Kyphosis is characterized by an abnormal spinal curvature which causes a physical deformity of the upper back commonly known as hunchback. Normally the thoracic spine has a “C”-shaped convexity, but an exaggeration of this convexity results in kyphosis.
Kyphosis may develop as a result of degenerative diseases such as traumatic injuries, osteoporotic fractures, arthritis, disc degeneration, and slipped-disc. Kyphosis mainly affects the thoracic spine, but sometimes the cervical and lumbar spine may also be affected. Kyphosis can also be caused by systemic diseases such as malignancies or infections of the spine, and specific types of systemic arthritis. Patients who underwent radiation therapy for management of malignancies in their childhood are predisposed to develop kyphosis.
Types of kyphosis
Adult kyphosis is categorized into the following major types:
- Postural kyphosis
- Scheuermann’s kyphosis
- Congenital kyphosis
- Paralytic disorders
- Post-traumatic kyphosis
- Post-surgical kyphosis
- Degenerative kyphosis
The symptoms of adult kyphosis depend on the severity of the disorder, ranging from a slight change in the shape or appearance of the back to additional neurological problems and long-term back pain. It may also be associated with weakness in the legs. Difficulty in breathing may arise from pressure over the lungs.
Your doctor will take a history which includes family history, history of your current symptoms, and previous medical history (history of any previous spinal surgery). This is followed by a physical examination to evaluate the movements of the spine, strength of the muscles and neurological function to arrive at an accurate diagnosis. Various diagnostic tests such as X-rays, MRI and CT scans may also be performed to view the structures of the spine and evaluate the curve. The MRI and CT scans assist in detection of nerve and spinal cord abnormalities.
The treatment options for adult kyphosis range from conservative methods to surgical correction and stabilization of the spine. Conservative treatment is the initial choice and includes medications, exercises, or supportive braces to support the spine. Physical therapy, exercises and a rehabilitation program help to control pain and improve strength and mobility to enable the performance of daily routine activities. Physical therapy plans may be scheduled 2-3 times a week and should be performed for at least six weeks.
If osteoporosis is the primary cause of kyphosis, slowing the progression of osteoporosis is recommended through the intake of vitamin D and calcium supplements and regular exercises. We recommend discussing your diagnosis of osteoporosis with your primary doctor or a metabolic bone specialist (endocrinologist) who may prescribe other medicines to improve your bone quality.
Spinal surgery is regarded as the last resort due to the associated risks and complications and is recommended only if the benefits of the surgery outweigh the risks. The situations in which surgery for kyphosis may be considered include:
- Curve progression
- Progressive neurologic deficit
- Chronic severe pain
- Cosmetic reasons
The goal of surgery is to re-align the spine and fuse the vertebrae to form a solid bone to reduce the deformity. Metal screws, hooks, and rods are employed to hold the vertebrae in place during fusion.