Kyphosis is a condition of abnormal curvature of the spine that causes rounding of the upper back or a hunchback. The thoracic portion of the spine normally has a “C”-shaped curve, but excessive forward curve in the spine leads to kyphosis. In adults, kyphosis may develop as a result of degenerative diseases such as arthritis, disc degeneration, osteoporotic fractures, traumatic injuries and slippage of vertebral disc. Kyphosis most commonly affects the thoracic spine, but can involve the cervical and lumbar portions too.
The symptoms of adult kyphosis may vary based on the severity, ranging from minor change in the shape or appearance of your back to more severe nerve problems and long lasting back pain. There may be weakness in the legs because of the pressure exerted on the spinal cord and nerve from the spinal curvature. Difficulty in breathing may also develop as a result of pressure over the lungs.
Your doctor will take a brief history which includes family history, history of your present symptoms, past medical history (whether you have undergone spinal surgery in the past).Then, a careful physical examination is done to evaluate the spine movement, strength of the muscles and sensation in order to make a proper diagnosis and also rule out other similar conditions. Some diagnostic tests such as X-rays, MRI scan and CT scan will be done to see the structure of the spine and measure the curve. The MRI and CT scan helps in identifying nerve and spinal cord abnormalities.
Adult kyphosis has several treatment options ranging from the most conservative methods to surgical correction of the spine. Conservative treatment is most often the first choice and includes medications, exercises, casts and support braces to the spine.
In cases where osteoporosis is the cause of kyphosis, slowing the progression of osteoporosis is recommended with the intake of vitamin D and calcium supplements, hormone replacement therapy, and regular exercises.
Physical therapy exercises and rehabilitation program helps to control pain, improve strength, mobility as well as perform daily activities easily. You can expect relief from pain even though the kyphotic curve cannot be rectified with the help of exercises. Physical therapy sessions may be scheduled 2-3 times in a week and should be continued for up to six weeks.
Spinal surgery is considered as the last treatment option due to the risks and complications that may occur and is recommended if the benefits of the surgery outweigh the risks. The situations in which surgery for kyphosis may be considered include:
- Chronic severe pain
- Progression of the curvature to more severe form
- Cosmetic reasons
The goal of surgery is to straighten the spine and join the vertebrae to form a solid bone and thus reduce the deformity. Metal screws, plates or rods are used to hold the vertebrae in place during the fusion.
Adult Kyphosis-Types and Causes
Adult kyphosis, the condition of curve in spine is categorized into the following major types:
- Postural Kyphosis
- Scheuermann’s Kyphosis
- Congenital Kyphosis
- Paralytic Disorders
- Post-Traumatic Kyphosis
- Post-Surgical Kyphosis
- Degenerative Kyphosis
Postural kyphosis is the result of poor posture and is common in adolescents and younger adults. Slouching posture when sitting or standing tends to cause the spine to curve forward.
It is often associated with hyperlordosis of the lumbar portion of the spine. The lumbar spine normally has an inward curve. Hyperlordosis means the lumbar spine curves too far in the opposite direction.
Postural kyphosis can be rectified by adopting correct posture while sitting and standing along with strengthening exercises for back muscles.
Scheuermann’s kyphosis is a condition in which the thoracic curve is between 45 and 75 degrees. Vertebral wedging of more than 5 degrees can be seen in three or more adjacent vertebrae. In these cases, the vertebrae appear triangular shaped. At the ends of the wedged vertebrae, Schmorl’s nodes (small herniations of the intervertebral disc) are formed. Exact cause for Scheuermann’s Kyphosis remains unknown and the probable causes may be avascular necrosis of the cartilage ring of vertebral body, vertebral disorders, or mild osteoporosis.
Congenital kyphosis is an inherited condition of spine caused because of abnormal development of spine in womb. There may be incomplete formation of the spine present at birth, which later can lead to a severe abnormal kyphosis. It may also cause paralysis of the lower part of the body. Congenital abnormalities in the urinary collecting system may also be associated with this type of kyphosis.
Surgery is considered successful in treating severe congenital kyphosis. Generally, early surgical intervention is said to provide good results and halt the progression of the curve further. However, non-surgical means are less suitable for this type of kyphosis.
Kyphosis may gradually develop in certain paralytic disorders such as poliomyelitis, spinal muscle atrophy, and cerebral palsy.
Spinal injuries can lead to kyphosis and nerve problems in the spine. Most of the times, when there is vertebral fracture in the thoracic or lumbar spine some degree of kyphosis may result.
Post-traumatic kyphosis can be treated with bracing or surgery depending on the severity of the condition.
Post-surgical Kyphosis is the development of kyphosis following the spine surgery to correct other defects. This occurs when the healing is improper after surgery. A spinal fusion may not heal completely leading to unstable fusion which may cause the spine to collapse. The ligaments of the spine may not heal in an adequate manner to support the vertebrae and a kyphosis may develop. These problems need to be corrected with a second operation.
Degenerative kyphosis may be caused by wear and tear of the lumbar portion of the spine. The degenerative process results in collapse of the intervertebral disc, changes in the shape of the vertebrae, and weakening of the ligaments that support the spine. This can cause kyphosis over a long period of time.
Systemic diseases also can cause kyphosis over time. These conditions include infection in the spine, cancer or tumors of the spine, and certain types of systemic arthritis. Kyphosis can also develop in people who have had radiation treatment for malignant cancers in their childhood.