Kyphosis: Symptoms, Types, Causes and Treatment

Kyphosis is a spinal condition characterized by an exaggerated forward curvature of the back, leading to a rounded or hunched appearance. While a slight curve in the thoracic spine is normal, kyphosis refers to cases where this curvature becomes excessive and may cause both physical and functional problems. Understanding kyphosis goes beyond its visible impact—it affects quality of life, mobility, and sometimes even vital organ function. This article explores the key symptoms, the various types and causes, and the latest evidence-based approaches to treatment.

Symptoms of Kyphosis

Kyphosis can present with a range of symptoms, from subtle postural changes to significant discomfort and neurological issues. Recognizing these signs early can help in timely diagnosis and management, improving long-term outcomes.

Symptom	Description	Severity	Sources
Postural Change	Rounded or hunched upper back	Mild to Severe	4 5 8
Back Pain	Localized or diffuse pain in the spine	Mild to Severe	4 5 8
Stiffness	Reduced mobility or flexibility in the spine	Variable	4 8
Neurological	Numbness, tingling, weakness, myelopathy	Moderate/Severe	4 10 11
Functional Loss	Difficulty walking, breathing, swallowing	Severe	4 10 11

Table 1: Key Symptoms

Postural and Visual Changes

The earliest and most noticeable sign of kyphosis is often a visible rounding of the back. This may manifest as a "hump" or stooped posture, particularly in the upper or middle spine. In some cases, the deformity is subtle at first and gradually worsens over time.

Pain and Stiffness

Many individuals experience pain in the affected region of the spine. The pain may be localized or extend to other areas, such as the neck or lower back. Stiffness and reduced flexibility are also common, making it harder to move or twist the spine comfortably 5 8.

Neurological Symptoms

If kyphosis is severe or compresses the spinal cord or nerves, neurological symptoms can develop. These may include numbness, tingling, weakness in the limbs, or even myelopathy—a condition involving spinal cord dysfunction. In cervical kyphosis, neurological deficits are particularly concerning and can affect walking and hand function 4 10 11.

Functional Impairments

Advanced kyphosis can impact daily living. Difficulty with walking, maintaining balance, and even basic activities like breathing or swallowing can occur—especially if the curvature is pronounced in the cervical or thoracic regions 4 10.

Psychosocial Impact

Beyond physical symptoms, kyphosis can affect self-image, confidence, and mental health. A visible spinal deformity may lead to social withdrawal or depression, particularly in adolescents and older adults 12.

Types of Kyphosis

Kyphosis is not a single entity; it encompasses various forms, each with unique features, underlying causes, and clinical implications. Knowing the type is crucial for effective management.

Type	Distinguishing Feature	Typical Age Group	Sources
Postural	Flexible, improves with posture	Adolescents, Adults	5 8
Scheuermann’s	Rigid, wedge-shaped vertebrae	Adolescents	3 5 8
Congenital	Present at birth, vertebral anomaly	Infants, Children	8
Degenerative	Linked to aging, disc/bone changes	Older Adults	6 9 8
Cervical	Curvature in neck region	All ages (esp. older)	4 10 11 14
Iatrogenic	Post-surgical or treatment-induced	All ages	8 10 11
Infection-related	Due to infections like tuberculosis	Children, Adults	7 8
Tumor/Trauma	Secondary to injury or tumors	Variable	8 10

Table 2: Common Types of Kyphosis

Postural Kyphosis

This is the most common form in adolescents and young adults. It is characterized by a flexible curvature that corrects with postural adjustment. Typically, it does not involve structural changes to the vertebrae and is often linked to poor posture habits 5 8.

Scheuermann’s Kyphosis

Named after the Danish radiologist Holger Scheuermann, this type involves rigid spinal curvature due to wedge-shaped vertebrae, often appearing in the thoracic spine during adolescence. Unlike postural kyphosis, it does not improve with changes in posture and can cause more significant functional and sensorimotor problems 3 5 8.

Congenital Kyphosis

Congenital kyphosis results from vertebral malformations present at birth. These abnormalities can lead to progressive and severe spinal curvature, sometimes requiring early surgical intervention 8.

Degenerative Kyphosis

Seen predominantly in older adults, degenerative kyphosis arises due to age-related changes in the spine, such as osteoporosis, vertebral fractures, and degenerative disc disease. It often progresses over time and may be associated with loss of bone mineral density and weight loss 6 9 8.

Cervical Kyphosis

This type affects the neck region. It can arise from degenerative changes, surgical complications (such as after laminectomy), trauma, or inflammatory diseases like ankylosing spondylitis. Symptoms may include neck pain, neurological deficits, and difficulty with horizontal gaze, swallowing, or breathing 4 10 11 14.

Iatrogenic, Infection-Related, and Other Types

• Iatrogenic kyphosis develops after spinal surgery or medical treatment that destabilizes the spine 8 10 11.
• Infection-related kyphosis, such as that caused by spinal tuberculosis, can lead to severe deformity, especially in children 7 8.
• Kyphosis from tumors or trauma occurs when the spine is structurally compromised by injury or the presence of a mass 8 10.

Causes of Kyphosis

The origins of kyphosis are diverse. Understanding these causes is vital for both prevention and targeted intervention.

Cause	Mechanism/Trigger	Populations Affected	Sources
Poor Posture	Slouching, weak musculature	Adolescents, Adults	5 8
Vertebral Fracture	Osteoporosis, trauma	Older Adults	6 9 13
Congenital Defect	Birth-related vertebral anomaly	Infants, Children	8
Degenerative Disease	Disc degeneration, bone loss	Older Adults	6 9 8
Infection	Tuberculosis, other pathogens	Children, Adults	7 8
Surgery	Post-laminectomy, fusion issues	All ages	8 10 11
Neuromuscular	Muscular dystrophy, CP, etc.	Children, Adults	8
Tumor	Benign or malignant spinal growths	Variable	8 10
Genetic Predisposition	Family history, inherited factors	All ages	6 9
Smoking	Decreased bone health	Adults, Elderly	6 9

Table 3: Major Causes of Kyphosis

Postural and Muscular Factors

Habitual slouching, weak back muscles, and imbalances in posture, especially in teenagers and office workers, can lead to postural kyphosis. This form is largely preventable and reversible with intervention 5 8.

Structural and Degenerative Changes

• Osteoporotic Vertebral Fractures: As people age, especially postmenopausal women, bone density decreases, making vertebrae prone to collapse and deformity. Only about a third of severe kyphosis cases in elderly are directly linked to vertebral fractures—other factors like low bone mineral density and degenerative disc disease also play crucial roles 6 9 13.
• Degenerative Disc Disease: Loss of disc height and elasticity leads to structural instability and increased forward curvature 6 9.

Congenital and Developmental Causes

Malformations in the vertebrae during fetal development lead to congenital kyphosis, which may worsen rapidly as the child grows 8.

Infectious and Inflammatory Conditions

Spinal infections, particularly tuberculosis, can destroy vertebral bodies and cause severe, sometimes "buckling" kyphosis, especially in children. Early detection and management are essential to prevent progression 7 8.

Iatrogenic and Traumatic Causes

• Iatrogenic kyphosis: Surgical procedures such as laminectomy may destabilize the spine, increasing the risk of abnormal curvature 8 10 11.
• Trauma: Fractures or injuries to the spine from accidents or falls can result in acute kyphotic deformity 8 10.

Neuromuscular and Other Systemic Factors

Neuromuscular diseases (e.g., muscular dystrophy, cerebral palsy) weaken postural muscles, leading to progressive kyphosis. Tumors within or near the spine can also disrupt normal alignment 8 10. Genetic predisposition and lifestyle factors like smoking can further increase risk by affecting bone and disc health 6 9.

Treatment of Kyphosis

Treatment options for kyphosis are diverse, reflecting its many causes and degrees of severity. The goals are to relieve symptoms, prevent progression, and restore or maintain spinal function and appearance.

Treatment	Indication/Approach	Effectiveness	Sources
Physical Therapy	Postural, mild-moderate kyphosis	High	5 12
Spine-Strengthening Exercise	Hyperkyphosis in older adults	High	12
Bracing	Scheuermann’s, growing children	Moderate	8
Medication	Pain, osteoporosis management	Supportive	6 9 8
Kyphoplasty/Lordoplasty	Osteoporotic fractures, acute cases	Moderate-High	13
Surgery (Osteotomy, Fusion)	Severe, progressive, or congenital	High (case-dependent)	1 4 7 10 11 14
Infection Management	Tuberculosis, infectious kyphosis	Variable	7 8

Table 4: Main Treatments for Kyphosis

Non-Surgical Management

Physical Therapy and Exercise

Physical therapy is the mainstay for mild to moderate kyphosis, especially postural and age-related forms. Evidence shows that spine-strengthening and postural training not only reduce the angle of kyphosis but also improve self-image and functional outcomes in older adults 12. For adolescents and adults with postural kyphosis, targeted exercises can correct posture and build supporting musculature 5.

Bracing

In growing children and adolescents with Scheuermann’s kyphosis, bracing can halt progression and even improve curvature if started early 8. The effectiveness depends on compliance and the severity of the curve.

Medications

Pain relief and management of underlying osteoporosis or bone loss are important, particularly in elderly patients. Bisphosphonates and other bone-strengthening agents may help reduce fracture risk and slow progression 6 9 8.

Interventional and Surgical Treatments

Kyphoplasty and Vertebral Augmentation

For acute osteoporotic vertebral fractures, kyphoplasty is a minimally invasive procedure that restores vertebral height and corrects some of the kyphotic deformity by inflating a balloon tamp and filling the cavity with cement 13. Lordoplasty, a variation, may offer superior correction in some cases 13.

Spinal Osteotomies and Fusion

Surgical correction is reserved for severe, progressive, or symptomatic kyphosis, especially when neurological deficits are present or conservative management fails 1 4 7 10 11 14. The choice of procedure depends on the type and flexibility of the deformity:

• Ponte osteotomy, pedicle subtraction osteotomy, vertebrectomy: Used for various degrees of column deficiency and severity 1.
• Anterior and/or posterior fusion: Especially for cervical kyphosis and post-laminectomy cases; may involve bone grafting and instrumentation with plates or rods 10 11 14.
• Combined anterior-posterior approaches: Offer greater correction but carry higher risk and are typically reserved for very complex or rigid deformities 14.

Infection Management

Infection-related kyphosis, such as from tuberculosis, requires both antimicrobial therapy and, in severe cases, surgical correction to prevent or address deformity and neurological compromise 7 8.

Individualized Care

Every case of kyphosis is unique. The choice of treatment must consider the patient’s age, health status, type and severity of kyphosis, underlying cause, and personal goals. The primary aim is to restore spinal balance, relieve symptoms, and improve quality of life 8 14.

Conclusion

Kyphosis is a complex spinal condition that can range from a simple postural issue to a severe, progressive deformity with significant impact on health and function. Early recognition and classification are key to guiding appropriate treatment. The management of kyphosis is highly individualized, drawing from a spectrum of conservative and surgical options based on cause, severity, and patient needs.

Key Points:

• Kyphosis presents with postural changes, pain, stiffness, and, in severe cases, neurological or functional impairment.
• There are multiple types of kyphosis, including postural, Scheuermann’s, congenital, degenerative, cervical, iatrogenic, and infection-related forms.
• Causes are diverse, ranging from poor posture and bone degeneration to congenital defects, trauma, infection, surgery, and genetic factors.
• Treatment options span physical therapy, exercise, bracing, medication, minimally invasive procedures like kyphoplasty, and complex surgical corrections.
• An individualized, evidence-based approach is essential for optimal outcomes, with the primary goal being to restore spinal balance, function, and quality of life.

Kyphosis is more than just a curvature—it's a condition that, when properly understood and managed, allows individuals to maintain active and fulfilling lives.