Kyphosis is an exaggerated rounding of the upper back, sometimes called a hunchback. Most often found in postmenopausal women, when it is referred to as a "dowager's hump," it is also fairly common in adolescent girls. At times, kyphosis is a congenital condition and it may also show up in boys between the ages of 10 and 15 as a manifestation of the hereditary disorder known as Scheuermann's kyphosis. Individuals with osteoporosis or who have connective tissue disorders, such as Marfan syndrome, are also at greater risk of developing kyphosis. Although patients with kyphosis may suffer back pain, stiffness or fatigue, most people with mild cases have no discernible symptoms.
There are many reasons a patient may present with kyphosis. In many cases, kyphosis is simply the result of slouching and is not evidence of any spinal deformity. In such instances, most common in adolescent girls, the condition is called postural kyphosis and requires no medical treatment. Other causes of kyphosis include:
- Birth defects of the spine
- Osteoporosis resulting in compression fractures
- Disc degeneration or arthritis
- Scheuermann's disease, a hereditary disorder
- Cancer of the spine, radiation, or chemotherapy
- Tumor or infection
- Neuromuscular disorders, such as polio or muscular dystrophy
- Spinal injury
- Certain endocrine disorders
While many patients with kyphosis, apart from their appearance, are asymptomatic, the condition can result in back pain, stiffness and fatigue. Some patients also experience tenderness along the spine. In severe cases, kyphosis may cause difficulty breathing.
Physical examination is usually enough to confirm the abnormal curving of the upper spine. The patient is also checked for any neurological problems below the curve. These may include weakness, unusual sensations, or even some degree of paralysis. In addition to the physical examination, the doctor may request X-rays, a test for neurological function, or an MRI scan to detect any underlying problems. If breathing has been compromised, pulmonary function tests will also be administered.
Treatment for kyphosis can vary depending on the type and severity of the condition. Mild cases may only necessitate regular monitoring and special exercises to strengthen the back muscles. Pain medication may be prescribed for patients troubled by discomfort. More severe cases of kyphosis may require bracing or surgery to correct the curvature since, left untreated, kyphosis can lead to physical deformity, severe back pain and body image problems. The most common surgical procedure performed is spinal fusion to permanently connect two or more vertebrae.
Underlying conditions must also be addressed. Congenital kyphosis requires surgery at an early age and Scheuermann's disease may necessitate surgery as well, if a back brace and physical therapy are insufficient to relieve symptoms. Patients whose kyphosis is the result of osteoporosis may be prescribed bone-strengthening medication. Patients whose kyphosis is caused by infection or tumor need aggressive treatment with medications or surgery.