Thoracolumbar kyphosis is an excessive forward curvature of the spine at the junction of the thoracic (mid-back) and lumbar (low-back) regions. While every spine has a natural curve, kyphosis refers to a rounding that is more pronounced, sometimes leading to a “hunchback” appearance. The condition’s severity varies, ranging from a minor issue to a source of significant discomfort and physical limitations.
Underlying Causes of Spinal Curvature
A frequent cause in teenagers is Scheuermann’s disease, a condition where the front sections of the vertebrae do not grow as fast as the back sections. This uneven growth results in several vertebrae becoming wedge-shaped instead of rectangular, causing the spine to curve forward. This structural change is distinct from poor posture and creates a more rigid, pronounced hump.
Another cause is congenital kyphosis, which occurs before birth when the spinal column does not form correctly. This can involve malformed or fused vertebrae, leading to a curve that can worsen as a child grows. Early surgical intervention may be used to correct the alignment and prevent the curve from worsening.
In adults, the condition often stems from degenerative changes in the spine. Osteoporosis can lead to vertebral compression fractures that cause the spine to curve forward. Degenerative disc disease also contributes as the discs that cushion the vertebrae flatten with age, worsening spinal alignment. A spinal injury, such as a fracture, can also alter vertebral shape and result in post-traumatic kyphosis.
Recognizing the Signs and Symptoms
The most apparent indication is a visible rounding or hump in the mid-to-lower back, which often becomes more noticeable when bending forward. Many people also experience persistent back pain, stiffness, and muscle fatigue as back muscles work harder to compensate for the alignment.
The degree of pain or stiffness does not always correlate with the curve’s severity. Some individuals with a significant curve report little discomfort, while others with a milder curve experience more pain. In mild cases, these may be the only symptoms present.
With a more pronounced curvature, symptoms can become more serious. A severe forward curve can compress the chest cavity, restricting lung capacity and making breathing difficult. The altered spinal alignment can also affect the digestive system, leading to issues like acid reflux. Neurological problems may arise if the spinal cord or nerves become compressed, causing numbness, tingling, or weakness in the legs.
How Doctors Diagnose the Condition
The diagnostic process begins with a physical examination. A doctor assesses the patient’s posture and spine shape, often using the Adam’s forward bend test. For this test, the patient bends at the waist, which makes the spinal curvature more prominent and helps evaluate its severity and rigidity.
Imaging tests are used to confirm the diagnosis and determine the curve’s extent. Standing X-rays of the spine allow a physician to measure the precise angle of the curve, known as the Cobb angle. A curve greater than 45 to 50 degrees is considered kyphotic.
If a patient has neurological symptoms or if surgery is considered, more detailed imaging is ordered. An MRI scan provides clear images of the spinal cord and nerves to identify compression or soft-tissue issues. A CT scan offers a detailed view of the vertebrae and is useful for assessing bone structure after an injury or in cases of congenital deformity.
Treatment Approaches for Thoracolumbar Kyphosis
Treatment depends on the curve’s cause and severity, the patient’s age, and symptoms. For milder curves, a non-surgical approach is used first, often starting with observation. This involves monitoring the curve with periodic X-rays to check for progression, particularly in growing adolescents.
Physical therapy is a primary non-surgical treatment, with exercises designed to strengthen core and back muscles to improve posture and alleviate pain. For adolescents with Scheuermann’s kyphosis, a brace may be prescribed to guide spinal growth and prevent the curve from worsening. Pain management with medication may also be used to address discomfort.
Surgery is reserved for severe or progressive cases, or when the curve causes significant health problems like debilitating pain or neurological deficits. The most common procedure is a spinal fusion, which involves permanently joining two or more affected vertebrae to correct the alignment.
During a spinal fusion, the surgeon uses metal rods and screws to correct the alignment and hold the vertebrae in a more upright position. Bone grafts are placed around the vertebrae, which heal and fuse over several months into a single, solid bone. This procedure stabilizes the spine, prevents further curvature, and can provide significant pain relief.