Kyphosis is a condition in which the spine curves too much. It is also known as hunch back or round back. Postural kyphosis, Scheuermann’s kyphosis, and kyphosis from birth are the three most common types of this condition.

In general, hyperkyphosis gets worse with age, especially after age 40. About 20% to 40% of adults 60 years or older have it. Even though both men and women get it, the rate of increase is higher in women, especially during menopause.

The cause of each type of kyphosis differs. In postural kyphosis, slouching in chairs and carrying heavy bags are the usual reasons. In Scheuermann, the problem is with the structure of the spine itself. Lastly in congenital kyphosis, the spine already develops an abnormal curve before birth. Kyphosis can also be caused by aging and back injury.

Having rounded shoulders or a hump in the upper back is the most noticeable sign of kyphosis. Another sign is tight hamstrings (the muscles at the rear of the thigh).

More severe cases of curvature are often accompanied by other symptoms, such as the following:

• Lower back and/or shoulder blade pain or stiffness;
• Legs that feel numb and feeble with a tingling sensation;
• Severe exhaustion;
• Difficulty of breathing;
• Balance problems;
• Incontinence (either bowel or bladder).

Getting a standing lateral spine X-ray is the best way to objectively measure kyphosis. Cobb’s angle must be calculated using lateral X-ray of the spine. When the kyphotic curve is greater than 40 degrees, then it is an indication for hyperkyphosis.

Treatment

Observation, physical therapy, and NSAIDs are conservative treatments and these are indicated for kyphosis less than 60 degrees. 

Regular doctor visits and x-rays will track the curve’s changes. 

The back and abdominal muscles can be strengthened with physical therapy, stretching, aerobics. All of these will relieve spine pressure and ultimately improve posture and reduce pain. 

Postural kyphosis is typically treated non-surgically. Many patients with hyperkyphosis are treated for osteoporosis with anti-bone resorptive or bone-building drugs to avoid spinal fractures, but not the kyphosis.

Not responding to non-operative pain management, deteriorating curvature, neurological impairments, cardiac compromise, and trunk deformity are all possible signs that surgical intervention is necessary (usually with kyphosis greater than 75 degrees). Both kyphoplasty and vertebroplasty are viable surgical options for treating osteoporotic vertebral body fractures, a common cause of age-related kyphosis. 

Preventing postural kyphosis can be done by:

• Keep a straight posture
• Develop a strong core and back
• Maintain a healthy BMI
• Use a sturdy backpack or roller bag for books
• Regular exercise to build muscle mass and develop flexibility 

References

Lam JC, Mukhdomi T. Kyphosis. [Updated 2022 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK558945/ 

Johns Hopkins Medicine (2022). Kyphosis. Retrieved December 10, 2022, from https://www.hopkinsmedicine.org/health/conditions-and-diseases/kyphosis

Cleveland Clinic (2022). Kyphosis. Retrieved December 10, 2022, from https://my.clevelandclinic.org/health/diseases/17671-kyphosis