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Kyphosis is a progressive spinal disorder that can affect children or adults. This disorder may cause a deformity described as humpback or hunchback. Kyphosis can be in the form of hyperkyphosis or sharp angular gibbus deformity (see 'Gibbus Deformity' below). Abnormal kyphotic curves are more commonly found in the thoracic or thoracolumbar spine, although they can be cervical.

· Postural round back
· Scheuermann's Disease
· Congenital Kyphosis
· Kyphosis associated with neuromuscular disorders
· Kyphosis secondary to trauma, tumors, infection, and arthritis

Kyphosis in the thoracic spine means exaggerated kyphotic angle from the spine's normal kyphotic curve. Normal lordotic curves in the cervical and lumbar regions may also be diminished to contribute to the overall pitched-forward posture. The spine's natural curves position the head over the pelvis and work as shock absorbers to distribute mechanical stress during movement.

Kyphosis is classified as either postural or structural. Postural means the kyphosis is attributed to poor posture, usually presenting a smooth curve, which can be corrected by the patient. Structural kyphosis is caused by an abnormality affecting the bones, intervertebral discs, nerves, ligaments, or muscles. Kyphosis with a structural pathology may require medical intervention because the patient alone cannot control curve progression.

A gibbus deformity is a form of structural kyphosis. The posterior (from behind) curve presents sharply angled; the curvature is not smooth. This deformity may result in a humpback found to be more prominent when bending forward.

This term is used to describe 'excessive' (hyper) curvature exceeding the normal range. Hyperkyphosis occurs in the thoracic spine. In adults, osteoporosis is a common cause often involving several vertebrae.

Congenital means the disorder is found at birth. Congenital kyphosis is a structural abnormality.

Scheuermann's Disease is juvenile (adolescent) thoracic kyphosis. Although the cause is unknown, it may be familial. This disease can cause decreased intervertebral disc space and vertebral wedging resulting in an excessive curve described as stiff or rigid. The classic definition of Scheuermann's is anterior (front) vertebral wedging of at least 5 degrees involving three consecutive vertebrae. The neck and head may present in an abnormal forward position. The onset usually begins (or is noticed) between the ages of 12 and 15 years affecting females more often than males. For many patients (up to 50%), pain is a common complaint.

Early treatment is especially important to the adolescent patient. Left untreated, the curve progression can lead to significant problems later during adulthood. Routine follow-up is essential to properly monitor curve progression.

Certain exercises may be recommended (e.g. physical therapy) to strengthen the patient's paravertebral muscles. Further, the patient must make a conscious effort to work toward correcting and maintaining proper posture.

Analgesics and anti-inflammatory medication may be used to provide relief. Padded orthoses can be used to control pain, but these do not control curve progression. The patient's age, remaining growth potential, degree of kyphosis, curve progression, and the amount of vertebral wedging determine treatment of Scheuermann's Disease.

Bracing is the standard treatment to control curve progression in adolescents. For curve correction, a Cervical Thoraco Lumbar Sacral Orthotic (CTLSO) may be worn for 24 hours per day for a period of one year. The physician determines the type of brace and how it is to be worn (e.g. hours per day, length of time). After the initial bracing period, the patient is weaned out of the brace. Bracing does not provide permanent benefit to patients 16 years or older. Adolescents may find bracing difficult because the brace can be uncomfortable, hot, rigid, unattractive and may make the patient self-conscious. Surgery is a consideration when kyphosis is severe (e.g. greater than 70 degree curve) and symptoms (e.g. pain) are unrelieved by conservative treatment.

Surgery is indicated when:

(1) The deformity is progressive beyond severe angle (e.g. 70 degrees for Scheuermann's Disease) or sagittal balance is significantly abnormal

(2) Neurologic symptoms exist

(3) When persistent pain cannot be alleviated using conservative treatment In addition, adolescents with significant deformity, who may not respond to conservative therapy (e.g. bracing) and adults with curve progression and/or chronic back pain, may be accorded surgery.

Spinal Instrumentation and fusion are surgical procedures that may be used to correct spinal deformity and to provide permanent stability to the spinal column. These procedures join and solidify the level where a spinal element has been damaged or removed (e.g. intervertebral disc). Instrumentation uses medically designed hardware such as rods, bars, wires, and screws. These devices hold the spine straight during fusion.

Fusion is the adhesive process joining bony spinal elements. In severe cases, spinal fusion is performed both anteriorly (from the front) through thoracotomy (entering chest cavity) and posteriorly (from behind) using instrumentation.