Kyphosis is an excessive outward curvature of the upper spine, often resulting in a rounded or “hunchback” appearance. While the upper spine naturally curves outward, a measurement greater than 50 degrees on an X-ray is considered hyperkyphosis. Whether this curvature can be corrected without surgery depends on the underlying cause, severity, and the patient’s age. For many individuals, especially those with posture-related conditions, correction is often achieved through conservative, non-surgical methods.
Understanding Different Types of Kyphosis
The management approach depends on whether the curve is flexible or rigid, separating the condition into postural and structural types. Postural kyphosis is the most common form, typically developing during adolescence. It presents as a flexible roundback that corrects when lying down or with conscious effort, as it does not involve fixed bone abnormalities.
Structural kyphosis involves a fixed, rigid deformity of the spinal bones that does not correct with changes in position. The most recognized structural type is Scheuermann’s kyphosis, an adolescent condition characterized by the wedging of three or more consecutive vertebrae. This condition often causes significant stiffness and pain.
Other forms include congenital kyphosis, a rare condition present at birth where spinal bones fail to form correctly, often requiring early intervention due to its progressive nature. Age-related kyphosis is prevalent in older adults and is frequently associated with osteoporosis and vertebral compression fractures. Postural kyphosis is the most amenable to non-surgical correction.
Assessment and Non-Surgical Correction Methods
Diagnosis relies on a physical examination and imaging studies to assess the curve’s magnitude and flexibility. A standing lateral X-ray is the standard diagnostic tool, allowing a specialist to measure the curve’s degree using the Cobb angle method. This measurement is determined by drawing lines along the endplates of the most tilted vertebrae at the upper and lower limits of the curve.
For milder cases, including postural kyphosis and less severe structural curves, non-surgical management is the primary course of action. This strategy focuses on managing symptoms, improving function, and halting progression, rather than achieving complete reversal of structural deformities.
Physical Therapy and Exercise
Physical therapy (PT) is a cornerstone of non-surgical treatment, especially for flexible postural curves and for pain relief in structural cases. The program emphasizes extension-focused exercises aimed at strengthening core muscles and back extensors to improve upright posture. Stretching tight muscles, such as those in the chest and hamstrings, is also incorporated to counteract forces contributing to the rounded posture. Specific exercises, like the shoulder blade squeeze, help build endurance in the upper-back muscles, facilitating a more natural spinal alignment.
Bracing
Bracing is reserved for adolescents with Scheuermann’s kyphosis who still have significant skeletal growth remaining. The goal of the brace (e.g., Milwaukee or TLSO) is to prevent the curve from worsening by applying hyperextension forces to the spine. Bracing is indicated for actively growing patients with curves exceeding 60 to 65 degrees, and it can stop the progression of the deformity. Patients typically wear the brace between 16 and 23 hours per day until skeletal maturity.
Pain Management
Pain associated with kyphosis, often caused by muscle fatigue or spinal joint irritation, is usually managed with non-opioid medications. Nonsteroidal anti-inflammatory drugs (NSAIDs) or muscle relaxants may be used to relieve discomfort. Long-term use of narcotic pain medication is avoided for managing chronic kyphosis pain.
When Spinal Surgery Is Required
Spinal surgery is typically considered a last resort, recommended only for severe deformities that have failed conservative treatments or pose risks to the patient’s health. The decision to operate is based on the curve’s magnitude, persistent pain, and any neurological compromise.
For Scheuermann’s kyphosis, surgery is indicated for thoracic curves progressing beyond 70 to 75 degrees, or curves greater than 65 degrees with severe, unresponsive pain. Surgery is also frequently required for congenital kyphosis because the structural malformation progresses rapidly and can threaten the spinal cord.
The most common surgical technique is posterior spinal fusion with instrumentation. The surgeon aligns the vertebrae and uses metal rods, screws, and hooks to hold the spine in a corrected position. Bone graft material, sometimes taken from the patient’s own body, is packed around the vertebrae to promote fusion, permanently joining the spinal bones to stabilize the curve.
In cases of rigid or severe deformity, the surgeon may perform an osteotomy, which involves removing a wedge of bone from the spine to achieve greater correction. Techniques like the Smith-Peterson osteotomy allow for substantial realignment of a fixed curve. The goal is to restore the spine’s sagittal balance, ensuring the head is positioned correctly over the pelvis for long-term function.
Long Term Management and Prognosis
The long-term outlook for individuals treated for kyphosis is generally favorable, especially when managed early in life. For postural kyphosis, the prognosis is excellent, as the condition is correctable through consistent posture correction and strengthening exercises.
Structural kyphosis in adults is managed to prevent further progression and reduce pain, as complete reversal of a fixed curve is unlikely without surgery. Long-term management involves maintaining physical activity to preserve muscle strength and spinal flexibility. Dedicated exercise and posture training can prevent the progression of kyphosis in older adults.
Following spinal fusion surgery, the recovery period at home typically lasts four to six weeks, with a full return to sports or heavy activity often taking up to a year. Surgical patients require lifelong monitoring, including regular X-rays, to ensure the fusion remains stable and to check for complications like hardware failure. Effective long-term outcome requires ongoing commitment to a healthy lifestyle and adherence to follow-up monitoring.