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KyphosisEdit

Kyphosis is a condition characterized by an abnormal outward curvature of the upper back, giving the appearance of a hunched or rounded shoulder posture. The thoracic portion of the spine normally has a gentle kyphotic curve, but kyphosis can become excessive or fixed when the curvature exceeds typical ranges. In many people, mild postural changes respond to exercise and good ergonomics, but in others kyphosis reflects an underlying structural problem that may require medical assessment and, in some cases, intervention. The curvature is usually quantified on imaging using the Cobb angle; a typical normal thoracic kyphosis falls within a certain range, with hyperkyphosis often defined as a larger angle than this range.

Kyphosis exists along a spectrum from flexible, posture-related changes to rigid deformities caused by bone or connective tissue abnormalities. Clinically, distinguishing postural kyphosis from structural forms is important because the latter may progress or cause complications if not managed appropriately. The condition can arise in people of different ages and etiologies, including adolescents and older adults, and it may involve the thoracic spine alone or extend into adjacent regions of the spine.

Types and causes

  • Postural kyphosis

    • Usually is flexible and improves with standing straight or corrective exercises. It is common in adolescents who spend long hours slouching and may respond to targeted physical therapy and posture training. Bracing is not typically needed for this form.

  • Structural kyphosis

    • Scheuermann's kyphosis (often called Scheuermann's disease)
    • A vertebral wedging disorder that produces a rigid hyperkyphosis in adolescence. It may be accompanied by back pain and limited spinal mobility. Management often includes physical therapy and, in skeletally immature patients, bracing to slow progression. In severe or progressive cases, surgical options may be considered. See Scheuermann's disease for a detailed discussion.
    • Congenital kyphosis
    • Resulting from vertebral anomalies present at birth, such as hemivertebrae, which can produce a fixed angle early in life and may require early surgical planning.
    • Osteoporosis-related kyphosis (fragility kyphosis)
    • Vertebral compression fractures from weakened bone structure can produce a sudden or progressive kyphotic deformity in older adults. Management focuses on fracture treatment, bone-strengthening measures, and pain relief. See vertebral compression fracture and osteoporosis for related topics.
    • Degenerative kyphosis (adult-onset)
    • Arises from age-related changes in the spine, including disc degeneration and facet joint arthropathy, which may contribute to a forward bend and reduced spinal height.

  • Other causes

    • Less common drivers include certain neuromuscular or metabolic conditions that affect spinal alignment, or injury and trauma that alter spinal structure.

Diagnosis

A clinician usually begins with history and physical examination to assess pain, posture, thoracic mobility, and neurological function. Imaging is used to define the degree and rigidity of the curvature. The mainstay is lateral radiographs of the thoracic spine, from which the Cobb angle is calculated to quantify kyphosis. Additional imaging, such as MRI or CT, may be employed to evaluate underlying vertebral abnormalities, disc herniation, or spinal cord compression when symptoms or exam findings suggest such pathology. In adults, evaluation for osteoporosis and vertebral integrity is often part of the workup, particularly if a fracture is suspected.

Treatment

  • Non-surgical management
    • For many individuals with mild, flexible postural kyphosis, targeted exercises that strengthen back extensors, improve core stability, and promote better posture can reduce the visible deformity and alleviate symptoms. Physical therapy is commonly recommended.
    • Bracing or orthotic devices are used mainly in growing children with spinal stiffness or progression of a structural kyphosis (e.g., Scheuermann's disease) to limit progression during growth.
    • Pain control and functional management include analgesics, activity modification, and management of contributing factors such as obesity or poor nutrition. In osteoporosis-related cases, strategies to improve bone density are important.
  • Surgical management
    • Indicated for rigid, progressive curves, significant pain unresponsive to conservative care, respiratory compromise in severe deformities, or neurological symptoms. The most common surgical approach is a posterior spinal fusion with instrumentation to realign and stabilize the spine. In some cases, osteotomy procedures such as a pedicle subtraction osteotomy may be used to achieve substantial correction.
    • In vertebral fracture–related kyphosis, procedures like vertebroplasty or kyphoplasty may be considered to stabilize fractures and reduce deformity when appropriate.
    • Surgical decisions balance the amount of correction, potential risks (infection, nerve injury, adjacent-segment degeneration), and the patient’s overall health and goals.

Prognosis and outcomes

Many individuals with postural kyphosis experience improvement with non-surgical therapy, especially when addressed early. Structural kyphoses carry a risk of progression during growth in children or, in adults, gradual worsening or persistent symptoms if not adequately addressed. When surgery is indicated, outcomes can include improved alignment, reduced pain, and better functional capacity, though risks and recovery time vary depending on the magnitude of correction and the patient’s health status.

Controversies and debates

  • Health care delivery and access

    • Debates exist about the most cost-effective and patient-centered ways to manage kyphosis across populations, particularly in cases of adolescent structural deformities versus observation. Conservative approaches (exercise programs, bracing) may offer benefits at lower cost, but determining which patients will progress or benefit most from early intervention remains a topic of clinical and policy discussion.
    • Some policy discussions emphasize personal responsibility and programmatic efficiency, arguing for more standardized criteria to initiate bracing or surgical referral, with attention to resource allocation and long-term outcomes.

  • Evidence and guidelines

    • There is ongoing discussion about the strength of evidence supporting routine screening for scoliosis or kyphosis in asymptomatic individuals and the best thresholds for intervention, especially in the pediatric and adolescent populations. Critics of over-testing argue that unnecessary interventions can lead to anxiety, overtreatment, and higher costs, while proponents emphasize early identification to prevent progression and disability.

  • Critiques of broader cultural critiques

    • In debates about medical practice and patient advocacy, some voices contend that excess emphasis on social or political narratives around health can complicate clinical decision-making. Proponents of a more straightforward, outcome-focused approach stress prioritizing proven treatments, patient autonomy, and cost-conscious care, while opponents may argue that addressing social determinants is essential for long-term spine health.

See also