The spine’s ability to maintain its natural curvatures and alignment factors into its overall health and function. There are a number of spinal conditions that involve a loss of the spine’s healthy curves, and the development of unhealthy ones, kyphosis being one of them.
Kyphosis is an over-exaggerated outward spinal curve, known to give the upper back a forward-rounded appearance. Kyphosis causation, symptoms, and treatment needs will depend on the type in question; postural, Scheuermann’s, and congenital are the most prevalent.
Before moving on to the specifics of kyphosis including causes, symptoms, and treatment, let’s discuss the nature of healthy spinal curves versus unhealthy ones.
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The spine’s natural curvatures make it stronger, more flexible, and facilitate its ability to absorb and distribute mechanical stress evenly so no one section of the spine is exposed to excess strain and wear.
When a healthy spine is viewed from the sides, it will have a soft ‘S’ shape, and when viewed from the front and/or back, it will appear straight.
There are three main sections of the spine, each with its own characteristic curvature type, either bending inwards towards the body’s center, or outwards, away from it: cervical spine (neck), thoracic spine (upper/middle back), and lumbar spine (lower back).
Kyphosis refers to spinal curvatures that bend outwards, away from the body’s center, while lordosis refers to spinal curves that bend inwards, towards the body’s center.
Even in a healthy spine, there is a natural range of kyphosis and lordosis curvature degree, but when that range falls beyond a normal level, problems can occur.
When a kyphotic or lordotic curve becomes over-pronounced, this disrupts the spine’s natural curvatures and alignment, impacting its overall health and function.
The term alignment refers to how the vertebrae (bones of the spine) are stacked on top of one another in a neutral and natural alignment.
As mentioned, the three main spinal sections feature a kyphotic or lordotic curve.
The cervical spine (neck) features a lordotic curve, and a healthy curvature range would fall between 20 to 40 degrees; the thoracic spine (middle/upper back) features a kyphotic curve that should also range between 20 and 40 degrees, while the lumbar spine’s (lower back) lordosis would fall in the 20-to-60 degree range.
Lordotic curves give the spine a ‘C’ shape, while kyphotic curves cause a reverse ‘C’ shape.
So when a person’s kyphosis and lordosis are normal and healthy, they would fall within one of the above curvature-degree ranges, but when they become over-exaggerated, they have moved beyond a healthy range, becoming problematic and requiring treatment.
This can be a touch confusing, but within the medical world, the terms kyphosis and lordosis are used interchangeably to refer both to healthy and unhealthy curvature degrees, while hyperkyphosis and hyperlordosis refer specifically to cases of unhealthy kyphotic and lordotic curves.
So now that we’ve defined the different curvature types of kyphosis and lordosis and contrasted their differences in terms of location and natural versus unnatural curvature-degree ranges, let’s focus on the specifics of kyphosis (aka hyperkyphosis).
So we know that kyphosis refers to the spine’s outward curvature that characterizes the thoracic spine (upper/middle back), and the term also refers to an over-exaggerated kyphotic spinal curve, known to cause a roundback appearance.
The thoracic spine is the largest spinal section and includes the T1 to T12 vertebrae, supporting the cervical spine above (neck), rib cage, soft tissues, flexible spinal joints, blood vessels, and nerves.
Kyphosis can develop at any age but is most common in older women, due to hormone/bone-density changes related to menopause.
Thoracic kyphosis is the most prevalent type, as this is the spinal section that features a natural kyphotic curve, but it can also affect the lumbar spine below, particularly in the thoracolumbar region: lower thoracic spine and upper lumbar spine.
When it comes to cervical kyphosis, we are talking about an excessively-curved neck or when the neck loses its natural kyphosis and becomes unnaturally straight, also known as military neck.
Now, when it comes to kyphosis causes, this will depend on the type in question. As is the case with most spinal conditions, there are different forms, determined largely by causation; the most common types of kyphosis are postural, Scheuermann’s, and congenital.
Postural kyphosis is classified as a nonstructural spinal condition, meaning it’s not caused by a structural abnormality within the spine itself.
Symptoms of Postural Kyphosis
Symptoms of postural kyphosis can include a pitched-forward posture and will likely involve some degree of muscle and/or back pain (more common in adults).
Causes of Postural Kyphosis
Postural kyphosis is caused by poor posture and slouching which, over time, and during growth, can excessively stretch the ligaments and muscles that surround the spine and provide it with support.
The stretching of surrounding ligaments/muscles can pull the vertebrae out of position, causing an excessive forward-rounding of the spine.
Treatment for Postural Kyphosis
As a nonstructural spinal condition, postural kyphosis is the least complex form to treat because it doesn’t involve a structural abnormality within the spine itself.
Cases of postural kyphosis can be remedied by a change in body positioning, so if a patient diagnosed with postural kyphosis was to make an active effort to stand up straight with their shoulders back, the unnatural kyphotic curve would decrease and fall back within a normal range.
In structural conditions, a change in position wouldn’t be enough to remedy an unnatural spinal curve because it’s the bones of the spine that are misshapen.
Postural kyphosis can develop at any age, but most commonly appears during adolescence.
Named after the radiologist who first described the condition, Scheuermann’s kyphosis is a structural condition that involves malformed vertebrae.
Scheuermann’s kyphotic curves are rigid in nature, worsen when the spine is in a forward-bend position, and most often develop during adolescence.
Symptoms of Scheuermann’s Kyphosis
The parameters that have to be met to diagnose Scheuermann’s kyphosis include kyphotic curves greater than 50 degrees (remember a normal range is between 20 and 40 degrees), and at least 3 adjacent vertebrae that feature a 5-degree wedge per vertebral body, accompanied by small disc herniations known as Schmorl’s nodes.
As a structural condition, symptoms tend to be more noticeable and severe, and the condition most commonly develops in adolescence during periods of growth, like puberty.
Symptoms can include a pitched-forward posture, fatigue, mild pain in the thoracic spine, and a rigid curve that doesn’t correct itself with position changes because it’s structural.
Scheuermann’s kyphosis can also present alongside scoliosis: a structural spinal condition that involves an unnatural sideways spinal curve, with rotation, and a Cobb angle measurement of at least 10 degrees.
Although somewhat rare, in severe cases of Scheuermann’s kyphosis, lung impairment can become a related complication as the unnatural spinal curve can encroach on lung space, and this decreased space can mean less room for the lungs to expand and contract.
As a structural condition, Scheuermann’s kyphosis is more complex to treat than postural kyphosis.
More like this: Kyphoscoliosis: What Is It, Symptoms, Diagnosis, & Treatment
Causes of Scheuermann’s Kyphosis
Scheuermann’s kyphosis is caused by a structural abnormality within the spine itself; this can involve the fronts of vertebrae not growing as quickly as the backs, and instead of being rectangular in shape, as they are in a healthy spine, becoming wedge-shaped, shifting the affected vertebrae forward, and causing the development of an unnatural outward spinal curve.
The abnormality in how the spinal vertebrae grow and develop can be familial, meaning it runs in families, and it’s also thought that height and weight can be contributing factors.
Treatment for Scheuermann’s Kyphosis
Scheuermann’s kyphosis varies from one patient to the next, as do treatment needs.
Factors such as condition severity, spinal flexibility, and the level of skeletal maturity (patient age) are key factors that shape the type of symptoms a patient is likely to experience, as well as guide the crafting of effective treatment plans.
Fortunately, most cases of Scheuermann’s kyphosis can be treated nonsurgically, especially if caught early on.
Here at the Scoliosis Reduction Center, as scoliosis so often coexists with Scheuermann's kyphosis, I have experience treating both conditions.
I offer patients of the Center a conservative chiropractic-centered treatment approach that prioritizes the spine’s overall health and function throughout treatment and beyond.
When it comes to treating Scheuermann’s kyphosis, observation plays a role, particularly with younger patients who are still growing as I want to observe how the spine is responding to treatment and growth.
I also integrate different treatment modalities such as condition-specific chiropractic care, in-office therapy, custom-prescribed home exercises, and corrective bracing; combining multiple treatment disciplines allows me to fully customize each and every treatment plan and allows for careful adjustments based on how the spine is responding to growth and treatment.
Chiropractic adjustments/remodeling can help with manipulating the most-tilted vertebrae of the curvature back into a healthier alignment with the rest of the spine.
A variety of condition-specific exercises and therapies can help to increase core strength; this strengthens the spine’s surrounding ligaments and muscles so the spine is optimally supported and stabilized.
Corrective bracing can be effective, particularly with growing patients, as it can hold the vertebrae in a more upright position.
Now that we have discussed the characteristics of postural and Scheuermann’s kyphosis, let’s address another prevalent type: congenital kyphosis.
In cases of congenital kyphosis, infants are born with the condition as the spine has developed abnormally in utero.
As infants and young children have so much growth yet to go through, and as growth triggers progression in a number of structural spinal conditions, congenital kyphosis sometimes needs a more-invasive treatment to realign the spine.
Infants and children with congenital kyphosis are also more likely to experience defects in other bodily systems and/or organs.
Symptoms of Congenital Kyphosis
Depending on the severity, the symptoms of congenital kyphosis can be subtle, or overt, which is why congenital kyphosis is sometimes not diagnosed until a child starts moving around on their own.
The excessively-rounded spine can appear as a lump in the back at birth.
Causes of Congenital Kyphosis
As mentioned earlier, in a healthy spine, the vertebrae are rectangular in shape and are stacked on top of one another in a straight and neutral alignment.
The vertebrae are connected by cartilage: an elastic tissue. In cases of congenital kyphosis, the front edges of one or more of the upper back’s vertebral bodies don’t develop as they should.
Instead of the bones being rectangular in shape, they form together in a wedge-shape, which makes the vertebrae shift to the front and can cause the development of a forward-rounding spinal curve.
Treatment for Congenital Kyphosis
As mentioned, due to the nature of congenital kyphosis and the danger of growth increasing the unnatural spinal curve, in severe cases, spinal fusion surgery can be recommended.
The first step of treatment is generally observation to see if progression with growth is going to be an issue; careful monitoring, chiropractic care, core strengthening, and corrective bracing in older children can help work towards impacting the condition on a structural level.
As congenital kyphosis involves a structural abnormality within the spine itself that developed in utero, the reality is that nonsurgical treatment isn’t always an effective treatment option.
While surgeons have their patients’ best interests at heart, no surgery comes without its share of risks, and this is especially true of spinal surgery because the spine and brain work in tandem to form the body’s central nervous system (CNS).
The CNS is involved in the function of virtually every working system within the body as it facilitates brain-body communication.
As such, spinal surgery for kyphosis should only be considered after other less-invasive forms of treatment have first been attempted.
If non-surgical forms of treatment such as chiropractic care, physical therapy, and corrective bracing have been unsuccessful at inducing a structural change, reducing pain, and other condition-related symptoms, surgery can be recommended as the best remaining treatment option.
Important patient/condition factors that determine the best course of treatment include curve severity, progression, balance and equilibrium, and whether or not neurological symptoms are present.
The location of the excessive kyphotic curve helps determine severity: thoracic kyphosis is considered severe if the curvature degree is 80+, while thoracolumbar kyphosis is deemed severe when the curvature degree is greater than 60-70 degrees.
As the thoracolumbar spine includes the lower thoracic and upper lumbar spine, excessive kyphotic curves that involve both spinal sections produce more noticeable visual signs, which is why they’re considered severe at 60-70 degrees.
In terms of progression, if non-surgical treatment hasn’t been able to slow the kyphosis down, meaning the excessive rounding of the back is increasing in size, surgery can be recommended to prevent further progression.
Balance and coordination can also be a determining factor of whether or not surgery is recommended.
Leaning forward as a result of the unnatural forward rounding of the spine can disrupt balance and coordination to the point that performing daily tasks can become difficult, and when this happens, kyphosis surgery is sometimes recommended as the best means of rebalancing the spine.
Kyphosis can also affect the spinal nerves and cause a variety of neurological symptoms; when the degree of nerve involvement is high, patients can experience numbness, weakness, tingling, and in severe cases, bowel and/or bladder dysfunction can become an issue.
When neurological symptoms start to become an issue, this can also lead to a surgical recommendation.
Surgical treatment for kyphosis can have different goals: cosmetic improvement by reducing the spinal deformity, reducing pain and condition-related symptoms, and/or preventing further progression.
Just as there are different types of kyphosis, there are different types of surgical procedures for correcting it.
Based on important patient/condition characteristics, and the surgery’s main goal, the best procedure will be selected and recommended.
The surgeon will also decide whether to perform the surgery through the front or back of the spine (known as an anterior or posterior approach), and this is based on the location of the most-affected vertebrae.
While there are several different types of kyphosis surgery, and some that combine more than one surgical technique, the most common include an osteotomy and spinal instrumentation and fusion.
Osteotomy
When an osteotomy is performed, the procedure involves the cutting of bone to correct structural angular abnormalities within the vertebrae of the spine; as this is done, the ends of affected vertebrae are realigned and allowed time to heal.
Sometimes, spinal instrumentation/fusion is combined with an osteotomy to help stabilize the spine while the bones fully heal.
Spinal Instrumentation and Fusion
While an osteotomy works towards realigning the spine, once the osteotomy has been performed, additional efforts can be made to stabilize the spine while it heals in its realigned position, and this is where spinal instrumentation and fusion comes in.
The process of spinal instrumentation and fusion involves the surgeon creating an environment that’s conducive to continued healing, and this involves the bones of the spine fusing together into one solid bone over time.
This process can involve the use of a bone graft or a type of biological substance that will encourage bone growth, and as the affected vertebrae are fused together and begin to heal as one solid bone, instead of separate and distinct vertebral bodies, movement in the area is eliminated; by extension, further growth of the kyphotic curve is also prevented, and when successful, this can provide the spine with long-term stability.
Spinal instrumentation involves the use of different hardware (wires, cables, plates, rods and screws) that are attached to the spine to hold it in place while the bones fully place, which can take months to complete the full fusion process.
As is the case with any spinal surgery, kyphosis surgery is a lengthy and costly procedure that comes with some heavy risks and potential side effects.
There are different types of spinal curves, both natural and unnatural; maintaining natural and healthy spinal curves are key to the spine’s optimal function and health.
There are a number of spinal conditions a person can develop that involve a loss of the spine’s healthy curves, kyphosis (aka hyperkyphosis) being one of them.
The spine’s natural curves either bend forward, towards the body’s center, or backward, away from the body’s center; the thoracic spine’s forward curve forms a reverse ‘C’ shape and is known as kyphosis, and the cervical and lumbar spine’s backward curves make a ‘C’ shape and are known as lordosis.
While a natural range of kyphosis would fall between 20 and 40 degrees, when a kyphotic curve becomes excessive and falls beyond that normal range, this becomes problematic.
There are also different types of kyphosis, the most common being postural, Scheuermann’s, and congenital kyphosis; each has its own unique causes, symptoms, and treatment needs.
In general, as kyphosis involves an excessively forward-rounded spinal curve of the middle/upper back, the most common symptom is a pitched-forward posture, commonly known as roundback.
In addition to postural changes, kyphosis can cause pain (more common in adults), issues with balance, coordination, and in severe cases, lung impairment.
When it comes to treatment options for kyphosis, there are both nonsurgical and surgical options to consider.
Here at the Scoliosis Reduction Center, I offer non-surgical treatment options that are applied through a conservative and chiropractic-centered approach.
While there are no treatment guarantees, I combine multiple treatment disciplines for the most specific and customized results.
Through integrating condition-specific chiropractic care, in-office therapy, custom-prescribed home exercises, and corrective bracing, I can work towards realigning the most-tilted vertebrae, increasing core strength so the spine is optimally supported and stabilized, and using corrective bracing to further augment treatment results and stabilize the spine.
