This spinal deformity can take several forms and treatment depends on the cause of the condition as well as severity of symptoms. The following are the most common causes and treatment options:
Osteoporosis-related kyphosis. The most common cause of kyphosis in adults is from vertebral fracture due to osteoporosis. This can occur in both men and women, but is more common in females than in males.1 As osteoporosis weakens the vertebral bones in the spine, the vertebrae are susceptible to fracture that typically occurs in a wedge shape – with the front of the vertebra collapsing and losing its height and the back of the vertebra maintaining its height. As the front of the bone is crushed, that segment of the spine tips forward, resulting in an excessive kyphotic curve and forward stooped posture. Treatment typically will address the underlying osteoporosis (to prevent future fractures) as well as pain reduction and possibly surgical repair of the fracture.
- Congenital kyphosis. This form of kyphosis typically presents itself in infants and young children, due to a malformation of the spinal column in the womb. Unlike other forms of kyphosis, this form most often requires surgery (at a young age) to re-align the spine and prevent progression of the deformity.
- Degenerative kyphosis. This form of deformity develops due to wear and tear on the spine over time. The underlying cause of the kyphosis typically is spinal arthritis with degeneration of the discs. Non-surgical treatments, such as pain medication, exercise and physical therapy are typically helpful treatments for pain. Surgery may be an option, but is uncommon for this diagnosis.
- Neuromuscular kyphosis. This form of the deformity can occur in children with certain neuromuscular disorders, such as cerebral palsy, spina bifida, or muscular dystrophy. Surgery can be an option to improve quality of life.
- Nutritional kyphosis. This condition is caused by certain vitamin deficiencies during childhood, such as a vitamin D deficiency.
- Postural kyphosis. This form of kyphosis is attributed to poor posture and slouching. It occurs in both young and older patients, is more prominent in females than in males, and rarely causes pain. Exercises to strengthen abdominal and back muscles can help correct kyphosis from poor posture and maintain a more normal alignment.
Scheuermann's Disease. It is estimated that 4 to 8% of the general population may suffer from Scheuermann's kyphosis.2 This condition occurs in adolescents due to abnormal growth of the spine and discs. It may become clinically evident in adolescents or adults, and is more common in males. Patients typically also have a mild scoliosis. The condition is typically treated with a brace, exercise, and physical therapy. Braces are indicated if the patient is still growing and has moderate to severe kyphosis with curves of 45 degrees or more and may have a long-term corrective effect. Bracing in adults for this condition is uncommon, with a goal of controlling pain, not correcting the kyphosis. Specific exercises may be recommended to strengthen the abdominal muscles and increase spinal flexibility. Surgery may be required for painful curves that are greater than 70 degrees or are progressive.
- Traumatic kyphosis. This can occur from mis-aligned healing of a spinal fracture or injury to the supporting ligaments of the spine.
Latrogenic kyphosis. "Iatrogenic" means "as a result of medical intervention," and refers to kyphosis developing as a complication of surgical treatment of the spine. Post-laminectomy kyphosis is the most common type of iatrogenic kyphosis, which can develop following decompressive spine surgery requiring removal of the posterior elements of the spine (the spinous processes, laminae, and intervening ligaments), typically for tumor removal in children and adolescents.
If kyphosis is suspected, it is advisable for patients to consult their primary care physician, chiropractor, or other spine specialist to obtain an accurate diagnosis through a physical exam, patient history and, as appropriate, diagnostic imaging such as X-ray or MRI scan.