and the young. In the young, it can be called 'slouching' and is reversible by correcting muscular imbalances. In the old, it may be called 'hyperkyphosis' or 'dowager’s hump'. About one third of the most severe hyperkyphosis cases have vertebral fractures. Otherwise, the aging body tends towards a loss of musculoskeletal integrity, and kyphosis can develop due to aging alone.
- Scheuermann's kyphosis (M42.0) is significantly worse cosmetically and can cause pain. It is considered a form of juvenile osteochondrosis of the spine, and is more commonly called Scheuermann's disease. It is found mostly in teenagers and presents a significantly worse deformity than postural kyphosis. A patient suffering from Scheuermann’s kyphosis cannot consciously correct posture. The apex of the curve, located in the thoracic vertebrae, is quite rigid. The patient may feel pain at this apex, which can be aggravated by physical activity and by long periods of standing or sitting. This can have a significantly detrimental effect on their lives, as their level of activity is curbed by their condition; they may feel isolated or uneasy amongst peers if they are children, depending on the level of deformity. Whereas in postural kyphosis the vertebrae and disks appear normal, in Scheuermann’s kyphosis they are irregular, often herniated and wedge shaped over at least three adjacent levels. Fatigue is a very common symptom, most likely because of the intense muscle work that has to be put into standing and/or sitting properly. The condition seems to run in families.
- Congenital kyphosis (Q76.4) can result in infants whose spinal column has not developed correctly in the womb. Vertebrae may be malformed or fused together and can cause further progressive kyphosis as the child develops.. Surgical treatment may be necessary at a very early stage and can help maintain a normal curve in coordination with consistent follow ups to monitor changes. However, the decision to carry out the procedure can be very difficult due to the potential risks to the child. A congenital kyphosis can also suddenly appear in teenage years, more commonly in children with cerebral palsy and other neurological disorders.
- Nutritional Kyphosis can result from nutritional deficiencies, especially during childhood, such as vitamin D deficiency (producing rickets) which softens bones and results in curving of the spine and limbs under the child's body weight
Treatment for kyphosis may involve anti-inflammatory drugs as well as exercises to strengthen the abdominal and hamstring muscles. Back hyper-extensions, done on a Roman chair or an inflatable ball, are exercises doctors prescribe to juvenile and adult patients to strengthen spinal muscles and improve posture. John Albert Odom, Jr., M.D. states that
"While physical therapy (PT) doesn't help in severe cases of scoliosis and kyphosis, it is still the mainstay of treatment for minor scoliosis and kyphosis, The sooner physical therapy is started, the more likely the child will not end up with a humpback. We recommend that PT be started as early as age 10. At age 15 PT is considered too late to start, at this point bracing or surgery are the two most viable treatments especially if the curve is progressive and/or is accompanied by C-spine deformity.
showed benefit in a randomized controlled trial
The Milwaukee brace is one particular body brace that is often used to treat kyphosis.
Surgical treatment can be used in severe cases. In patients with progressive kyphotic deformity due to vertebral collapse, a procedure called a kyphoplasty
may arrest the deformity and relieve the pain. The procedure is serious and consists of fusion of the abnormal vertebrae.