When viewed from the side, the spine has several normal curves. Kyphosis is the term used to describe the natural curve of the thoracic spine, as well as to describe an abnormal curvature or rounding of the upper back. It can also describe a flattening of the normal curve or lordosis of the lumbar spine. Scoliosis, degenerative disease, vertebral compression fractures, prior surgery, or trauma can result in abnormal kyphosis. Mild kyphosis typically causes few problems. Severe kyphosis can result in a ‘hump back’ type deformity or may pitch the patient forward into a painful posture. This can lead to problems and discomfort when standing or walking.
Types of Kyphosis
Scheuermann’s disease is a relatively rare condition that starts in childhood. Although the exact cause is unknown, the front of the vertebral body becomes wedge-shaped. The wedge deformity causes the vertebrae to angulate forward, resulting in an exaggerated curve of the thoracic spine. Often, the disease is not discovered until adolescence, when many patients, especially boys, begin to complain of back pain and difficulty maintaining a normal posture.
Scheuermann’s disease may go unnoticed until adulthood, as there can be a tendency to mistakenly attribute mild kyphosis to poor posture. Atypical or increasing back pain usually drives patients to seek diagnosis. The pain of Scheuermann’s disease is felt along the side of the spine, below the deformity. Older patients with Scheuermann’s disease are at risk for herniated disc, due to wear and tear placed on the spine by the deformity. Sometimes the spinal cord can be compressed by the deformity, but this is rare.
Young patients with mild kyphosis may benefit from bracing or physical therapy. Sometimes, no treatment is required and the condition improves on its own. If the kyphosis worsens and/or pain increases, surgery may be recommended. Posterior or combined spinal fusion is generally reserved for the patient whose spine has not yet matured or for whom kyphosis is greater than 75º.
Post-traumatic kyphosis can occur after a fall or accident. A fractured spine can lead to spinal deformity i.e., injury-induced kyphosis, scoliosis, and instability.
Post-traumatic kyphosis occurs in the lower middle-back and lumbar regions and often occurs in patients with paraplegia or quadriplegia. Unrecognized (or untreated) injury to the spine and surgical treatment failure are common causes of this disorder.
This type of kyphosis typically causes significant pain and disability. Spinal ligaments and muscles become easily fatigued, and nerve compression is common. Surgical treatment i.e., spinal fusion, is directed toward correcting the deformity, stabilizing the spine, and alleviating pain.
Senile kyphosis occurs with advancing age. Development of this condition can be postural, often corrected with adherence to an exercise and strengthening program. Usually, an underlying condition is the root cause of the deformity.
Osteoporosis, cancer, and long-term use of steroids or other drugs can decrease bone mass, increasing the risk for vertebral compression fractures. Multiple fractures may cause the development of a dowager’s hump. Everyday activities like gardening or carrying groceries bending can cause the vertebra to collapse, setting the stage for yet another fracture. Back pain may or may not accompany the fracture.
Patients may not “feel” kyphosis happening to them, but over time, spinal misalignment and a tendency to lean forward affects other body systems. Breathing becomes difficult and sleep is often interrupted as a result of back pain. Early satiety (feeling full after little nourishment) is common with severe kyphosis because postural changes reduce the space in the chest cavity.
Treatment of senile kyphosis involves medical management of the underlying disorder e.g., medicine to combat osteoporosis. In addition, minimally invasive procedures such as kyphoplasty and vertebroplasty can help correct deformity and relieve pain. Rarely is open surgery indicated for senile kyphosis.