Kyphosis

At Children’s Hospital Boston, our team pioneers innovative spine treatments. And because our research informs our treatment, we’re known for our science-driven approach. We’re home to the world’s most extensive pediatric hospital research enterprise, and we partner with elite health care and biotech organizations around the globe. But as specialists in family-centered care, our doctors never forget that your child is precious, and not just a patient.

In dealing with your child’s kyphosis, you may want to know the basics about how the spine works:

What is the spine?

Made up of many individual bones called vertebrae, the spine is joined together by muscles and ligaments. Flat, soft discs separate and cushion each vertebra from the next. Because the vertebrae are separate, the spine is flexible and can bend. Together the vertebrae, discs, muscles and ligaments make up the vertebral column or spine.

Different regions of the spine are named differently. The cervical spine refers to the neck region, the thoracic spine to the chest region (where kyphosis occurs), and the lumbar and sacral spines to the lower back region.

Spine viewed from the front and side

What are normal and abnormal front-to-back spine curves?

The normal spine is strong and mobile. While it varies in size and shape from person to person, the healthy spine has natural front-to-back curves that enable us to walk, balance, sit, stand and twist—all of which are complex interactive movements. When these natural front-to-back curves become too large, they can present problems:

• When the forward curve in the thoracic spine is too great, the condition is called kyphosis (hyper-kyphosis, thoracic hyper-kyphosis, “round back”).
• When the inward curve in the lower back is too great, the condition is called hyper-lordosis (“swayback”). '

Left: normal front-to-back spine curves; middle: kyphosis; right: hyper-lordosis.

When do normal spine curves develop?

• in utero: During fetal development, the primary curves develop (thoracic and sacral).
• as babies: All infants start life with a C-shaped spine. Their secondary curves (cervical and lumbar) develop as they become:
  • able to lift the head (cervical)
  • able to sit up (cervical)
  • able to crawl, stand and walk (lumbar)
• as children: As children grow, their natural spinal curves continue to develop into a normal spine.

What are the symptoms of kyphosis?
 

Each child may experience symptoms differently. However, the following are the most common symptoms of kyphosis:

• excessive rounding of the shoulders
• head bending forward compared to the rest of the body
• shoulder height difference
• difference in shoulder blade height or position
• height of the upper back appears higher than normal when bending forward
• tight hamstring (back thigh) muscles
• pain (uncommon in mild cases)
• excessive fatigue

Pain down the legs and changes in bowel and bladder habits aren’t symptoms commonly associated with kyphosis. If your child is experiencing these types of symptoms, you should seek further medical evaluation by a physician.

The symptoms of kyphosis may resemble other spinal conditions or deformities, or may be a result of an injury or infection. Always consult your child's doctor for a diagnosis.

Are there different categories of kyphosis?

The major types of kyphosis are:

• postural kyphosis: the most common type, normally attributed to slouching; can be treated by correcting imbalances in the musculature of the back, usually with exercise or bracing
• Scheuermann (juvenile) kyphosis: usually more severe, more rigid and more cosmetically deforming; typically occurs in early-adolescent boys; can run in families; often requires brace or surgery
• congenital kyphosis: present at birth if a child’s spinal column did not develop normally in the womb; often requires surgery

How do you diagnose kyphosis?

Doctors use medical and family histories, physical exams (including angle measurement) and diagnostic testing to determine the nature and extent of your child’s kyphosis.

Diagnosing kyphosis is usually done by x-rays that measure and evaluate the degree of spinal curvature. A determination for treatment can often be made based on this measurement.

In unusual circumstances, diagnostic testing can include:

• MRI (magnetic resonance imaging)
• CT or CAT scan (computerized tomography scan)
• bone scan
• blood test (not standard—for associated metabolic conditions)
• pulmonary function test(if breathing is affected)

Routine school screenings will sometimes detect kyphosis in children, even if they have no symptoms (referred to as “asymptomatic”). Detecting kyphosis early is important for successful treatment.

How do you treat kyphosis?

Treatment for your child’s kyphosis depends on the nature and severity of the condition. Whether your child’s condition is congenital (present at birth), metabolic- or neuromuscular-related, the Children’s Spinal Program provides comprehensive treatment—including evaluation, diagnosis, consultation and follow-up care.

Treatments can include:

• simple observation and monitoring
• bracing
• surgery
• physical therapy                                                                                    

Will my child be OK?

Your child’s treatment for kyphosis will be individualized, depending on her age, amount of curvature and amount of time remaining for skeletal growth. Your child's physician should examine your child often to monitor the curve as she grows and develops. Early detection is important. If left untreated, kyphosis can lead to impaired lung function, worsening deformity and pain.

Causes

Kyphosis can be:

• postural (attributed to slouching)
• congenital (present at birth due to abnormal development of the spine in utero)
• neuromuscular (associated with a neuromuscular condition such as cerebral palsy or spina bifida)
• related to metabolic conditions (internal body chemistry)
• related to an infection or tumor
• related to an untreated or poorly healed fracture
• hereditary (sometimes runs in families)

Symptoms

• The following are common symptoms of kyphosis:
• excessive rounding of shoulders
• head bending forward compared to the rest of the body
• shoulder height difference
• difference in shoulder blade height or position
• height of the upper back appears higher than normal when bending forward
• tight hamstring (back thigh) muscles

When to seek medical advice

Congenital kyphosis is present at birth, but may not be apparent until later. Consult your pediatrician if your child is developing a rounded upper back, and/or if your family has a history of spinal problems.

Questions to ask your doctor

Lots of parents find it helpful to jot down questions about their child’s condition before a doctor’s appointment—that way, when you talk to your child’s doctors, you can be sure all your concerns get addressed.

• Some of the questions you may want to ask include:
• What is happening to my child, and why?
•  Are other tests needed to diagnose my child?
• What actions will you take to treat my child’s kyphosis? Why?
• How long will her treatment last—weeks, months, years?
• Will my child be in pain?
• What will happen with growth over time?
• Will there be restrictions on my child’s activities?
• Will there be long-term effects?
• What can we do at home?

Who’s at risk

Risk factors for developing kyphosis vary. Common risk factors and predispositions can include:

• a family history of spine problems
• other birth defects
• neuromuscular conditions
• metabolic conditions that affect bones
• syndromes that affect neurologic function
• other genetic syndromes                                                                                

Complications

• Untreated kyphosis can become progressively worse and can become painful and deforming, and can result in lung problems, worsening deformity and pain.
• If surgery is needed, there is a very slight chance of complications from the surgery, such as bleeding, infection or nerve damage.
• A very small percentage of patients who have had surgery will need an additional procedure, usually for cosmetic reasons.
• Older children and teens can have body image issues as a result of their kyphosis.

Long-term outlook

When treated successfully, kyphosis curves can be corrected, and children can go on to lead normal, active, unrestricted lives.

If your child needs surgery, she should be able to walk around in a day or two, and return home in about a week.

She can go back to school within a month or so, and resume most activities within three to four months.

Complete fusion takes about one year.

For teens

If you’re a teen with kyphosis, you have a lot to cope with. Besides the typical issues any teenager faces—from social acceptance to body image and more—you’ll also have to deal with medical appointments and procedures, some delay of your natural wish for independence, feeling different and assuming a big personal responsibility for maintaining your own good health.

The good news is that with successful treatment and your own compliance with bracing or other therapies, your kyphosis has a great chance of being corrected in the near future. But for now, if you feel self-conscious, depressed or anxious, speak to your doctor, nurse, parents or counselor—they’re all on your team, and they all want to help.

Prevention

Most spinal problems have no definite cause and/or no known method of prevention. Some are genetic in origin. Proper nutrition, prenatal care and vitamin consumption (especially folic acid) are always important if you’re pregnant, or if pregnancy is a possibility. If your family has a history of birth defects, consult a geneticist.

Kyphosis glossary

• brace, bracing (spinal orthosis): If your growing child’s curve shows significant worsening or is already greater than 45 degrees, your physician may recommend a program in which a brace is designed specifically for your child’s particular curve. The brace holds your child’s spine in a straighter position while she’s growing in order to partly correct the curve or prevent it from increasing.

There are many types of brace, including the Boston Brace developed at Children’s. A bracing program may help avoid surgery.

• Center for Families at Children’s: dedicated to helping your family to find the information, services and resources you need to understand your child’s medical condition and take part in his care
• congenital kyphosis:The spine forms and develops between three and six weeks after conception. Congenital kyphosis results from abnormal in utero spinal development, such as a partial or missing formation or a lack of separation of the vertebrae.
•  (hyper-) kyphosis: A spine affected by kyphosis shows evidence of excessive backward curvature of the back bones (vertebrae) in the upper back area, giving the child an abnormally rounded or “humpback” appearance. Abnormal (hyper-) kyphosis is a type of spinal deformity and should not be confused with poor posture.
• neuromuscular: affecting, or characteristic of, both neural (nerve) and muscular tissue
•  orthopedics: the medical specialty concerned with diagnosing, treating, rehabilitating and preventing disorders and injuries to the spine, skeletal system and associated muscles, joints and ligaments
•  orthopedic surgeon, orthopedist: a physician specializing in surgical and non-surgical treatment of the spine, skeletal system and associated muscles, joins and ligaments
• orthotics: the science of designing and fitting of devices such as braces to treat orthopedic conditions
• physical therapy: a rehabilitative health specialty that uses therapeutic exercises and equipment to help patients improve or regain muscle strength, mobility and other physical capabilities
• progression, curve progression: worsening of a spinal curve
• spina bifida (myelodysplasia): a condition in which there is abnormal development of the back bones, spinal cord, surrounding nerves and the fluid-filled sac that surrounds the spinal cord. This neurological condition can cause a portion of the spinal cord and the surrounding structures to develop abnormally. The defect can occur anywhere along the spine. Kyphosis can be an associated condition.
• spinal cord: a nerve bundle within the vertebral column that extends down from the brain stem; it conducts signals in both directions between the brain and extremities, and allows for bodily motion and sensation
• spinal abnormality: a condition in which the spine develops abnormally. Some abnormalities are present at birth, such as congenital kyphosisor congenital scoliosis. Some are the result of nerve or muscle (neuromuscular) diseases, injuries or illnesses—for example, cerebral palsy or spina bifida. In some cases, there’s no definite cause (idiopathic) or means of prevention for the spine’s failure to develop normally.
• spinal fusion:usually a solid fusion (solidification) of the curved part of the spine, achieved by operating on the spine, adding bone chips and allowing the vertebral bones and bone chips to slowly heal together to form a solid mass of bone called a fusion
• spine (spinal column, vertebral column): the series of vertebrae that move and form the axis of the skeleton and protecting the spinal cord
• spine curves, normal and abnormal: front-to-back and sideways curves of the spine
• All spines have normal front-to-back curves. Abnormal front-to-back curves can indicate “round back” (hyper-kyphosis) or “swayback” (hyper-lordosis).
• Normal spines do not have much sideways curvature. An abnormal sideways “S” or “C” curve can indicate scoliosis.
•  vertebra, vertebrae: the individual spine bones that form the spinal column
• x-rays: a diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film

• Did you know? Children’s orthopedics is first in the nation
  Ranked first in the nation for pediatric orthopedic care by U.S.News & World Report, our orthopedic team offers comprehensive care for a wide variety of congenital and acquired disorders.

  Our orthopedic team

  Children’s is the primary pediatric teaching hospital of Harvard Medical School, where our physicians hold faculty appointments. We’re the largest pediatric orthopedic department in the nation, with 13 specialty clinics; an onsite brace shop; a plaster room; and a clinical team of orthopedic surgeons, orthopedic residents and fellows, certified physician assistants, nurse practitioners, registered nurses, physical/occupational therapists, brace technicians and cast technicians.