Kyphosis (Hunchback)
What Is Kyphosis?
Kyphosis, also known as hunchback or dowager's hump, is an abnormal outward curvature of the upper back (thoracic spine) that causes hunching or a rounded appearance of the shoulders and upper back. While everyone has some natural curve in their spine, kyphosis occurs when this curve becomes exaggerated.
Kyphosis is caused by vertebrae (which are normally block-shaped) becoming wedge-shaped, causing the spine to curve outward. This develops due to a number of underlying conditions. The extent of effects caused by kyphosis depends on the underlying condition, age, and severity of the curvature.
Mild cases of kyphosis may not cause any symptoms beyond the visible curve. However, more severe cases can lead to back pain, stiffness, and, in extreme situations, may affect the nerves, lungs, and nearby organs and tissues. In very severe cases, the curved spine can cause the rib cage to press against the lungs, making it difficult to breathe.
Causes of Kyphosis
Kyphosis can develop from several different conditions and factors:
Postural Kyphosis
Postural kyphosis does not involve an actual deformity in the spine but an exaggerated curve in the upper spine, which develops from poor posture over time. This is one of the most common types and often affects adolescents and young adults.
Disc Degeneration
Soft discs between the vertebrae cushion the bones of the spine. With age and other spinal conditions, these discs can become brittle or shrink, lessening the support between vertebrae and damaging the bone. This degenerative process, also known as degenerating discs, can lead to kyphosis.
Osteoporosis
Osteoporosis is a bone-thinning disorder most commonly seen in older women. The weakened vertebrae can develop compression fractures even during normal daily activities. These fractures can alter the shape of the vertebrae, leading to the characteristic hunched appearance.
Cancer & Cancer Treatments
Cancer as well as treatments for cancer such as radiation or chemotherapy can weaken the vertebrae, causing compression fractures which deform the shape of the vertebrae and contribute to kyphosis.
Scheuermann’s Disease
Scheuermann’s disease is a hereditary disorder that can cause kyphosis during the growing period before a child hits puberty. This disease is generally seen more often in boys than girls.
Birth Defects
In rare cases, a baby’s spinal column does not develop fully or properly in the womb, leading to kyphosis.
Symptoms
The most evident symptom of kyphosis is the abnormally curved portion of the upper spine, which creates a rounded or hunched appearance. Additional symptoms may include:
- Back pain and stiffness in the affected area
- Muscle fatigue in the back
- Rounded shoulders and forward head posture
In severe cases, kyphosis can cause nerve compression, breathing difficulties due to pressure on the lungs, and other complications affecting organs and surrounding tissue. The best treatment option for kyphosis depends on the underlying condition and the symptoms.
Nonsurgical Treatments
Medications
Medication options include over-the-counter pain relievers such as acetaminophen (TYLENOL®), ibuprofen (Advil), or naproxen (Aleve®) to help manage pain and inflammation. If the condition is related to osteoporosis, there are special osteoporosis medications that help strengthen the bones and prevent further damage. Be sure to talk to your pharmacist before purchasing anti-inflammatories as these medications may be contraindicated or may interact with other medications and medical conditions.
Physical Therapy & Exercise
Stretching and flexibility exercises for the back can help alleviate kyphosis symptoms and improve posture. A physical therapist can design a customized program that includes exercises to strengthen the back muscles, improve spinal alignment, and increase flexibility. Regular exercise can help maintain better posture and reduce discomfort.
Bracing
Wearing a body brace may be recommended, especially for children and adolescents whose bones are still growing. A brace can help prevent the curve from worsening and may help correct mild to moderate curves during the growth period.
Lifestyle Modifications
Maintaining good posture during daily activities, using ergonomic furniture, and being mindful of body positioning can help manage symptoms and prevent worsening of the condition. For those with osteoporosis-related kyphosis, calcium and vitamin D supplementation along with weight-bearing exercises may be recommended.
Surgical Treatments
For severe cases of kyphosis with a severe curve or pinched nerves, surgery may be necessary to correct or reduce the deformity. Surgery is typically considered when conservative treatments have failed and the kyphosis is causing significant pain, breathing problems, or neurological issues.
Spinal Fusion
Spinal fusion is the most common surgery to correct kyphosis. This procedure fuses two or more vertebrae together to reduce the abnormal curve and stabilize the spine. During the surgery, bone graft material is placed between the vertebrae, and metal rods, screws, or plates are used to hold the spine in the corrected position while the bone heals and fuses together.
Vertebroplasty & Kyphoplasty
For kyphosis caused by osteoporosis-related compression fractures, minimally invasive procedures such as vertebroplasty or kyphoplasty may be options. These procedures inject bone cement into the fractured vertebra to stabilize it and relieve pain, and kyphoplasty can help restore some lost vertebral height, which may improve posture and reduce deformity.