Kyphosis

Kyphosis is an excessive outward curve of the upper spine that can make the back look rounded or hunched. The thoracic spine normally curves outward to help support the chest and upper body, but too much curvature is called thoracic kyphosis. This kyphosis definition can apply to a flexible posture-related curve or a more fixed structural change. It can occur in children, adolescents, or adults, and its effects vary by cause and severity.

Kyphosis may result from poor posture or flexible postural kyphosis, vertebral growth changes such as Scheuermann kyphosis, or congenital differences in spinal development. In adults, osteoporosis-related compression fractures, arthritis, infection, tumors, and neuromuscular conditions can also change the shape or support of the spine. More than one factor may contribute to thoracic kyphosis.

How the cause affects the curve

Postural kyphosis is often flexible, meaning the curve may lessen when a person changes position or straightens the back. Structural kyphosis, including some cases of Scheuermann kyphosis, is linked to changes in the vertebrae and is less likely to correct with posture alone. A clinician uses an examination and, when needed, imaging to determine the underlying cause rather than assuming every rounded back is caused by posture.

Having a risk factor does not mean that someone will develop kyphosis. Some cases, including postural kyphosis, may improve with targeted care, while others develop without an identifiable preventable cause.

A clinician usually begins with a medical history and physical examination. They may assess posture, spinal flexibility, pain, changes in height, movement, balance, and neurologic findings such as weakness or altered sensation. The examination can also help identify whether the curve is flexible or fixed and whether symptoms suggest an underlying bone, nerve, or muscle problem.

Imaging and curve measurement

Standing X-rays show the spinal curve and the structure of the vertebrae, allowing clinicians to measure its severity. MRI or CT may be used when nerve compression, a fracture, infection, tumor, or another structural problem is suspected. Bone-density testing can assess osteoporosis, and laboratory tests may help investigate infection or other medical causes. Kyphosis is an outward curve, lordosis is an inward curve, and scoliosis is a side-to-side curve; a person can have more than one type of spinal curvature.

Kyphosis treatment may include observation, physical therapy, exercises, bracing, treatment for bone loss or pain, or surgery. The choice depends on the person’s age, cause, curve severity, symptoms, flexibility, and whether the curve is progressing or affecting nerves or breathing.

Nonsurgical care

Observation may be appropriate for a mild, stable curve, with follow-up visits and imaging when needed. Physical therapy and prescribed kyphosis exercises can improve strength, flexibility, posture, and function, although they may not straighten a fixed structural curve. Pain treatment and management of osteoporosis or another contributing condition may reduce symptoms and help prevent further fracture-related progression. A brace may be considered for selected growing adolescents, particularly when the curve is still changing.

Spinal surgery

Spinal surgery may be considered for severe, worsening, or painful kyphosis, or when the curve causes neurologic or breathing problems. Procedures such as spinal fusion stabilize and realign selected parts of the spine, but a spine specialist must weigh the cause, curve measurement, age, symptoms, risks, and expected benefit. Recovery can involve a hospital stay, gradual return to activity, rehabilitation, and ongoing follow-up; the course varies by procedure and individual health.

Mild, flexible, or postural kyphosis may remain stable or improve with targeted care. Structural or progressive kyphosis may require long-term monitoring and treatment of its underlying cause, such as osteoporosis or vertebral changes.

What influences long-term outcomes

Outcomes depend on age at onset, the cause, curve measurement, pain, neurologic or breathing symptoms, bone health, adherence to therapy, and scheduled follow-up. Scheuermann’s kyphosis and other structural curves may behave differently from flexible postural kyphosis. Many people can manage symptoms and maintain function, but treatment cannot guarantee complete correction or prevent progression in every case.

Schedule a medical evaluation for a newly noticeable rounded back, persistent back pain or stiffness, loss of height, a curve that appears to be worsening, or symptoms that interfere with activity. An evaluation can help distinguish kyphosis from other causes of a changed posture and identify problems that may need treatment.