Kyphosis - Types, Causes, Symptoms, Diagnosis, and Treatment

What Does Kyphosis Mean?

Kyphosis, otherwise called hunchback or roundback, is when the upper portion of the spine has severe curvature. The part of the spine present in the upper back (thoracic region of the spine) is slightly curved naturally. But, extensive curvature results in a prominent hump in the upper back, and it can appear rounded or protruding from the side. Individuals affected with kyphosis slouch and have a visible rounding of the shoulders. This abnormal spine curvature puts excess pressure on the spine, leading to back pain, stiffness, and altered gait. Sometimes, the person might find it hard to breathe due to pressure on the lungs. This condition can occur at any age but is more common in teenagers and older women. Dowager's hump is used to describe kyphosis in older women. Weakness in the spinal bones is to be blamed for age-related kyphosis, and kyphosis in infants or adolescents is due to the spine's malformation.

The spine naturally has a series of inward curves in the neck and lower back when seen from the side, which helps in the absorption of shock due to the body weight and supports the head's weight and is called lordosis or lordotic curvature. The upper back spine has a slight outward curvature called kyphosis, and hyperkyphosis is when this curvature is abnormal. But in everyday usage, a prominent or abnormal bend in the upper back is called kyphosis.

Mostly, kyphosis does not cause severe complications and does not require treatment. Sometimes, a back brace might be needed to strengthen the spine. In severe kyphosis cases, surgery might be required to reduce excessive curvature and relieve pressure on the lungs.

What Are the Types of Kyphosis?

There are three main types of kyphosis:

1. Postural - The most common form and is caused by poor posture. You have to maintain the natural curvature of the spine at all times, and slouching too much can result in this abnormal curvature. It is mostly seen in adolescent girls.

2. Congenital - It is the rarest form of kyphosis and is caused during fetal development. Here, vertebrae are fused, which can worsen with age.

3. Scheuermann's Kyphosis - Otherwise called Scheuermann's disease. When the vertebrae's front portion does not grow as fast as the back, the bones take a wedge shape, resulting in this type of deformity. It can also involve the lower spine. It is commonly seen in adolescent girls.

What Are the Signs and Symptoms Associated With Kyphosis?

Mild cases of kyphosis make the patients self-conscious about how they look but do not cause health problems. In severe cases, it can result in:

• Rounded or hunched back.

• Back pain.

• Upper back stiffness.

• Tight hamstring.

• Breathing problems.

These signs become evident after a growth spurt occurs around puberty. These symptoms do not worsen or progress with time and generally remain constant.

Rarely, the compression of the spinal cord and nerves can result in:

• Weakness.

• Numbness or loss of sensation in the legs.

• Loss of bowel or bladder control.

• Balance problems.

Sometimes, it can compress the heart and lungs, leading to chest pain and shortness of breath, leading to heart or respiratory failure.

What Causes Kyphosis?

The possible causes of kyphosis include:

1. Aging - Aging, when combined with poor posture, is the main cause of kyphosis.

2. Vertebral Fractures or Spinal Injury - Compression fracture of the vertebrae can result in abnormal spine curvature.

3. Ehlers - Danlos syndrome and Marfan syndrome.

4. Weak muscles in the upper back.

5. Arthritis or bone degeneration diseases like ankylosing spondylitis.

6. Herniated disc.

7. Muscular Dystrophy - This genetic condition causes the weakening of the muscles, including the ones around the spine.

8. Disc Degeneration - With age, discs that provide cushioning between spinal vertebrae shrink and result in kyphosis.

9. Osteoporosis - A condition where the bones become thin, including the bones in the spine, making the vertebrae weak and prone to vertebral compression fractures. It commonly affects older women and people under prolonged corticosteroid treatment.

10. Congenital Abnormalities - Sometimes, infants are born with spinal bone deformities.

11. Cancer - Cancer of the spine can result in weakened vertebrae and increase the risk of compression fractures and kyphosis.

12. Scoliosis - Abnormal spinal curvature sideways.

13. Spine infection.

14. Polio - Otherwise called poliomyelitis, it is caused by the poliovirus.

15. Paget Disease - It is a chronic condition where there is excessive bone resorption, resulting in bone deformities.

When to Consult a Doctor for Kyphosis?

If your spine is abnormally curved, and you are experiencing pain, tiredness, or breathing problems, consult your doctor immediately. You might also experience flexibility problems and struggle to maintain proper posture.

How Is Kyphosis Diagnosed?

A physical examination, including height, is usually sufficient to diagnose kyphosis. You might be asked to bend forward so that the doctor can view the spinal curvature from the side. The doctor will assess your balance and range of motion by asking you to perform various stretches and exercises. You might also be asked to lie flat on a surface while the doctor examines the spine. If the spine remains curved, it is congenital or some other type of kyphosis, and if the spine straightens out, poor posture is likely the cause.

A neurological examination might be needed to check for muscle strength and reflexes. X-rays, CT (computed tomography) scans, and MRI (magnetic resonance imaging) might be needed to detect spine deformities.

What Are the Treatment Options of Kyphosis?

Most cases of kyphosis do not need treatment, as they are mild and do not result in any symptoms. For moderate to severe cases, treatment aims to prevent the worsening of the curvature and relieve symptoms. The treatment options include:

1) Non-Surgical Treatment

Physiotherapy is done to strengthen the muscles in the back and abdomen. This relieves pressure on the spine, improving posture. Postural and Scheuermann's kyphosis are usually treated with non-surgical treatment. A spinal brace can also be used to support the spine and correct posture, and help proper growth. But, braces are useful only when the spine is still growing. NSAIDs (nonsteroidal anti-inflammatory drugs) can help with discomfort.

2) Surgical Treatment

People with severe and congenital kyphosis might benefit from surgery. Spinal fusion is the most often used surgical option for kyphosis. Here, vertebrae are fused to form a single bone segment. And for severe kyphosis, rods, screws, and plates are inserted into the spine to correct the curvature.

What Are the Possible Complications of Kyphosis?

Back pain is the main complication associated with kyphosis. The other complications are:

• Breathing difficulties due to pressure on the lungs.

• Weak back muscles can affect a person's ability to do tasks like walking and standing up straight. It can also cause pain when looking up or lying down.

• Compression of the digestive tract can result in acid reflux, digestive problems, and problems swallowing.

• Teens and adolescents with kyphosis develop a poor body image due to a hunched back and rounded shoulders. This can lead to anxiety, social isolation, and depression.

• Numbness or weakness in the arms and legs.

• Loss of bladder and bowel control.

Conclusion:

Untreated or progressive kyphosis is known to be associated with complications that can significantly reduce your quality of life. In most cases, kyphosis is caused due to poor posture, so treating kyphosis early by strengthening the muscles of the back can help improve your posture and can prevent your condition from progressing.

For more information on the various treatment options for kyphosis, consult an orthopedician or physiotherapist online.