Hunchback

Page last reviewed: 13/07/2011

Kyphosis is a condition in which the top of the back is excessively curved and appears more rounded than normal. 

While some degree of curvature is normal, a curve of more than 40 degrees would be considered a sign of kyphosis.

Kyphosis doesn't usually cause any symptoms other than your back appearing slouched or hunched. Some cases may cause:

  • back pain and stiffness
  • tiredness

Read more about the symptoms of kyphosis.

Treating kyphosis

Your course of treatment for kyphosis depends on the extent of the curve, whether there are additional symptoms such as back pain, as well as the underlying causes.

Mild cases in children often don't require any treatment as many children grow out of kyphosis as their body matures. Alternatively, it may be possible to correct the spine using non-surgical treatments such as bracing.

More severe cases will need surgery to correct the spine.

Types of kyphosis

Causes of kyphosis include bad posture or a structural problem with the spine.   

The two main types of kyphosis are:

  • postural kyphosis - this usually develops during the teenage years due to poor posture, such as slouching during childhood, which affects the normal development of the spine
  • Scheuermann's kyphosis - this also develops during the teenage years. For reasons that are still unclear, the vertebrae that make up the spine don't develop in the way they should, and the back takes on a curved appearance

A less common type of kyphosis is congenital kyphosis, which is when the spine doesn't develop normally in the womb.

Kyphosis can also develop later on in life as the result of an underlying condition, such as osteoporosis (weakening of the bones).

Outlook

The outlook for many cases of kyphosis is good as symptoms tend to improve as a child grows older.

More severe cases do carry a risk of causing complications, such as breathing difficulties or urinary incontinence, but these sort of complications would usually only occur if the condition was left untreated.

Page last reviewed: 13/07/2011

Many cases of kyphosis won't cause any noticeable symptoms other than a change in appearance of the upper back, giving a person a slouched or hunched appearance.

(In mild cases of kyphosis, the change of appearance of the back may only be noticeable to a health professional with expert knowledge of the back).

The most commonly reported symptoms of kyphosis are:

  • back pain
  • stiffness and tenderness in the spine
  • feeling unusually tired

In very severe cases, kyphosis can cause breathing difficulties and problems with eating. If you have severe kyphosis, your symptoms may get worse with time.

Fatigue
Fatigue is extreme tiredness and lack of energy.
Pain
Pain is an unpleasant physical or emotional feeling and your body's way of warning you that it has been damaged.
Spine
The spine supports the skeleton and surrounds and protects the delicate spinal cord and nerves. It is made up of 33 bones called the vertebrae.

Page last reviewed: 13/07/2011

To better understand the potential causes of kyphosis, it's useful to learn more about the structure of the spine.

The spine

Your spine extends from your skull to your pelvis. It's made up of 24 individual rectangular-shaped bones called vertebrae, which are stacked on top of one another.

The vertebrae are separated by soft pads, or discs, which act as shock absorbers.

The vertebrae are also held together by tough bands of tissue called ligaments. Together with the spinal muscles, the ligaments give the back its strength.

In cases of kyphosis, the middle section of vertebrae, which are known as the thoracic vertebrae, are curved out of position.

There are several reasons why these vertebrae can be affected in this way. They are discussed below.

Bad posture

Poor postural habits in childhood, such as slouching, leaning back in chairs and carrying heavy backpacks and schoolbags, can cause stretching of the ligaments and, in some cases, the muscles that support the vertebrae. This in turn can pull the thoracic vertebrae out of their normal position, resulting in kyphosis. 

Kyphosis resulting from bad posture is medically known as postural kyphosis.

Abnormal-shaped vertebrae

Kyphosis can be caused when the vertebrae don't develop in the right way. They take on a wedged, triangular shape rather than a rectangular, box-like shape. This leads to the vertebrae being out of position. It's known medically as Scheuermann's kyphosis.

The ligaments in people affected by Scheuermann's kyphosis also appear to be thicker than normal. This may contribute further to the condition.

It's unclear exactly what disrupts the normal formation of the spine. One idea is that the blood supply to the vertebrae becomes disrupted, affecting the growth of the vertebrae.

There also appears to be genetic factors associated with Scheuermann's kyphosis as the condition runs in families.

Congenital kyphosis

Congenital kyphosis is caused when something disrupts the normal development of the spine before birth. In many cases of congenital kyphosis, two or more of the vertebrae fuse together.

It's often unclear why certain children are affected in this way. But some cases of congenital kyphosis run in families, so it seems that genetics also play a role in this type of kyphosis.

Conditions that cause kyphosis

Conditions that can cause kyphosis include:

  • osteoporosis
  • spondylosis - a medical term used to describe the general 'wear and tear' that occurs in the bones, discs and ligaments of the spine as a person gets older
  • spina bifida - a birth condition where the spine hasn't formed properly
  • Paget's disease - a condition in which the development of new bone cells are disrupted, leading to the weakening of the bones
  • neurofibromatosis - a genetic disorder that affects the nervous system
  • muscular dystrophy - a genetic condition that causes progressive weakening of the muscles
  • tuberculosis - a bacterial infection that mainly affects the lungs but can sometimes spread
  • cancer that develops inside the spine or spreads to the spine from another part of the body

Kyphosis can also develop as a result of an injury to the spine.

Congenital
Congenital means a condition that is present at birth. It could be hereditary or develop during pregnancy.
Spine
The spine supports the skeleton and surrounds and protects the delicate spinal cord and nerves. It is made up of 33 bones called the vertebrae.

Page last reviewed: 13/07/2011

Your GP should be able to diagnose kyphosis by making a physical examination of your (or your child's) spine.

During the examination, your GP may ask you to perform a number of exercises to assess the impact the condition has on your balance and range of movement.

You may also be asked to lie down so that your GP can see if the curve is caused by bad posture or by a structural problem with the spine.

Although it's not always the case, if the spine straightens when you lie down it's likely that kyphosis is due to poor posture (postural kyphosis).

But if the spine stills curves while you're lying down, it's likely that kyphosis is due to a problem with the structure of the spine, as found in the Scheuermann's or congenital types of kyphosis.

An X-ray can usually confirm the diagnosis and determine the cause of the kyphosis.

Further scans would normally only be required if complex treatment, such as surgery, were being planned, or you had additional symptoms that suggested that the nervous system has been affected, such as numbness in the arms or legs.

These scans would probably involve:

  • computerised tomography (CT) scan - a series of X-rays are taken to build up a detailed 3-D image of the spine
  • magnetic resonance imaging (MRI) scan - strong fluctuating magnetic fields are used to produce a detailed image of the inside of the spine

Adults

If you develop kyphosis in adulthood then it's likely that you'll need additional tests to determine the underlying cause.

The tests that you'll be referred to will depend on what additional symptoms you have. They may include:

  • blood tests, which can be useful for checking for infections such as tuberculosis
  • a bone density scan, which is a special type of X-ray used to assess how strong your bones are - this can be useful in diagnosing conditions that cause weakening of the bones, such as osteoporosis or Paget's disease
  • CT and MRI scans
Spine
The spine supports the skeleton and surrounds and protects the delicate spinal cord and nerves. It is made up of 24 bones called the vertebrae.
X-ray
An X-ray is a painless way of producing pictures of inside the body using radiation.

Page last reviewed: 13/07/2011

Most cases of kyphosis don't require treatment.

Kyphosis that's caused by bad posture (postural kyphosis) can normally be corrected by improving your posture.

And kyphosis that's caused by abnormally shaped vertebrae (Scheuermann's kyphosis) will usually improve once you're fully grown.

Mild to moderate kyphosis

Over-the-counter painkillers such as ibuprofen or paracetamol can also help relieve symptoms such as back pain.

Regular exercise and a course of physiotherapy may also be advised to help strengthen the muscles in your back.

Teenagers with mild to moderate kyphosis may have to wear a back brace (a piece of equipment that supports your back). A brace will stop the curve from getting worse, and it's worn while the bones are still growing.

You'll probably find wearing a brace restrictive at first, but most people get used to them with time. Modern braces are designed to be as convenient as possible, so you should be able to still take part in a wide range of physical activities.

The brace will have to be worn until you're fully grown, which is usually around age 16 for girls and 18 for boys.

(Bracing isn't usually recommended for adults who have stopped growing as it won't correct the position of the spine).

Surgery

Surgery can successfully correct the appearance of the back and relieve symptoms of pain. However, it carries quite a high risk of complication. This means that surgery would only be recommended in more severe cases of kyphosis. And only if it were felt that the potential benefits of surgery outweighed the risks.

Surgery would normally be recommended if:

  • the curve of the spine is very large (more than 70 degrees)
  • the curve is causing persistent pain that can't be controlled with medication
  • the curve is disrupting other important functions of the body, such as breathing and the nervous system
  • without surgery it's likely that the structure of the spine would become even more deformed

Surgery is also normally recommended for babies who are born with congenital kyphosis.

A technique called spinal fusion is usually used to treat kyphosis. This involves joining together the vertebrae that are responsible for the curve of the spine.

Spinal fusion is carried out under general anaesthetic (you're asleep throughout the procedure). An opening is made in your back, the curve in your spine is straightened using metal rods and hooks, and the spine is fused into place using bone grafts (a sample of bone taken from another place in your body - usually the pelvis). This surgery takes between four and eight hours.

You will need to stay in hospital for around one week following the operation. You may have to spend time in the intensive care department after the surgery. Normally, you will have to wear a cast or back brace for up to nine months. This is to support your spine while it heals.

You should be able to return to school, college or work after four to six weeks, then be able to play sports about a year after surgery.

Complications of spinal fusion surgery include:

  • post-operative infection
  • excessive bleeding at the site of the surgery
  • accidental damage to the discs of the back
  • accidental damage to the nerves that run through the spine, which could then affect some of the functions of the body such as bladder control (urinary incontinence)
  • Paralysis temporary and permanent

You should discuss the benefits and risks associated with spinal surgery with the doctor in charge of your care.

Anaesthetic
Anaesthetic is a drug that either numbs a part of the body (local) or puts a patient to sleep (general) during surgery.
Pain
Pain is an unpleasant physical or emotional feeling and your body's way of warning you it has been damaged.
Physiotherapy
Physiotherapy uses physical movements, massage and exercise to relieve illness or injury.
Spine
The spine supports the skeleton and surrounds and protects the delicate spinal cord and nerves. It is made up of 24 bones called the vertebrae.

Page last reviewed: 13/07/2011

A common complication of kyphosis in older children is that they become concerned or embarrassed about the effect of kyphosis on their appearance or the fact that they have to wear a back brace.

Teenagers are naturally more sensitive and self-conscious about their body image. Anything that makes them 'stand out from the crowd' can be an issue of concern.

These concerns can affect children in different ways, such as:

  • becoming socially withdrawn
  • being reluctant to take part in activities that may expose their back or the fact that they have to wear a brace
  • they become moody
  • they become reluctant to discuss issues around their treatment, or perhaps, argue that they don't need any more treatment

There are no easy answers to these problems. But it can sometimes help if you try to reassure your child that their condition is temporary and will improve with time.

Other complications

Other complications of kyphosis usually only occur in more severe cases. They include:

  • persistent pain that can't be controlled with medication
  • breathing difficulties that are caused by the spine compressing the lungs and airways

Occasionally, people with kyphosis can have difficulties when the nerves that run through the spine become compressed or pinched. This can disrupt nerve signals and cause symptoms such as:

  • a feeling of numbness or weakness in your arms and legs
  • problems with your sense of balance
  • loss of normal bladder and/or bowel control (urinary incontinence and bowel incontinence)

If you develop these more serious complications then surgery would normally be recommended.

Lungs
Lungs are a pair of organs in the chest that control breathing. They remove carbon dioxide from the blood and replace it with oxygen.
Pain
Pain is an unpleasant physical or emotional feeling and your body's way of warning you it has been damaged.

Page last reviewed: 13/07/2011

Postural kyphosis can be prevented by encouraging your child to adopt good postural habits and to take care of their back.

In particular they should:

  • avoid slouching
  • sit upright while making sure they have support in the small of their back
  • avoid carrying over-heavy satchels or schoolbags that can pull on the muscles and ligaments of the back; the best schoolbag for your child is a well-designed backpack
  • take regular exercise as this will strengthen your child's back and also help to keep it flexible - activities such as swimming, jogging and walking are ideal to help prevent back problems
Congenital

Congenital means a condition that is present at birth. It could be hereditary or develop during pregnancy.

 

Hormone replacement therapy
Hormone replacement therapy or HRT involves giving hormones to women when the menopause starts, to replace those that the body no longer produces.
Spine
The spine supports the skeleton and surrounds and protects the delicate spinal cord and nerves. It is made up of 24 bones called the vertebrae.

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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