Kyphosis becomes a problem when it is larger than expected in the thoracic spine, or it occurs in the cervical or lumbar spine. We call larger-than-normal amounts of kyphosis “hyperkyphosis”.
In children, hyperkyphosis can be due to overly angulated bones (Scheurman’s Kyphosis”), Infection, or poorly-shaped or connected bones (congenital kyphosis). In adults, hyperkyphosis can be due to compression fractures, or prior surgery that reverses the normal lumbar lordosis (commonly called “flatback” or “fixed sagittal imbalance”).
When to See a Specialist
Children with poor posture that improves easily when you ask them to “stand up straight” generally do not need a spine specialist. Patients who struggle to put their head on the pillow when lying on their back tend to have more severe curves.
Treatments are dependent on the type of kyphosis, and the associated symptoms. Generally, observation or an exercise program is all that is necessary, no matter the size of the curve. Bracing may be indicated in children or adolescents with larger curves if they still have significant amounts fo growth remaining.
Surgery is recommended in larger curves that cause pain - typically over 80-90 degrees (20-40 degrees is normal). If the patient is able to stand up reasonably straight, a basic spinal fusion may be all that is necessary. In patients that lean forward significantly, we typically recommend a larger procedure in which we cut the bones and bend them backwards.
For more information on spinal fusions and bone-cutting procedures (osteotomies), please read Dr. Rinella’s chapter on Adult Scoliosis and Kyphosis.
Hyperkyphosis can be detected on physical exam, especially when patients bend forward. Children tend to compensate for the increase curvature by having increased “sway back” in their lower back. They typically struggle to maintain good posture despite their best efforts. When they bend forward, more rigid curves can become quite angular. In adults, arthritis slowly wears out the discs in the low back and it becomes difficult to stand up straight.
 |
 |
 |