Kyphosis is the term used to describe a type of abnormal curve in the spine. The thoracic spine naturally has some kyphosis or "C"-shaped curve. A kyphotic spinal deformity means there is too much forward curve in the spine.
Adult kyphosis can have varying symptoms and degrees of severity, from minor changes in the shape of your back to severe deformity, nerve problems, and chronic pain. Kyphosis is most common in the thoracic spine, though it can also affect the cervical and lumbar spine.
Methods of treating kyphosis have evolved over time. Today there are numerous effective treatment options for correcting a severe kyphotic deformity.
Learn about adult kyphosis including
- What parts of the spine are affected
- How doctors classify the various types of kyphosis
- What causes the condition
- How kyphosis can be treated
In order to understand your symptoms and treatment choices, it is helpful to start with a basic understanding of the anatomy of the mid back. This includes becoming familiar with the various parts that make up the thoracic spine and how they work together.
The thoracic spine is made up of the middle 12 vertebrae of your spine. A kyphotic curve is normally present in the thoracic spine. A kyphotic curve looks like the letter "C" with the opening of the C pointing towards the front. The normal amount of curve is considered to be from 20 to 40 degrees within the entire thoracic spine. There is a range because the amount of "normal" curve varies from person to person. If the curve is more than 40 to 45 degrees, it is considered a spinal deformity.
Kyphosis in adults has several causes.
- The abnormal curve can be congenital, which means it is a condition present from birth. A congenital spine problem affects the development of the spine
- The deformity can also be traumatic, which means it is caused by a trauma or injury to the spine
- Iatrogenic factors are from the effects of medical treatment or surgery
- Osteoporosis is the most common cause of kyphosis in adults. Osteoporosis is a condition that leads to major losses of bone mass, leaving the bones brittle and prone to fractures
Symptoms of kyphosis can range from unattractive posture, to pain, to severe problems of pressure on the lungs and abdomen. The pain occurs primarily in the area of the kyphosis. A severe curve can also begin to put pressure on the spinal cord and spinal nerve roots, which may cause weakness in the lower extremities. Eventually there can be pressure on the lungs and abdomen, affecting breathing and appetite.
In order to make a proper diagnosis and rule out other possible conditions, the first step is to take a history. If kyphosis is suspected, your doctor will want to know about the following specific things:
- Family History - Some types of kyphosis tend to run in families, so it may have a genetic cause. Your provider will want to know if anyone else in the family has the problem
- Date of Onset - When did you first notice the appearance of the spinal condition?
- Measured Curve Progression - If X-rays have been taken of your spine in the past, the doctor will want to see if the curve is getting worse. This can be measured comparing new X-rays with old ones, measuring the size of the curve, or measuring changes in your height
- The Presence or Absence of Pain - Not all cases of kyphosis produce pain. If there is pain, your doctor needs to know where it is, what brings it on or intensifies it, and if there is any radicular pain (radiates away from the spine). This usually comes from irritation of the nerves as they leave the spine
- Bowel or Bladder Dysfunction - Are you having problems knowing when you have to urinate or have a bowel movement? This is extremely important because it could signal the presence of pressure on the spinal cord or the nerves that go to the pelvis
- Motor Function - Has there been a change in how your muscles work? This may be the result of pressure on the nerves or spinal cord
- Previous Surgery - If you have had any surgery on your spine, it may have caused the kyphosis due to weakened muscles or other problems. In order to evaluate your condition properly, it is important that your physician knows about any spinal surgery you have had in the past
You will then be given a physical exam. Your doctor will want to get an understanding of the curve in your back and how it is affecting you. This means first trying to get a "mental picture" of how the spine is curved from examining your back and watching you move. The doctor will look at the flexibility you have by asking you to bend in certain directions. Your doctor will generally be looking for abnormalities in the following areas:
- Spine Movement - Is there pain when you twist, bend, or move? If so, where? Have you lost flexibility?
- Strength - The strength of your muscles will be tested. You might be asked to try to push or lift your arm, hand, or leg against resistance
- Pain - The doctor may try to determine if you have tenderness in certain areas
- Sensation - Can you feel certain sensations in specific areas of your feet or hands?
- Reflexes - Your tendon reflexes might be tested, such as below the kneecap and in the Achilles tendon behind your ankle
- Motor Skills - You might be asked to walk on your heels or toes
- Special Signs - Your doctor will also check for any indicators of something other than spinal/vertebrae problems. Some signs of other problems include tenderness in certain areas, a fever, an abnormal pulse, chronic steroid use (leads to loss of bone mass), or rapid weight loss
Usually after the exam, X-rays will be ordered that allow your doctor to see the structure of the spine and measure the curve. You will be asked to hold very still in certain positions while standing or lying on a table. If thoracic kyphosis is suspected, the following images may be taken:
- Front view of the entire spine taken from the front
- Lateral view of the entire spine taken from the side
- Extension view of the spine while you are bending backwards
Depending on the outcome of your history, physical exam, and initial X-rays, other tests may be ordered to look at specific aspects of the spine. The most common tests that are ordered are: an MRI scan to look at the nerves and spinal cord; a CT scan to get a better picture of the vertebral bones; and special nerve tests to determine if any nerves are being irritated or pinched.
Adult kyphosis has a variety of treatment options. Body casts were originally used to treat adult kyphosis. Treatment later turned to surgery. Today, conservative treatments are chosen first whenever possible. Conservative treatments commonly include medications, exercise, and certain types of braces to support the spine. Spinal surgery will generally be the last treatment choice due to the risks involved.
If osteoporosis is present, treatment of the condition may also slow the progression of the degenerative kyphosis. This can be accomplished in several ways. The current recommendations include increasing calcium and vitamin D intake, hormone replacement therapy, and weight-bearing exercises. Learn more about preventative measures for osteoporosis.
The use of a spinal brace may provide some pain relief. However, in adults, it will not cause the spine to straighten. Once you have reached skeletal maturity, bracing is used for pain relief rather than prevention. Learn more about braces used to treat back problems.
Your doctor may have you work with a physical therapist. A well-rounded rehabilitation program assists in calming pain and inflammation, improving your mobility and strength, and helping you do your daily activities with greater ease and ability.
Exercise has not proven helpful for changing the kyphotic curve in the back. However, it can be helpful in providing pain relief. Therapy sessions may be scheduled two to three times each week for up to six weeks.
The goals of physical therapy are to help you
- Learn correct posture and body movements to counteract the effects of kyphosis
- Maintain appropriate activity levels
- Maximize your range of motion and strength
- Learn ways to manage your condition
Surgery for adult kyphosis has some significant risks. For this reason, surgery is only recommended when the expected benefits far outweigh the risks. Surgery will not be recommended for most cases of kyphosis but may be recommended in the following situations:
The most common reason for kyphosis surgery is pain relief for chronic discomfort that keeps getting worse. Most cases of adult kyphosis surgeries are done to relieve severe pain. However, if the pain is manageable through conservative treatments, surgery will probably not be recommended.
Progression of Curve
Progression of the kyphosis deformity is another reason for considering surgery. If the curvature continues to worsen, surgery may be suggested. Surgery is recommended in this situation to prevent the problems that come from severe kyphosis.
In most cases of kyphosis, surgery will not be recommended merely for the sake of appearance. However, in some cases, the kyphosis causes physical deformity that is unbearable to the patient. In these cases, surgery becomes the only option for correcting the condition. Most cases of cosmetic kyphosis surgery are in young adults that have very noticeable curves.
When adult kyphosis requires surgery, doctors have many different procedures from which to choose. Each case of kyphosis is somewhat different and may require a very specialized approach for optimal results. Surgery is suggested to solve the problems brought on by the kyphosis, not just to straighten the spine. The goals of most surgical procedures for adult kyphosis are to
- Reduce the deformity (straighten the spine as much as possible)
- Stop the progression of the deformity
- Remove any pressure from the nerves and spinal cord
- Protect the nerves and spinal cord from further damage
To achieve these goals, your surgeon may suggest an operation on the back of the spine, the front of the spine-or both. The goal is to first straighten the spine and then to fuse the vertebrae together into one solid bone.
Nearly all surgeons will use some type of metal screws, plates, or rods, in order to help straighten the spine and hold the vertebrae in place while the fusion heals and becomes solid. The screws are placed into the vertebrae. The rods or plates then attach to the screws to connect everything together. Tightened together, they form an internal brace to hold the vertebrae in alignment while the fusion heals.