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Hyperkyphosis

(Roundback of the Spine; Congenital Kyphosis; Postural Kyphosis; Scheuermann’s Kyphosis; Hunchback)

Definition

Kyphosis 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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Causes

Three 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
Other causes of hyperkyphosis are unknown.

Risk Factors

Factors that may increase your chances of hyperkyphosis include:

Symptoms

Hyperkyphosis 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

Diagnosis

Most 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:
Your doctor may need to measure how well you breathe if the curve is severe enough. This can be done with pulmonary function tests.

Treatment

There 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:

Observation

Your 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 Therapy

Your 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.

Medications

Nonsteroidal anti-inflammatory drugs (NSAIDs) may be given for pain or discomfort.
Nonsteroidal anti-inflammatory drugs (NSAIDs) may be given for pain or discomfort.

Back Brace

Braces are sometimes used. They can help correct hyperkyphosis or reduce discomfort.

Surgery

Surgery 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.

Prevention

There are no current guidelines to prevent hyperkyphosis.

RESOURCES

American Academy of Orthopaedic Surgeons http://orthoinfo.org

North American Spine Society http://www.spine.org

CANADIAN RESOURCES

Canadian Orthopaedic Association http://www.coa-aco.org

Canadian Orthopaedic Foundation http://www.canorth.org

References

Acute low back pain. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated November 22, 2013. Accessed February 7, 2014.

Kyphosis. Children’s Hospital Boston 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 (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):S115-119.

Scheuermann's kyphosis correction. Virginia Spine Institute website. Available at: http://www.spinemd.com/operative-treatments/scheuermanns-kyphosis-correction-reston-va.php. Accessed February 7, 2014.

Wenger DR, Frick SL. Scheuermann kyphosis. Spine. 1999;24(24):2630-2639.

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