What Is Kyphosis?
Kyphosis is a larger-than-normal forward bend in the spine, most commonly in the upper back. In
adults, 3 forms of kyphosis are seen:

Post-traumatic kyphosis is most commonly in the mid- to lower-back of affected patients,
often found in patients who have fractured one or several of their vertebra due to a
traumatic injury. It can also occur if there is severe ligament damage in the spine
associated with a fracture.

Age-associated kyphosis results from the aging process and, more specifically,
conditions like osteoporosis, muscle weakness, degenerative disc disease, and spine
fractures.

Scheuremann’s kyphosis that developed in adolescence can progress into adulthood.
A patient with this form of kyphosis has a spine that is stiff due to the abnormal shape of
the vertebrae.
Post-traumatic Kyphosis
Post-traumatic kyphosis occurs most commonly in the mid- to lower-back. Kyphosis of this kind
is typically found in patients with severe fractures and neurologic deficits such as quadriplegia or
paraplegia. (See Figures 1A-1C)
One example of kyphosis is post-laminectomy kyphosis. In rare instances, the spine will
develop a forward bend after a common procedure (laminectomy) used to treat spinal stenosis
(pinched nerves) in adults – especially if many levels are decompressed.
Figure 1A-C. Post traumatic kyphosis can result from an injury going undetected or unrecognized.
It can also result from inadequate surgical treatment.
Symptoms
Progressive kyphosis can develop when there is major spine injury. This type of kyphosis can
result in chronic, disabling pain:
• Spinal muscle fatigue
• Chronic swelling
• Progressive degeneration of the spine
• Pinched nerve(s)
• Problems with sitting balance with severe kyphosis
• Skin alterations in paraplegic patients with severe kyphosis
Evaluation/Diagnostics
• X-ray detects fracture and helps determine the type of fracture.
• MRI evaluates any pressure on the nerves that could cause neurologic and motor symptoms
• CT scan provides enhanced imaging when x-ray is not sufficient and/or the physician identifies
other reasons it is needed; commonly used to evaluate spinal fractures.
• Biopsy can rule out tumors, infection or other conditions as the underlying cause of
compression fracture.
Treatment
Nonoperative Treatment
Goals of treatment for kyphosis includes curve correction, spine stabilization, pain alleviation, and
improved neurologic function. The treatments shown below do not necessarily take into account
the kyphosis patient who has osteoporosis. Numerous medications—e.g., Calcitonin, Forteo
(teriparatide)—are now available; while they may decrease the pain, they cannot correct kyphosis.
Current treatment options include:
• Physical therapy
• Non-steroidal anti-inflammatory medication.
• Braces to support the spine and decrease muscle spasm
Operative Treatment
If these conservative measures do not help, surgery may be necessary to control pain and
improve deformity or decompress nerve roots. Posterior spinal fusion and instrumentation
alone is often used to treat more flexible deformities. Fixed deformities often require more
complex surgery.
Age-associated Hyperkyphosis
Age-associated hyperkyphosis is a pronounced forward bend in the upper spine found in older
adults. Sometimes called Dowager’s hump or gibbous deformity, this type of kyphosis makes
mobility difficult and increases the risk of falls and fractures. Hyperkyphosis can stem from a
number of spinal conditions, like osteoporosis, muscle weakness, degenerative disc disease,
and vertebral fractures, or a combination of these.
Symptoms
•
•
•
•
Pain
Difficulty with movement and performing activities of daily life
Stiffness
Reduced height
Imaging Evaluation
Standing x-rays are typically used to assess hyperkyphosis. Elderly patients, however, can be xrayed lying on their backs. Using the x-ray, the physician will measure the degree of the
forward-bending angle to determine the severity of kyphosis.
Treatment Options
Nonoperative Treatment
• Physical therapy
• Targeted daily exercise, under the guidance of a physician and/or a physical therapist, can
help to strengthen core muscles key to preventing further progression of kyphosis
• Bracing and similar orthotic devices have shown some promise for age-associated
kyphosis but have not been rigorously tested
Operative Treatment
If these conservative measures do not help, surgery may be necessary to control pain and
improve deformity or decompress nerve roots.
Scheurmann’s Kyphosis
Figures 1 and 2. Magnified image of wedged vertebrae in Scheuremann’s kyphosis
Scheuremann’s kyphosis is a structural kyphosis that typically develops during adolescence,
causing the kyphotic spine to become rigid, and sometimes progresses into adulthood. In the
spines of these patients, the front sections of the vertebrae grow more slowly than the back
sections. Instead of normal and rectangular with ideal alignment, the vertebrae are wedge-shaped
and cause misalignment (Figures 1 and 2). The abnormal kyphosis is best viewed from the side
in the forward-bending position where a sharp, angular abnormal kyphosis is clearly visible.
Figures 2 and 3. Lateral x-ray of a patient with Scheuremann's disease, and close-up x-ray
demonstrating wedge-shaped vertebrae characteristic of Scheuremann’s disease.
Symptoms & Imaging Evaluation
• Symptoms include poor posture and back pain.
• Standing x-rays are usually the best way to evaluate and monitor Scheuremann’s kyphosis.
Treatment Options
Nonoperative treatment
•
•
Non-steroidal anti-inflammatory drugs (NSAIDS) like ibuprofen or acetaminophen
Physical therapy & exercise to strengthen muscles and ultimately help alleviate pain
Operative treatment
Spinal Fusion
If kyphosis has become severe (greater than 80 - 90°) and causes frequent back pain, surgical
treatment may be recommended. Surgery provides significant correction without the need for
postoperative bracing. Pedicle screws are placed, 2 per vertebra, and connected with 2 rods. This
process promotes gentle straightening of the spine. Most surgeries are performed from the back;
however, some physicians recommend additional surgery on the front of the spine. Patients are
usually able to return to normal daily activities within 4 to 6 months following surgery.
Smith-Peterson Osteotomy
Moderately flexible curves often straighten simply from lying face down; however, rigid curves
may require surgical intervention. The Smith-Peterson osteotomy involves cutting the bone in the
back of the spine that connect the facet joints. The removal of this bone and the joints allows the
spine to move backwards into extension or more of an upright position. This type of osteotomy is
commonly performed during the surgical treatment of Schuermann's kyphosis.