Kyphosis is the natural curve in the upper back called “round back”. The normal range for kyphosis is a curve of 30-40 degrees. Lordosis is the natural curve in the lower back called “sway back”. The normal range for lordosis is 55-65 degrees.
If the curve of the thoracic spine is more than 45 degrees, it is considered abnormal. This deformity is sometimes called "hunchback".
Increased kyphosis is most often the result of poor posture and not by structural changes in the spine. Postural kyphosis can be distinguished from Scheuermann’s kyphosis by the fact that the increased curvature resolves when the patient lies down. Exercises to strengthen the musculature in the upper (thoracic) spine may be recommended for a patient with postural kyphosis.
With Scheuermann's kyphosis
, ligament "thickening" occurs in the anterior longitudinal ligament (running along the front of the spine). This thickening, or tightening, leads to more growth on the back of the vertebrae and less in the front. Wedge-shaped vertebrae are the result, causing the abnormal curve.
Scheuermann's kyphosis is the most common cause of hyperkyphosis (hunchback) in young, otherwise healthy people. It develops in late childhood/early adolescence. Scheuermann’s thoracic kyphosis is a structural deformity of the thoracic spine, defined by anterior wedging of at least 3 or more adjacent thoracic vertebral bodies. While occasionally genetic, obesity or damage to a growing spine by excessive lifting leads to damage to the growth centers on the top and bottom of several adjacent vertebrae. Once these growth plates are damaged, subsequent growth is altered and a deformity (excessive kyphosis) results.
This vertebral disorder may be the result of the rapid growth spurts of adolescence, causing abnormal bone growth. Some doctors believe it is caused by a mild form of osteoporosis. Most agree there is a genetic predisposition to inherit this disease.
As with scoliosis, an X-ray is used to confirm the diagnosis.
Treatment varies according to the size of the curve, the patient's age and flexibility. For many adolescent patients, the kyphosis can be somewhat reversed by wearing a brace. Depending of the severity of the curve, patients may wear a brace for 1-2 years.
Specific exercises may be helpful to stretch and strengthen the hamstrings, thus reducing back pain and fatigue.
Surgery may be considered for patients with severe deformities (greater than 70 degrees). Because Scheuermann's kyphosis usually occurs in the thoracic spine (where there is little motion), the patient does not lose range of motion.
Patients with true Scheuermann’s kyphosis need to sleep on 2-3 pillows at night because the deformity continues to be present even when lying down making it difficult to lay flat. They walk with a leaning forward stance because the spine may no longer be able to adequately support the body. It can lose its flexibility, and it often causes the chest, lungs, and heart to become too crowded. This is why people with severe kyphosis can develop breathing and heart problems as well as back pain as adults.
Scheuermann’s kyphosis can be treated with a Milwaukee brace if the child is still growing and has not reached skeletal maturity. Most often, surgery is the treatment. The surgery always includes a fusion with spinal instrumentation (rods and screws or hooks) to correct the deformity and stabilize the spine.
Surgery typically includes two steps:
1. Front/Anterior approach to release the tightened ligament, remove the discs and insert bone grafts;
2. Back/Posterior approach to place rods and screws to hold the spine straight during bone fusion.
For many adults, the treatment usually includes anti-inflammatory drugs, observation and possibly surgery, depending on the symptoms.