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)


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)


Postural kyphosis (roundback)

Scheuermann kyphosis

Congenital kyphosis

Diagnostic Considerations

Postural kyphosis

Only gold members can continue reading. Log In or Register to continue

Stay updated, free articles. Join our Telegram channel

Mar 12, 2022 | Posted by in ORTHOPEDIC | Comments Off on Kyphosis

Full access? Get Clinical Tree

Get Clinical Tree app for offline access