Kyphosis is an excessive forward rounding of the back, affecting posture and potentially causing discomfort. While a natural degree of curvature exists in the upper back, an exaggerated curve can become noticeable, often appearing as a hunched posture. This article explores the different forms of kyphosis and various approaches to address them.
Understanding Kyphosis
Kyphosis is an exaggerated convex curvature of the spine, particularly in the thoracic or mid-back region. A normal thoracic spine typically exhibits a gentle kyphotic curve ranging from 20 to 45 degrees; anything beyond this range is considered hyperkyphosis. This condition can stem from various causes, leading to different types of kyphosis.
One common type is postural kyphosis, often flexible, resulting from sustained poor posture. This form typically develops during adolescence and does not involve structural vertebral abnormalities. In contrast, structural kyphosis involves changes to the spinal bones, making the curve more rigid and less amenable to conscious correction.
Scheuermann’s kyphosis, a structural form, is characterized by wedge-shaped vertebrae that develop during adolescence, making the spine round forward. This condition can be painful, especially during activity or prolonged sitting, and is more common in males. Congenital kyphosis, another structural type, is present at birth due to improper spinal development, where vertebrae may fail to form or separate correctly.
Assessing Correctability
Determining whether kyphosis can be corrected involves a thorough medical evaluation. This assessment typically begins with a physical examination, where a doctor observes the spinal curve and checks its flexibility. The Adam’s forward bend test helps distinguish between flexible postural curves and rigid structural ones; a prominent curve when bending forward often indicates a structural issue.
Imaging studies are crucial in diagnosis. X-rays provide detailed views of the spine, allowing measurement of the curvature angle using the Cobb angle method and identification of vertebral anomalies. A kyphotic curve greater than 50 degrees on an X-ray is considered abnormal.
Several factors influence the potential for correction, including age, the severity and flexibility of the curve, and its underlying cause. Postural kyphosis, being flexible, has a higher potential for correction through conservative methods. Structural kyphosis, especially in growing adolescents, may also respond to non-surgical interventions, though severe cases or those with neurological involvement may require more aggressive treatment.
Non-Surgical Approaches
Non-surgical methods are often the initial course of action for kyphosis, particularly for postural or milder structural cases. Physical therapy is a foundational component, focusing on exercises to strengthen core muscles, improve posture, and enhance spinal flexibility. These targeted movements help re-educate the body and support a more upright alignment.
For adolescents with Scheuermann’s kyphosis, bracing can prevent the curve from worsening or reduce its severity. Braces are typically worn for many hours daily until growth completion, guiding the spine into a straighter position. This method aims to influence spinal development while bones are maturing.
Lifestyle modifications also play an important role in managing kyphosis. Practicing good ergonomics, regular exercise, and maintaining posture awareness can significantly contribute to symptom management and progression prevention. Weight management can also alleviate stress on the spine, supporting corrective efforts.
Surgical Interventions
Surgery for kyphosis is typically considered when non-surgical treatments are ineffective, or when the condition is severe. This includes:
Curves exceeding 70 to 75 degrees.
Rapidly progressing curves.
Neurological issues such as weakness, numbness, or problems with bowel or bladder function.
Intractable pain unresponsive to conservative management.
Breathing or heart difficulties due to spinal deformity.
The goals of surgical intervention are to correct the spinal curve, prevent progression, alleviate pain, and restore balanced posture. Spinal fusion is the most common surgical technique for kyphosis. This procedure joins two or more vertebrae using bone grafts that fuse into a solid bone, and internal fixation with metal rods and screws to hold the spine corrected.
While surgery offers substantial correction and relief, it is a last resort due to its invasive nature and potential risks. These risks include:
Infection
Excessive bleeding
Nerve damage
Non-healing of the fusion (pseudoarthrosis)
Hardware complications
The decision involves weighing potential benefits against these risks.
Recovery and Long-Term Outlook
Recovery following kyphosis treatment varies significantly depending on the approach. For non-surgical interventions, consistent adherence to physical therapy exercises and maintaining posture awareness are crucial for long-term success. Ongoing engagement in strengthening and flexibility routines helps sustain improvements and prevent the return of the curvature.
After surgical correction, patients typically spend several days to a week in the hospital, with close pain management. Early mobilization, like walking, is encouraged to promote healing and circulation. A structured physical therapy program usually begins weeks to months post-surgery, focusing on regaining strength, flexibility, and balance.
Full recovery from spinal fusion surgery can take six months to a year, as bones need time to achieve solid fusion. Long-term follow-up appointments are essential to monitor spinal stability and ensure correct fusion healing. Maintaining a healthy spine through continued exercise and good posture practices preserves corrected alignment and overall spinal health.