(Roundback of the Spine; Congenital Kyphosis; Postural Kyphosis; Scheuermann’s Kyphosis; Hunchback)
DefinitionKyphosis 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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CausesThree 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’s—a type that is genetic, but appears during the teenage years
Risk FactorsFactors that may increase your chance of hyperkyphosis include:
- Bad posture
- Vertebral fractures
- Trauma to the spine
- Spine infection
- Certain diseases, such as Marfan syndrome or cerebral palsy
SymptomsHyperkyphosis 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
DiagnosisMost cases can be diagnosed during a physical exam. Some cases are found at school during a scoliosis check. Your doctor will ask 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:
TreatmentThere 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:
ObservationYour 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 TherapyYour 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.
MedicationsNonsteroidal anti-inflammatory drugs (NSAIDs) may be given for pain or discomfort.Nonsteroidal anti-inflammatory drugs (NSAIDs) may be given for pain or discomfort.
Back BraceBraces are sometimes used. They can help correct hyperkyphosis or reduce discomfort.
SurgerySurgery 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.
PreventionThere are no current guidelines to prevent hyperkyphosis.
North American Spine Society
Ortho Info—American Academy of Orthopaedic Surgeons
Canadian Orthopaedic Association
Canadian Orthopaedic Foundation
Acute low back pain. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated November 22, 2013. Accessed February 7, 2014.
Kyphosis. Boston Children’s Hospital website. Available at: http://www.childrenshospital.org/health-topics/conditions/kyphosis. Accessed February 7, 2014.
Kyphosis. Seattle Children’s Hospital website. Available at: http://www.seattlechildrens.org/medical-conditions/bone-joint-muscle-conditions/spinal-conditions-treatment/scoliosis/kyphosis. Accessed February 7, 2014.
Kyphosis correction. Virginia Spine Institute website. Available at: http://www.spinemd.com/treatments/scheuermanns-kyphosis. Accessed February 7, 2014.
Kyphosis (roundback) of the spine. American Academy of Orthopaedic Surgeons Ortho Info website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00423. Updated September 2007. Accessed February 7, 2014.
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.
- Reviewer: Teresa Briedwell, PT, DPT, OCS, CSCS
- Review Date: 12/2014
- Update Date: 12/20/2014
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