Postural Kyphosis

Postural kyphosis is the most common type of kyphosis. It is often attributed to slouching. It represents an exaggerated, but flexible, increase of the natural curve of the spine.

Postural kyphosis usually becomes noticeable during adolescence. It is more common among girls than boys. It rarely causes pain.

Although exercise to strengthen the abdomen and stretch the hamstrings may help relieve associated discomfort, it is unlikely to result in significant correction of the postural kyphosis. Postural kyphosis typically does not lead to problems in adult life.

Clinical photographs of an adolescent male with an abnormally rounded back; the deformity is localized to the thoracic spine. This patient's severe kyphosis is most obvious when bending forward.

(Courtesy of Texas Scottish Rite Hospital for Children)

Scheuermann's Kyphosis

Scheuermann's kyphosis is named after the Danish radiologist who first described the condition.

As with postural kyphosis, Scheuermann's kyphosis often becomes apparent during the teen years; however, patients with Scheuermann's kyphosis have a significantly more severe deformity, particularly thin individuals.

Scheuermann's kyphosis usually affects the upper (thoracic) spine. It can also occur in the lower (lumbar) back area. If pain is present, it is usually felt at the apex of the curve.

Activity can aggravate the pain, as can long periods of standing or sitting. Exercise and anti-inflammatory medication can help ease associated discomfort.

When x-rays of patients with kyphosis are examined, the vertebrae and disks will appear normal in those with postural kyphosis, but they will appear irregular and wedge-shaped in those with Scheuermann's kyphosis.

Congenital Kyphosis

In some infants, the spinal column does not develop properly while the fetus is still in the womb. The bones may not form as they should. Several vertebrae may be fused together. Either of these abnormal situations may cause progressive kyphosis as the child grows.

Surgical treatment may be needed at a very young age. Surgery can help maintain a more normal spinal curve. Consistent follow-up is required to monitor any changes.

Clinical photograph and MRI scan of a child with an abrupt congenital kyphosis in the thoracic spine. The MRI scan shows a posteriorly located hemivertebra causing impingement on the spinal cord.

(Courtesy of Texas Scottish Rite Hospital for Children)

Nonsurgical Treatment

An initial program of conservative treatment that includes exercises and anti-inflammatory medications (for discomfort) is recommended for patients with Scheuermann's kyphosis. If the patient is still growing, the doctor may prescribe a brace. The patient typically wears the brace until skeletal maturity is reached.

Surgical Treatment

Surgery may be recommended if the kyphotic curve exceeds 75°. The goals of surgery are:

• To reduce the degree of curvature by straightening and fusing the abnormal spinal segments together
• To maintain the improvement over time
• To alleviate significant back discomfort, if present preoperatively