CHAPTER 12

Kyphosis

Introduction/Etiology/Epidemiology

• Normal thoracic kyphosis is a normal rounding of the upper back of 20 to 45 degrees.

• Thoracic hyperkyphosis, clinically referred to as “kyphosis,” involves curvature greater than 50 degrees.

• Unlike scoliosis, kyphosis is not associated with rotational abnormalities.

— Scoliosis with kyphosis is referred to as kyphoscoliosis.

• Kyphosis may be postural, structural, or congenital.

— Postural kyphosis of the thoracic or thoracolumbar spine is a common cause of kyphosis among teens and preteens.

■Kyphosis greater than 50 degrees

■Usually associated with a growth spurt

■Normal vertebral and disk anatomy without any significant wedging of vertebral body

■Considered a normal variant or related to deconditioning

— Structural kyphosis in otherwise healthy teens and preteens is most commonly caused by Scheuermann disease/kyphosis.

■Anterior wedging of vertebral body of more than 5 degrees over 3 or more consecutive levels

■Classically involves the thoracic spine but may also occur in the thoracolumbar or lumbar spine

■More common in boys than girls

■Seen in 0.4% to 10% of the population

— Congenital kyphosis can occur anywhere in the spine and is associated with congenital vertebral anomalies present since birth.

■Can be progressive: growth spurts can lead to rapid progression

■There can be large variation in curve severity.

■There can be sharp, angular deformities and potential for neurologic compromise.

Signs and Symptoms

• General features may include the following:

— Rounded shoulders

— Head leaning forward compared to body

— Visible hump

— Tight hamstrings (deconditioning)

— Stiffness

• Postural kyphosis

— Most often asymptomatic and presents as a cosmetic concern

■May be associated with activity-related back pain or pain after prolonged sitting

— Parents often bring in the child with reports of slouching or poor posture

• Scheuermann kyphosis

— More frequently causes pain

■Pain usually at apex of the deformity

■Low back pain can result from compensation for the thoracic deformity.

— There is often a family history of similar deformity.

— Often present during teenaged years and can progress rapidly during skeletal growth

• Congenital kyphosis

— Present at birth: varying degrees of severity

— Can be asymptomatic despite severity

— Presenting symptoms can include pain and neurologic dysfunction.

Differential Diagnosis

• Metabolic conditions leading to poor bone quality

• Neuromuscular conditions (check Gowers sign if there is concern for weakness)

• Tumor

• Postural kyphosis (roundback)

• Scheuermann kyphosis

• Congenital kyphosis

Diagnostic Considerations

• Postural kyphosis

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