• Hyperkyphosis

    (Roundback of the Spine; Congenital Kyphosis; Postural Kyphosis; Scheuermann’s Kyphosis; Hunchback)

    Definition

    Kyphosis is a normal rounding curve that is seen in the in the upper back. Hyperkyphosis, or hunchback, occurs when the angle of the outward curve is exaggerated. The sooner hyperkyphosis is treated, the better the outcome.
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    Causes

    3 main types of hyperkyphosis and their causes include:
    • Postural—the most common abnormal type, caused by bad posture
    • Congenital—a type that is present at birth, frequently with abnormalities of the vertebral bodies
    • Scheuermann—a type that is genetic, but appears during the teenage years
    Other causes of hyperkyphosis are unknown.

    Risk Factors

    Factors that may increase your chance of hyperkyphosis include:

    Symptoms

    Hyperkyphosis may cause:
    • Back pain or stiffness
    • Intense fatigue
    • Exaggerated rounding of the shoulders
    • Forward-bending head in comparison to the rest of your body
    • Differences in shoulder height

    Diagnosis

    Most cases can be diagnosed during a physical exam. Some cases are found at school during a scoliosis check. You will be asked about your symptoms and medical history. A physical exam will be done to look for abnormal curve in the spine, rounded shoulders, and a hump on the back. Some tests may be done to rule out or confirm other conditions that may be causing hyperkyphosis.
    Your doctor may recommend imaging tests to see the spinal curve and the structures around it. These may include:
    Your doctor may need to measure how well you breathe if the curve is severe. This can be done with pulmonary function tests.

    Treatment

    There are a variety of treatments available for hyperkyphosis, depending on the severity. You may need additional treatment to resolve any underlying conditions that contribute to your hyperkyphosis. Your doctor may refer to you a specialist who treats spinal disorders.
    Options include the following:

    Observation

    Your doctor may recommend an observation period to see if the curve progresses or if there are any changes in your symptoms. This means you may have more follow-up appointments. If you notice any progression, changes, or worsening of symptoms, you should contact your doctor.

    Physical Therapy

    Your doctor may refer you to a physical therapist to learn specific exercises. This may include strength work, stretching, and overall conditioning. You may also be taught how to maintain a correct posture. You may be instructed to sleep on a firm mattress.

    Medications

    Nonsteroidal anti-inflammatory drugs (NSAIDs) may be given for pain or discomfort.
    Nonsteroidal anti-inflammatory drugs (NSAIDs) may be given for pain or discomfort.

    Back Brace

    Braces are sometimes used. They may help reduce discomfort.

    Surgery

    Surgery may be used when the curve is severe, progresses, or when other treatment methods fail. The goal of surgery is to correct the exaggeration of the curve. The spine is corrected with a metal rod, hooks, or screws in the back bones. Surgeons also use a bone graft to promote new growth and stability.
    Vertebral compression fractures are sometimes treated with special cement. The cement is injected into the affected vertebral bodies to restore shape.

    Prevention

    There are no current guidelines to prevent hyperkyphosis.

    RESOURCES

    North American Spine Society http://www.spine.org

    Ortho Info—American Academy of Orthopaedic Surgeons http://www.orthoinfo.org

    CANADIAN RESOURCES

    Canadian Orthopaedic Association http://www.coa-aco.org

    Canadian Orthopaedic Foundation http://www.canorth.org

    References

    Acute low back pain. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated November 25, 2015. Accessed December 1, 2015.

    Kyphosis. Boston Children’s Hospital website. Available at: http://www.childrenshospital.org/health-topics/conditions/kyphosis. Accessed December 1, 2015.

    Kyphosis. Seattle Children’s Hospital website. Available at: http://www.seattlechildrens.org/medical-conditions/bone-joint-muscle-conditions/spinal-conditions-treatment/scoliosis/kyphosis. Accessed December 1, 2015.

    Kyphosis correction. Virginia Spine Institute website. Available at: http://www.spinemd.com/treatments/scheuermanns-kyphosis. Accessed December 1, 2015.

    Kyphosis (roundback) of the spine. Ortho Info—American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00423. Updated September 2007. Accessed December 1, 2015.

    Lowe TG, Line BG. Evidence based medicine: Analysis of Scheuermann kyphosis. Spine. 2007;32(19 Suppl):S115-S119.

    Wenger DR, Frick SL. Scheuermann kyphosis. Spine. 1999;24(24):2630-2639.

    Revision Information

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