Everyone's spine is slightly rounded as it runs up the back. The thoracic vertebrae, which are attached to the ribs, usually round forward at a gentle angle that everybody has, about 20-40 degrees. If this angle is too pronounced, more than 50 degrees or so, it's called kyphosis (also known as roundback or hunchback).
In many cases with kyphosis, the spine may look normal and the condition will require no treatment. Some cases of kyphosis in kids can even be fixed by teaching them not to slouch, and strengthening their back with core exercises and physical therapy.
Severe and visible cases of kyphosis, however, can be painful, cause problems in the lungs and other organs, or lead to issues with self image or appearance.
Most of the time, kyphosis will become evident during adolescence, though adults can develop it as they age due to spine trauma and the onset of degenerative conditions such as arthritis and osteoporosis.
Treatment for adolescent kyphosis can include bracing and rarely will require surgery. Even after surgery, kids can usually resume an active lifestyle.
Kyphosis is an abnormal rounding of the spine that occurs in the upper and middle part of the back. Only the most serious cases will result in a hunchback or cause discomfort or breathing problems.
Different types of kyphosis can affect kids, each with its own cause:
Postural kyphosis, the most common type of kyphosis, usually becomes noticeable during adolescence. It can cause mild discomfort, but rarely causes pain or problems later in life. Postural kyphosis occurs when bones and muscles develop abnormally, possibly due to slouching or poor posture. It's more common among girls than boys.
Scheuermann's kyphosis, named for a Danish radiologist, also typically appears during adolescence, especially during a growth spurt. It can run in families, and causes the vertebrae to appear wedge-shaped, rather than rectangular, when viewed from the side on X-rays. It's slightly more common among boys than girls.
Congenital kyphosis occurs when the spinal column develops abnormally before a baby is born. Several vertebrae can be fused together or the bones can form improperly. Growth can cause the kyphosis to get worse. It's important to check children with this condition for other orthopedic problems and heart or kidney defects.
In the most severe cases of kyphosis, there can be a visible rounding of the upper back or a hump that is easy to see. In many cases, though, kyphosis won't exhibit any obvious symptoms and can be hard to diagnose.
To check for kyphosis, a doctor will examine the spine and might ask a child to bend forward from the waist. Often, kyphosis becomes more apparent when the back is bent this way. A child might also be asked to lie down, which can help in diagnosing postural kyphosis.
If kyphosis is suspected, the doctor will order X-rays of the spine, which can help determine which type of kyphosis it is. To see if the kyphosis is affecting breathing, the doctor may ask the child to perform pulmonary function tests.
If a doctor thinks something else is causing the problem, such as an infection or tumor, an MRI (magnetic resonance imaging) scan of the back might be ordered.
If it appears the rounding of the back isn't going to cause any problems, kyphosis may not need any treatment, just routine checkups to make sure the rounding doesn't become worse. Most cases of kyphosis will stop progressing once kids are fully grown.
Some cases may be referred to an orthopedist, a doctor who specializes in treating medical conditions involving the bones. The orthopedist will examine the spine to determine the cause and extent of the kyphosis and then recommend treatment.
Treatment varies depending on the type of kyphosis and how severe it is:
Postural kyphosis doesn't progress and can improve on its own. All that may be required is physical therapy to decrease pain and improve posture, plus exercises to strengthen the back muscles to help them support the spine better. Some people also respond well to sleeping on a firm bed.
Scheuermann's kyphosis may require a brace. Surgery might be required in severe cases (rounding of 75 degrees or more), if there is pain or breathing difficulty, or if the back doesn't respond to other treatments.
Congenital kyphosis sometimes requires surgery at an early age to fix.
Braces often need to be worn — some just at night, others for 18-20 hours a day — until a child stops growing and the kyphosis is unlikely to progress. The purpose of the brace is to try to keep the degree of rounding from getting worse while the bones develop.
The brace that the orthopedist recommends will depend on the location of the rounding and its severity. One common type of brace used in the treatment of kyphosis is a thoracolumbosacral orthosis, or TLSO, a brace that comes up under the arms and can be worn beneath the clothes.
If kyphosis requires surgery, the orthopedic surgeon will likely perform a spinal fusion. In this procedure, several of the affected vertebrae are fused (joined together) to reduce the rounding in the spine. The surgeon will attach new pieces of bone to the vertebrae with metal rods and screws, placed deep under the spine muscles.
After a few months to a year, the bones grow together, or "fuse," but the metal pieces are typically allowed to stay in place, as they are not noticeable, can't be felt, and don't cause any discomfort. Doctors will often prescribe physical therapy after surgery to help the back recover more quickly.
Every situation is different, but most kids who've had surgery to correct their kyphosis are up and walking within a day or two, and can generally go home from the hospital within a week. Most will return to school within a month of the surgery and can resume some activities in 3 to 4 months. By 6 months to a year, most will be able to resume all routine activities; the bones should be fully fused by about 1 year. Most kids who've had this surgery and their parents report being very satisfied with the results.
With proper observation and the right treatment — be it exercise, a back brace, or surgery — almost every child with kyphosis can lead an active, normal life with no restrictions on activities.