Mild forms of kyphosis will remain asymptomatic with abnormal curvature, poor posturing, and rounding of the back. The abnormal curvature of the spine may adversely affect the morphology of the pelvic canal that may intervene during normal vaginal childbirth [4]. Nerve compression signs will usually present with chronic low back pains, fatigue, and back stiffness among affected individuals. The pain of nerve compression are more pronounced during heavy activity and is usually relieved by rest [5]. The involvement of the thoracic nerve roots that supply the diaphragm muscles would present clinically as difficulty in breathing.

• Weakness

  Weak or overstretched muscles in the upper thoracic area account for many cases of dorsal kyphosis. [backandneck.about.com]

  Because the natural tendency of the thoracic spine is to curve forward, any weakness of the supporting structures will tend in that direction. [encyclopedia.com]

  These include weakness, paralysis, or changes in sensation below the curve. [nlm.nih.gov]

  […] middle-/lower-trapezius and rhomboid muscles Local tenderness with palpation seen in vertebral compression fractures Scapular winging Forward head positioning Weak spinal extensors Tight cervical extensors Weak cervical flexors Respiratory problems Pain [accessphysiotherapy.mhmedical.com]

• Fatigue

  Symptoms may include fatigue, mild back pain, a rounded upper back appearance, spine tenderness and/or stiffness. [spineuniverse.com]

  Although patients with kyphosis may suffer back pain, stiffness or fatigue, most people with mild cases have no discernible symptoms. Causes Of Kyphosis There are many reasons a patient may present with kyphosis. [losalortho.com]

  However, in some cases the condition results in back pain and stiffness, tenderness of the spine and fatigue. Back pain can be particularly problematic in adults with kyphosis because the body has to compensate for the spinal abnormality. [nynjcmd.com]

  To address this issue, cobalt chrome (CoCr) rods, which are advantageous because of their greater strength and resistance to fatigue relative to Ti rods, have been introduced. [ncbi.nlm.nih.gov]

  Symptoms may include back pain, muscle pain, muscle fatigue and stiffness in the back. Most often, these symptoms are fairly constancy and do not become progressively worse with time. [canningtonchiro.com.au]

• Collapse

  Basically, the surgeon stick a straw in the area that has collapsed, blows up a little balloon, and fills it with special cement. [empowher.com]

  For older patients a similar form of bracing can be used to reduce pain and the danger of postural collapse. [hudsonvalleyscoliosis.com]

  When the vertebrae are fractured, the bone can collapse and cause the spine to curve. Scheuermann’s Kyphosis This is a disease process causing the vertebrae to become trapezoid shaped instead of rectangular shaped. [nationwidechildrens.org]

  Disc degeneration, as a normal result of aging, can cause the circular discs that act as cushions between spinal vertebrae to dry out and shrink, causing the vertebrae to collapse on one another and pitch the spine forward. [weillcornellbrainandspine.org]

  During this procedure a small balloon is inserted, through a small incision, into the collapsed bone to restore its shape. It is then filled with a substance that hardens and helps the bone expand. [ucsfhealth.org]

• Surgical Procedure

  We describe the use of a novel surgical procedure combining forward-shifting of anterior column of the wedge hemivertebra and circumferential fusion for treatment of congenital kyphosis secondary to a wedge hemivertebra in a case of a 13-year-old boy [ncbi.nlm.nih.gov]

  Early surgical intervention usually produces the best results and can prevent progression of the curve. The type of surgical procedure will depend on the nature of the abnormality. [umm.edu]

  Recovery A surgical procedure to correct kyphosis is a major procedure, requiring a gradual and careful recovery period. Prior to surgery the team at Scoliosis Associates will explain what to expect in the recovery process. [scoliosisassociates.com]

• Developmental Delay

  The physician also will ask about developmental milestones since some types of kyphosis can be associated with other neuromuscular disorders. Developmental delays may require further medical evaluation. [ivanchengmd.com]

  The health care provider also will ask about developmental milestones since some types of kyphosis can be associated with other neuromuscular disorders. Developmental delays may require further medical evaluation. [vidanthealth.com]

  The healthcare provider also will ask about developmental milestones since some types of kyphosis can be associated with other neuromuscular disorders. Developmental delays may require further medical evaluation. [stanfordchildrens.org]

• Dyspnea

  A 24-year-old female with tuberculous angular kyphosis presented with bilateral lower extremities paresis and dyspnea. The vertebral bodies from T3 to T9 were severely destructed, with a Cobb's angle of 180°on radiographs. [ncbi.nlm.nih.gov]

  고강도의 천식 치료를 하고 있음에도, 환자의 증상(천식의 4대 증상인 기침[cough], 호흡 곤란[dyspnea], 천명[wheezing], 가슴 답답함[chest tightness] 중 한 가지 이상) 개선이 미비하다면, 가장 먼저 확인할 것은 기존에 천식이 확진(confirm diagnosis) 되었는지 확인하는 것이다. [ekjm.org]

• Diarrhea

  Most males with Hunter syndrome develop joint stiffness, chronic diarrhea, enlarged liver and spleen, heart valve problems, hearing loss, and kyphosis. [yourdictionary.com]

• Chest Pain

  However, a severely rounded spine can squeeze the contents of the chest and abdomen. The disorder may eventually put pressure on the heart, lungs, and abdomen. This can cause chest pain, shortness of breath, and loss of appetite. [polyclinic.com]

  […] bladder control The amount of diminished space in the chest can cause cardiac and pulmonary problems leading to: Chest pain Shortness of breath Eventual pulmonary and/or heart failure. [nynjcmd.com]

• Heart Failure

  Severe kyphosis can deform the chest and affect the lungs and heart, leading to breathing difficulties, fatigue, and even heart failure. Digestion problems can result, too, as well as neurological issues from compression of the nerves in the spine. [weillcornellbrainandspine.org]

• Fracture

  However, fractures in patients older than 60 years, those with osteoporosis or osteopenia, fractures located in the thoracolumbar junction, solitary fractures, and fractures in AO type A2 or A3, are more inclined to increase in compression and kyphosis [ncbi.nlm.nih.gov]

  Best-case scenario is diagnosing osteoporosis early so it can be aggressively treated and prevent thoracic vertebral fractures altogether. [empowher.com]

• Osteoporosis

  In very severe cases, osteoporosis medication may be needed to help prevent additional spinal fractures that can exacerbate kyphosis. [hudsonvalleyscoliosis.com]

  Best-case scenario is diagnosing osteoporosis early so it can be aggressively treated and prevent thoracic vertebral fractures altogether. [empowher.com]

  National Osteoporosis Foundation. 1150 17th St., Suite 500 NW, Washington, DC 20036-4603. (800) 223-9994. 〈 http://www.nof.org 〉. Osteoporosis and Related Bone Diseases-National Resource Center. 1150 17th S. [encyclopedia.com]

  Finally, osteoporosis can cause kyphosis in adults. Osteoporosis is a condition that leads to major losses of bone mass, leaving the bones brittle and prone to fractures. Osteoporosis is the most common cause of kyphosis in adults. [umms.org]

• Muscle Spasm

  Scoliosis can occur from bony abnormalities of the spine at birth, growth abnormalities in adolescence, degenerative spine changes in adulthood or abnormal twisting of the vertebrae because of muscle spasm after injury. [canningtonchiro.com.au]

  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. [med.virginia.edu]

  This includes: How well you can bend your neck and roll your head in all directions How well you can twist your neck If there is tenderness around the neck If there are muscle spasms around the neck and shoulders Tests that examine the nerves that leave [umm.edu]

  Scoliosis can occur from bony abnormalities of the spine at birth, growth abnormalities especially with adolescence, degenerative spinal changes in adulthood, or abnormal twisting of the vertebrae because of muscle spasm after an injury. [medicinenet.com]

• Leg Pain

  A 54-year-old-male who underwent T8-L3 PSF in 1972 because of congenital kyphosis presented 44 years after surgery with lower back pain, buttock, and bilateral posterior leg pain. [ncbi.nlm.nih.gov]

  Children rarely have leg pain (sciatica), or other symptoms such as numbness or weakness. If present, a magnetic resonance imaging (MRI) test should be obtained to evaluate the possibility of a neurologic lesion. [uscspine.com]

  Patients with kyphosis may notice difficulty with standing upright or have ongoing back or leg pain. Symptoms usually worsen as the day goes on and the patient will feel they lean further and further forward the longer they try to stand erect. [spinemd.com]

• Spine Pain

  […] and stiffness at rest/sleep Inability to sleep supine Stiffness in the spine Pain in the upper and middle thoracic spine Tight pectoral, hamstring, hip flexor muscles Fatigue Overstretched and weak middle-/lower-trapezius and rhomboid muscles Local tenderness [accessphysiotherapy.mhmedical.com]

  Some people have no problems (mild threatening) but others will experience problems such as increasing curved spine, pain, neurological, heart or lung problems. [physio-pedia.com]

• Tingling

  If there are signs that the spinal cord is being compressed (squeezed), like numbness or tingling, bladder or bowel incontinence, and poor balance, the doctor might also order a magnetic resonance imaging (MRI) scan to get a more detailed look. [my.clevelandclinic.org]

  If you've had symptoms like weakness, numbness, or tingling, your doctor may do a neurological exam to check your reflexes and muscle strength. For symptoms like breathing problems, a pulmonary function test can check how well your lungs work. [webmd.com]

  In more severe cases, patients report shortness of breath, chest discomfort or pain, and/or numbness, weakness and/or tingling in the legs. Does Kyphosis Need Treatment? A spine specialist can determine if your kyphosis requires treatment. [spineuniverse.com]

  In patients with congenital kyphosis, progressive curves may lead to symptoms of spinal cord compression, including pain, tingling, numbness, or weakness in the lower body. [orthoinfo.aaos.org]

• Paresthesia

  When these tiny structures (designed to safely guide nerve roots away from the neck) fill with calcium and hypertrophy, clients often suffer paresthesias, sensory deficits, motor loss and radicular pain syndromes. [erikdalton.com]

A thorough clinical history and a meticulous physical examination are needed to identify kyphosis among patients. Primary physicians may ask patients to stand upright while measuring their heights. Patients are viewed laterally while they are asked to slowly bend forward until the rounding at the upper back portion becomes eminent with kyphosis. The following tests and diagnostic methods are used to evaluate patients suffering from kyphosis:

• X-ray or chest radiograph: Plain chest X-ray at posteroanterior with lateral views are used to determine the degree of curvature and detect vertebral malformations of the spine in kyphosis [6].
• Computerized tomography (CT): This imaging technique will also utilize X-ray beams taken at different angles of the spine, elucidating the different soft tissue structures of the spine for a more detailed view of the vertebral structures.
• Magnetic resonance imaging (MRI): This imaging modality makes use of magnetic resonance to demonstrate a detailed view of the spinal structures. This the imaging technique of choice to elucidate spinal tumors and cancers in the spine.
• Nerve conduction studies: This neurologic conduction test determines the integrity of the spinal nerves in conducting impulses from the spine to the extremities. It is only utilized among kyphotic patients presenting with nerve compression signs.

The treatment of kyphosis is largely dependent on the extent of the curvature and the associated signs and symptoms of the disease. Over the counter pain relievers like acetaminophen, ibuprofen, and naproxen reduce the symptoms of back pain. Bone strengthening drugs like calcium carbonate and androgen may afford some relief in the impending primary osteoporotic conditions that causes the kyphosis among postmenopausal women. Patients with mild Scheuermann’s disease does not require any treatment and any interventions [7].

Physical therapy may control the progressive exaggeration of the back curvature and modulate pain symptoms while restoring normal mobility to carry out everyday tasks. Back bracing or orthosis is sometimes implored to support the back and prevent nerve root compression of the spine [8]. Surgery of the spine may be indicated in severe cases of kyphosis where a spinal fusion procedure is done to bind the vertebral bodies together with the use of screws and bolts in the spine [9]. Kyphosis caused by the destruction of the vertebral bodies from tuberculosis will benefit from the surgical fusion procedure of the spine to regain functionality [10].

The general outlook of patients with kyphosis due to degenerative diseases depends on the extent of the kyphosis. Spine curvature beyond 60 degrees kyphosis with nerve compression signs is associated with poorer prognosis. Corrective surgery is indicated to correct the deformity and control the pain of nerve compression. Patients with juvenile kyphosis have a better prognosis even without corrective surgery because symptoms may regress beyond the growth spurt years of adolescence.

Kyphosis occurs when there is a wedging of the upper spinal column and vertebrae. The genetic basis of inheritance for kyphosis among the juvenile cases has been extensively studied but its definitive mode of genetic transmission is still not well understood [2]. The eminent wedging causing the exaggerated curvature can be caused by the following medical conditions:

• Degenerative bone disease: The disk in between the vertebrae can shrink and dry up with age causing an excessive curvature of the spine.
• Osteoporosis: This clinical condition is very common among postmenopausal women or in patients undergoing chronic corticosteroid therapy. The consequent thinning of the bones may result in compression fractures and the abnormal wedging of the vertebrae. 
• Juvenile kyphosis: This spinal disease condition is also referred to as Scheuermann’s disease characterized by spinal kyphosis during the pubertal growth spurt period among adolescent males. Kyphosis will progressively worsen even beyond the growing years among these patients.
• Congenital spinal defects: Infants may be born with congenital spinal defects which may present as kyphosis during childhood. Congenital syndromes like Marfan syndrome and Prader-Willi syndrome can manifest as kyphosis among the afflicted children.
• Cancer and cancer treatments: Cancerous neoplasm within the spine can cause the weakening of the spinal column and cause exaggerated curvature. Chemotherapy and radiotherapy in the same way can also lead to bone softening and compression fractures in the future.

The international incidence of kyphosis may reach to as high as 8 cases per 100 people population. The relative angulation of the spine and the presence of concurrent nerve compression signs varies directly with the morbidity of the disease. In the elderly population, kyphosis is more commonly seen among osteoporotic female patients than their male counterparts. Juvenile kyphosis however, is more commonly seen among male adolescents beyond the age of 10 years old.

Kyphosis among the adult population typically presents after a direct injury to the spinal vertebrae. Degenerative diseases of the bone and arthritis may soften the intervertebral disk causing a wedging of the vertebral column at the upper spine. Traumatic injury and tumorous growths in the spine directly disrupts the integrity of the vertebral bodies causing the exaggerated curvature of the spinal column. The slippage of one or more vertebral bodies due to trauma and weight may cause the spinal condition spondylolisthesis and lead to kyphosis. In Scheuermann’s disease, an autosomal-dominant disease that causes an osteochondrosis of the secondary ossification centers during adolescence can adversely affect the lower thoracic and the upper lumbar spine [3].

The early active control of osteoporosis by taking daily doses of calcium and Vitamin D3 supplementations may prevent the onset of kyphosis due to degenerative bone diseases. Juvenile kyphosis must immediately be brought to medical attention to prevent the need for surgical interventions in the future. Weight management and regular exercises may strengthen the back muscles and prevent the early degeneration of the vertebras.

Kyphosis is a clinical condition characterized by the abnormal curvature of the spine commonly referred to as humpback. The abnormal curving of the spinal column can give rise to the bowing and rounding of the back which may result to a slouching posture.

Although kyphosis can occur in all age groups, it is most commonly seen among the elderly female population. The age related deformity with kyphosis is due to the cracking and compression of the spinal bones following a progressive osteoporosis. Children may present with kyphosis secondary to the wedging of the spinal bones or the congenital malformation of the spine. Severe cases of kyphosis can cause chronic pain, permanent disfigurement, and disrupt daily normal physical activities [1]. 

Definition

Kyphosis is the medical condition of the spine characterized by the abnormal or exaggerated rounding of the back. Severe cases will result to hunchback among elderly patients.

Cause

Kyphosis has been seen to have a genetic origin but it can also be caused by other clinical conditions like osteoporosis, trauma, spinal tumor, and other spinal deformities.

Symptoms

Patient will present with an abnormal posturing with the rounding of the spine at the upper back. Patients may complain of low back pains and difficulty of breathing when nerve compression is concurrently seen.

Diagnosis

A detailed clinical history, physical examination, and neurological examination are needed to evaluate patients with kyphosis. Imaging studies like chest X-ray, CT-scan, and MRI may be needed to elucidate the lesion and its extent. Nerve conduction studies are implored for those with nerve compression involvements.

Treatment and follow-up

Mild symptoms of back pain are treated with common oral pain killers. Physical therapy and the use of back braces may allay the symptoms and prevent the progressive rounding of the back. Surgical spinal fusion is indicated for severe cases of kyphosis.

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2. Damborg F, Engell V, Nielsen J, Kyvik KO, Andersen MØ, Thomsen K. Genetic epidemiology of Scheuermann's disease. Acta Orthop. Oct 2011; 82(5):602-5.
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