"Kyphosis" (ki-fo-sis) refers to an exaggerated curvature of the spine that results in a rounded or hunched back. When observed from the side, a normal spinal column has a number of gentle curves due to the shape and alignment of the vertebrae . In a healthy spine, a 25-40-degree thoracic curve is considered normal. When the thoracic curve is greater than 40 degrees medical attention is recommended.
Causes of Kyphosis
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. Kyphosis develops for several different reasons:
- It can be congenital, which means it is a condition present from birth. A congenital spine problem affects the development of the spine
- Slouching and poor posture can increase the natural curve of the spine
- Kyphosis can be caused by a trauma or injury to the spine
- Another type of kyphosis may develop in later life, especially in women, as a result of osteoporosis. As the bones of the spine weaken and become more porous, they experience small fractures that cause them to compress upon each other (vertebral compression fractures). The result is sometimes called a "dowager’s hump" or "hunchback" and left untreated, becomes gradually more significant, more painful and more debilitating
- And "iatrogenic factors"; these are from the effects of medical treatment or surgery
- Other serious forms of kyphosis can result from long-term use of steroids, infection (ie. tuberculosis), trauma to the back, degenerative diseases like arthritis, spondylolisthesis, endocrine diseases, Paget’s disease, polio or tumors
Signs & Symptoms
The symptoms of kyphosis can range from simply being unattractive to causing pain to severely affecting the function of the lungs and heart. Kyphosis can be painful and the pain is primarily in the area of the curvature. If the curve is severe it can begin to put pressure on the spinal cord and cause problems due to the compression of the nerves of the spinal cord. This can cause weakness in the lower extremities. Kyphosis in the thoracic spine can make it difficult to breath and affect the function of the heart as well.
In order to make the correct diagnosis and rule out other possible conditions, the first step is to take a history. Your doctor may ask you about the following:
- Family History - Some types of kyphosis tend to run in families, so it may have a genetic cause
- Date of Onset - When did you first notice your spinal condition?
- Measured Curve Progression - If X-rays have been taken of your spine in the past, your doctor will want to see if the curve is getting worse. This can be done by 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 cause pain. However, if there is pain, your doctor needs to know where it is, what brings it pn or makes it worse, and if there is any pain that radiates away from the spine itself
- Bowel or Bladder Dysfunction - Are you having problems knowing when you have to urinate or have a bowel movement? This is important because it could mean the presence of nerve damage
- 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 itself
- Previous surgery - If you have had any surgery on your spine, it may have caused the kyphosis due to weakened muscles or other problems. Your doctor needs to know about any past surgery to properly evaluate your condition
Your doctor will perform a physical exam, which allows for an understanding of the curvature of your spine and how it affects your movement. Your doctor will check the flexibility you have bending in certain directions. Finally, your nerves will checked by testing: your sensation, your reflexes, and the strength of your muscles. Usually, after the physical exam, X-rays will be ordered that allow your doctor to see the structure of the spine and measure the curve. 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: the MRI scan - to look at the nerves and spinal cord; t he CAT scan - to get a better picture of the vertebral bones; and special nerve tests - to determine if any nerves are being irritated or pinched.
Whenever possible, the first choice of treatment for adult kyphosis is always going to be conservative. Spinal surgery will always be the last choice of treatment due to the risks involved. Conservative treatment that is commonly recommended includes: medications, exercise, and certain types of braces to support the spine.
If osteoporosis is present, then treatment of the osteoporosis may slow the worsening of the kyphosis.
Physical therapy and exercise is an important part of treating adult kyphosis. A well-designed exercise program can also provide pain relief in many patients. A physical therapist will develop an appropriate exercise routine for your case.
Surgery for adult kyphosis carries with it some risks. For this reason, surgery is only recommended when the risks far outweigh the expected benefits. Surgery is not be recommended for most cases of kyphosis. However, when the kyphosis is caused by compression fractures of the spine and continued pain is present, a procedure called Kyphoplasty can be performed. Surgery may be recommended in the following situations:
- Pain - The most common reason for surgery is pain relief for increasing, chronic discomfort. Most cases of adult kyphosis surgeries are done to relieve severe pain
- Progression of Curve - Worsening of the kyphosis deformity is another reason for considering surgery. If the curvature continues to worsen, surgery may be suggested
- Cosmetics - In most cases of kyphosis, surgery will not be recommended simply for the sake of appearances. However, in some cases, kyphosis causes physical deformity that is unbearable to the patient. In these cases, surgery is the only option for correcting the condition. Most cases of cosmetic kyphosis surgery are in young adults that have very noticeable curves