What is Kyphosis?
Written by Neil Badlani, M.D., Chief Medical Officer, North American Spine

The spine is comprised of 33 bones that make up the spinal column. This includes 7 in the cervical region, 12 in the thoracic region, 5 in the lumbar region, and 4 in the coccygeal region. These bones are separated from each other by soft discs that absorb impact. Without your spinal column, you would not be able to twist, bend, or even stand. When viewed from the side, the spine should have an S-shaped curve. The lower back and neck regions curve inward while the sacral and thoracic regions curve outward slightly. There are several spinal disorders that exaggerate this healthy curve.

Kyphosis is a type of spine curvature in which the upper back has an excessive curve that causes abnormal rounding. The spinal disorder is known as a “roundback” or a “hunchback” if the curve is severe.

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More About Kyphosis

lumbar foraminotomyLike other spinal disorders affecting curvature, such as scoliosis and lordosis, roundback usually occurs in adolescence but it can occur at any age. It’s also more common among older women. There are three types of roundback that usually affect children and teenagers:

The first is postural roundback, which is caused by poor posture but does not come with serious structural abnormalities in the spine.

Second, Scheuermann’s roundback which can cause more deformity than the postural form of the disorder and is caused by a structural problem in the spine. Instead of the typical rectangular shape seen in vertebrae from the side, an X-ray reveals veterbrae with a triangular shape that wedges the vertebrae together with an exaggerated curve.

Finally, congenital roundback happens when the spinal column does not develop normally during development. Some vertebrae may be fused or the bones may not form correctly.

Symptoms of Kyphosis

Symptoms of kyphosis can vary depending on the severity of the curvature and the cause of the disorder. Common symptoms include:

  • Rounded shoulders
  • A visible hump on the upper to middle back
  • Fatigue
  • Spinal stiffness
  • Tight thigh muscles
  • Back pain that is usually mild.

As the disorder progresses and the curvature worsens, it can cause difficulty breathing, loss of sensation, and tingling or numbness in the legs.

How is Kyphosis Diagnosed?

A hunchback is usually diagnosed through a physical exam that includes a measurement of your height. You will also be asked to bend forward at the waist with your arms at your side so the physician can check the spine from the side to look for abnormal curvature. This test is called the Adam’s Forward Bending Test and it’s important because the condition is best seen from the side. Your doctor may test your range of motion by asking to you twist and bend backward, forward, and sideways. An x-ray may also be ordered to assess the degree of the curvature and look for deformities of the vertebrae. A normal curve is between 20 and 50 degrees by a curve exceeding 50 degrees is sufficient for a diagnosis of the spinal condition. For older adults, a bone density test may be used because low bone density can worsen the condition and it can be caused by advanced osteoporosis.

Common Causes of Kyphosis

low back pain

There are many possible causes of kyphosis. The spinal disorder is often the result of problems in spinal bone development that causes the bones to crack or compress. Malformation of the spine or wedging of the vertebrae can also cause an exaggerated curvature. One of the most common developmental disorders affecting the spine is Sheuermann’s disease, which causes abnormal growth of the upper spine and sometimes the lumbar spine. In children, a roundback can also be associated with some syndromes like Marfan syndrome and Ehlers-Danlos syndrome.

In older women, a roundback is usually the result of osteoporisis, which can cause bones in the upper spine to break. Vertebrae are suspectible to fracturing in a wedge shape with the front of the bone collapsing and losing height. This tips the section of the spine forward. This causes kyphosis back pain, loss of height, and a hunched posture. Degeneration of the spinal discs and spinal arthritis can also cause degenerative roundback in older adults. When the discs or bone in the spine degenerate over time, the spinal column becomes deformed. When the spinal disorder affects older adults, it may be called a “dowager’s hump.”

How is Kyphosis Treated?

Treatment and procedure options for Kyphosis range from conservative options like injections to more intensive procedures like spinal fusions.

Conservative Options

Conservative treatment options include nerve root blocks and steroid injections. These are designed to provide temporary relief (up to one year), and you may elect to have the procedure done multiple times. Other conservative strategies may include the placement of a spinal cord stimulator–or STIM–which is designed not to correct the underlying degeneration, but to lessen the pain the condition causes.

Decompression

Minimally invasive decompression surgery aims to relieve pressure on the nerves of the spine. This pressure is often caused by stenosis, bulging or herniated discs, and more. Relieving this pressure can be achieved by reducing or removing soft tissue (disc material or scar tissue) or bone (bone spurs, a section of the lamina or foramina) to decompress the affected nerve. When the compression is caused by soft tissue material, a surgical laser may be used to shrink the impinging material.

Fusion/Stabilization

Fusion surgeries are similar in goal–to remove damaged disc tissue and fuse the bones together–but differ in approach, including the use of specialized hardware to reinforce stability, and the location used to gain access to the spine. A related procedure is an artificial disc replacement, in which a damaged cervical disc is replaced with a synthetic disc, and the vertebrae are not fused.

How Much Does Treatment Cost?

Treatment cost depends on several factors, especially what insurance you have and how much of your deductible has been met. IN the last two years, 90% of our patients have paid less than $2000 out-of-pocket. Some have paid literally nothing, and other have paid much more than that. It depends. The good news is: our Patient Care Managers will handle as much as they can directly with your insurance company, and all your costs will be known up-front.

Important note: spine surgery often pays for itself within a year or two. Many people actually spend more money trying to live with the pain than they do getting the pain fixed. The following calculator is intended to give you a sense of what you spend on managing—rather than eradicating—your pain.

 

Calculate how much you've spent on back pain this year.
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This past year you have spent on your pain treatment:

Get surgery now. Getting surgery now is the smartest financial move. Over the last two years, the average North American Spine patient spent around $2,000 out-of-pocket for treatment. You’ve spent that much or more this year to manage your back pain than you could to fix it.

Get surgery soon. Over the last two years, the average North American Spine patient spent around $2,000 out-of-pocket for treatment. At your current rate, you will spend that much or more within the next two years. The sooner you get treatment, the sooner it will pay for itself.

Keep an eye on your spending. Currently, you are managing your pain efficiently from a financial perspective but over time, your expenses could add up. Surgery should be strongly considered if you start missing more work or spending more on treatment medication.

Great job! You are spending very little on your back pain. Keep it up!

Equipment Used in Diagnosis and Treatment of Kyphosis

Abnormal spinal curvature is typically diagnosed through a physical exam although the severity and cause are based on an X-ray and sometimes an MRI if the physician needs more detail.

The most common forms of medical equipment in the treatment of spinal curvature are braces and body casts. Casting is usually used for infants and very small children to correct a spinal deformity prior to the use of a brace or even to reverse curvature. These casts are essentially braces that can’t be removed except by a physician. Braces are used for adolescents and adults with abnormal curvature of the spine. A brace should be worn for at least 18 hours a day to stop progression of a roundback or hunchback and reverse some of the curvature. The most common type of brace is a hard custom-molding plastic shell but some patients can use a brace with straps.

How Does Kyphosis Compare to Other Spine Conditions?

A roundback or hunchback is one of three similar spinal conditions affecting different parts of the spine. A roundback causes an excessive outward curve of the middle to upper spine which forces the lower back to compensate. This problem may be postural or structural and lead to deformity, limited range of motion, and pain.

Lordosis is a similar condition in which the lumbar or lower spine has an excessive inward curve. It may also affect the cervical spine in the neck, although this is less common. This spinal condition causes an exaggerated posture and buttocks that appear more prominent and it may also limit range of motion and cause pain.

Finally, scoliosis causes sideways curvature of the spine. Most cases have an unknown cause but it may be caused by several conditions like cerebral palsy. Over time, the curvature becomes more severe, painful, and disabling.

Analogy: Blow-Out vs Flat Tire

A bulging disc is like a flat tire, a slipped disc is like a blowout. When you have a flat tire, the wheel’s material loses its shape, but it stays more or less together. In a blowout, the inside of the wheel becomes exposed to the outside.

Both conditions can cause pain, and both should be professionally evaluated. And don’t forget: a bulging disc (flat tire) can progress to become a slipped disc (blowout).

Blow-Out

Blow-Out = Instant Rupture

Flat Tire

Flat Tire = Slow Leak

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