Kyphosis
Kyphosis is an exaggerated forward curvature of the upper back. A modest forward curve in the thoracic spine is normal, but when this curve becomes excessive, the spine develops a rounded or hunched appearance. Kyphosis may be present from childhood or develop later in life because of poor posture, growth-related changes, osteoporosis, vertebral fractures, degenerative spine disease, or other spinal conditions. Mild kyphosis often causes no symptoms, while more severe curvature can lead to back pain, stiffness, reduced flexibility, balance problems, or breathing difficulty.
What is it?
The spine naturally contains gentle curves that help support posture, distribute weight, and absorb impact during movement. In the thoracic spine, or upper back, the normal curve bends slightly forward. Kyphosis occurs when this forward curvature becomes exaggerated, creating a rounded or hunched appearance of the upper back.
Kyphosis is commonly measured on standing spinal X-rays using a measurement called the Cobb angle. Larger angles indicate more pronounced curvature.
There are several forms of kyphosis. Postural kyphosis is the most common and often develops during adolescence or adulthood because of prolonged slouching, poor posture, or muscular imbalance. This form is usually flexible and often improves with posture correction and strengthening exercises.
Scheuermann disease is a more rigid form of kyphosis that develops during adolescence when several vertebrae grow unevenly into wedge-like shapes.
In older adults, kyphosis commonly develops from age-related degeneration of the spine, weakening of the back muscles, disc degeneration, and vertebral compression fractures caused by osteoporosis.
Less common causes include congenital spinal abnormalities, prior trauma, spinal tumors, infections, neuromuscular disorders, inflammatory conditions, and complications from prior spinal surgery.
Symptoms depend on the severity and cause of the curvature. Mild kyphosis may produce only cosmetic changes or mild stiffness. More significant curvature can lead to chronic upper or mid-back pain, muscle fatigue, reduced flexibility, loss of height, difficulty standing upright, or impaired balance.
Severe kyphosis may reduce chest expansion and lung capacity, causing breathing difficulty, especially in older adults with underlying lung disease.
In some cases, associated spinal degeneration or vertebral collapse may narrow the spinal canal or neural foramina, potentially compressing nerves or the spinal cord.
Standing spine X-rays are the primary imaging test because they clearly show spinal alignment, vertebral shape, and the degree of curvature.
MRI of the spine is useful when there is concern for disc disease, spinal cord compression, nerve involvement, tumors, infection, or surgical planning.
CT provides detailed evaluation of the bony anatomy and may be used before surgery or when vertebral fractures are suspected.
Bone density testing (DEXA scan) is commonly recommended in older adults to evaluate for osteoporosis, particularly when vertebral compression fractures are present.
Important to Know
Many cases of mild kyphosis do not require aggressive treatment and can often be managed with posture improvement, exercise, stretching, and strengthening of the core and back muscles.
Physical therapy is commonly used to improve posture, spinal mobility, flexibility, and muscular support of the spine.
In adolescents with progressive Scheuermann kyphosis, bracing may help limit progression while the spine is still growing.
Treating underlying osteoporosis is especially important in older adults because vertebral compression fractures are a major contributor to worsening kyphosis.
Surgery is generally reserved for severe, progressive, or symptomatic kyphosis, particularly when there is significant pain, neurological compromise, spinal instability, or impaired breathing function.
Because kyphosis often coexists with other spinal conditions such as degenerative disc disease, scoliosis, spinal stenosis, or vertebral fractures, treatment decisions are individualized based on symptoms, imaging findings, spinal balance, and overall health.
Imaging findings are always interpreted together with the patient’s symptoms and physical examination rather than in isolation.
Red flag symptoms include sudden severe back pain, rapidly worsening spinal curvature, progressive weakness or numbness, gait or balance difficulty, breathing problems, unexplained weight loss, fever with back pain, or loss of bowel or bladder control. These symptoms warrant prompt medical evaluation because they may indicate vertebral fracture, spinal cord compression, infection, or another serious spinal condition.