Kyphosis: The Curvature of the Upper Back

Kyphosis: The Curvature of the Upper Back

Kyphosis, commonly known as a hunched back or rounded shoulders, is a spinal deformity characterized by an abnormal inward curvature of the upper back. While a mild degree of thoracic curvature is normal, kyphosis refers to excessive rounding that can impact one's posture, breathing, and overall well-being if left untreated. In this comprehensive blog post, we will explore the anatomy of the spine, causes of kyphosis, diagnostic evaluation, treatment options, and tips for long-term management.

Anatomy of the Spine

The spine is made up of 33 vertebrae that are divided into 5 regions - cervical, thoracic, lumbar, sacrum, and coccyx. The thoracic region, located between the neck and lower back, consists of 12 vertebrae referred to as T1 through T12. In a healthy spine, these vertebrae have a natural C-shaped curvature that helps absorb shock and maintain balance. Kyphosis occurs when this thoracic curvature, known as the thoracic kyphosis, exceeds normal limits.

Causes of Kyphosis

Several potential causes can lead to the development of kyphosis:

Postural Kyphosis: One of the most common types, postural kyphosis develops gradually from poor posture habits like slouching while sitting for long periods. It is more prevalent in teenage girls going through puberty.

Scheuermann's Disease: A developmental disorder causing abnormal vertebral growth during adolescence. It leads to wedging or compression of one or more vertebrae, resulting in kyphosis.

Osteoporosis: Weakening of the bones from this condition can cause compression fractures in the thoracic vertebrae due to minimal trauma. It is more common in post-menopausal women and older adults.

Traumatic Fractures: A forceful injury or fall on the back can damage vertebrae and lead to kyphosis, especially in high-risk activities like contact sports.

Neurological Disorders: Conditions affecting the nervous system like cerebral palsy, muscular dystrophy, and spinal cord injuries can impair muscle function and balance, predisposing to kyphotic deformity.

Inflammatory Arthritis: Diseases causing inflammation in the spine like ankylosing spondylitis can lead to bony fusion of the vertebrae and kyphotic changes over time.

Genetic Disorders: Rare inherited conditions like Klippel-Feil syndrome involving fusion of cervical vertebrae can also be associated with thoracic kyphosis.

Symptoms of Kyphosis

The symptoms of kyphosis can vary depending on the severity of curvature, but may include:

1.  Visible rounding or hunching of the upper back
2. Slouching posture and forward head position
3.  Prominence of the chest wall and abdomen (called "barrel chest") 
4.  Shoulders appear rounded and slumped forward
5. Back pain or discomfort exacerbated by activity or prolonged sitting/standing
6.  Shortness of breath or respiratory issues due to reduced lung capacity
7.  Fatigue from compensating for the abnormal posture
8. Reduced mobility and flexibility of the spine
9.  Self-consciousness about physical appearance

Diagnosing Kyphosis

A thorough physical examination and patient history is the first step in evaluating kyphosis. Additional tests that may be ordered include:

1. Standard X-rays: Provides images to accurately measure the Cobb angle and assess vertebral structure.
2. MRI or CT scan: Useful for detecting spinal cord or disc issues associated with more severe kyphosis or underlying conditions.
3. Bone density test: Determines if low bone mineral density from osteoporosis is contributing to vertebral fractures.
4.  Laboratory tests: May be done to check for inflammatory markers if arthritis is suspected.
5. The degree of curvature is classified based on the Cobb angle measurement: mild 20-40°, moderate 40-75°, and severe >75°. This helps determine the appropriate treatment approach.

Nonsurgical Treatment Options

Mild to moderate kyphosis can often be managed nonsurgically with posture correction, exercises, and bracing:

1. Physical therapy focused on stretching, strengthening, and posture re-training exercises.
2.  Custom-fitted thoracolumbosacral orthosis (TLSO) brace worn during the day for support.
3. Osteoporosis medication if underlying cause to prevent further fractures.
4. Spinal injections to relieve pain from compression fractures.

Surgical Treatment

More severe, rigid kyphosis may require surgical intervention to correct the deformity:

1. Vertebral body tethering in children to halt the progression of Scheuermann's kyphosis.
2. Spinal fusion uses instrumentation like rods and screws to permanently join vertebrae.
3. Vertebral column resection for severe, rigid curves over 100° involving bone removal. 
4. Kyphoplasty to repair a collapsed vertebra through balloon tamp inflation and cement injection.

Long-Term Management

With appropriate treatment, further progression can often be stopped. Ongoing physical therapy, stretching, core strengthening, and posture awareness are important for long-term management. Timely treatment of any underlying conditions like osteoporosis or arthritis is also key to preventing additional vertebral fractures. With a multidisciplinary approach, patients can effectively manage kyphosis and improve their quality of life.

kyphosis is a spinal deformity causing excessive inward curvature of the upper back. A combination of conservative care and surgery, if needed, can help correct the abnormal posture and reduce pain. With long-term management strategies, individuals suffering from kyphosis can regain mobility and confidence.

Author:

Dr. Maajid Mohi Ud Din Malik (M.Sc. Ph. D.)

Radiology and Imaging Technology