Kyphosis refers to the excessive outward curvature of the thoracic spine, the upper and middle back, often resulting in a rounded-back appearance. While a degree of forward curvature is normal, the condition becomes hyperkyphosis when the curve exceeds approximately 50 degrees. Whether kyphosis can be corrected or “cured” depends entirely on the underlying cause of the deformity and its severity.
Understanding the Types and Causes
The cause of the excessive curvature dictates the potential for complete correction versus long-term management. The most common form is postural kyphosis, which is typically flexible and results from habitual poor posture or muscle imbalance. This non-structural type can often be fully reversed through focused attention and exercise.
A more complex category is structural kyphosis, where the shape of the vertebrae themselves is altered. Scheuermann’s kyphosis, often developing during adolescence, involves the vertebral bodies becoming wedge-shaped instead of rectangular. This structural change makes the curve rigid and less responsive to simple postural correction, requiring a focus on halting progression and managing the deformity.
Kyphosis can also be congenital, resulting from a malformation of the spine during fetal development. Finally, age-related or secondary kyphosis frequently develops in older adults, often due to vertebral compression fractures caused by osteoporosis or degenerative disc disease. Structural kyphosis types like Scheuermann’s or congenital forms are managed and corrected through intervention, but the underlying skeletal condition remains a factor in treatment planning.
Non-Surgical Paths to Correction
For the majority of patients, especially those with postural kyphosis or mild-to-moderate structural curves, non-surgical methods are the primary treatment path. Physical therapy is a core component, focusing on strengthening the back extensor muscles that help pull the shoulders back and the spine upright. Improving flexibility is another aim, often involving stretching tight muscle groups like the hamstrings and chest muscles that contribute to a forward-slouched posture.
Adolescents with Scheuermann’s kyphosis are often treated with spinal bracing while their bones are still growing. The brace is custom-fitted with the goal of preventing the curve from worsening and encouraging gradual correction. Compliance is a major factor in the success of bracing, as it may require wearing the device for 16 to 20 hours a day until skeletal maturity is reached.
For managing associated discomfort, pain relief often involves non-steroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and muscle soreness. Applying heat or cold therapy can also provide localized relief from muscle tension and pain. Regular X-rays are used to monitor the curve’s Cobb angle measurement, ensuring the deformity is not progressing, particularly in growing individuals.
Surgical Intervention for Severe Cases
Surgery is reserved for severe and progressive cases of structural kyphosis that have not responded to conservative treatment, or when the curve threatens neurological function. Indications for surgical intervention typically include structural curves exceeding 70 to 80 degrees, curves that are rapidly progressing, or those causing persistent, debilitating pain. The primary goal of the operation is to achieve spinal fusion and stabilization, which is necessary to restore the sagittal balance of the spine.
The most common procedure performed is a posterior spinal fusion with instrumentation. This involves accessing the spine from the back, correcting the curvature using metal rods, screws, and hooks, and then fusing the affected vertebrae together. Bone graft material is placed between the vertebrae to encourage them to heal into a single, solid bone segment, permanently stabilizing the corrected alignment.
This major procedure requires careful surgical planning, often involving intraoperative neurological monitoring. Recovery is substantial, typically requiring a hospital stay of several days followed by a gradual return to normal activities over several months to a year. The expected outcome is a significant reduction in the curve magnitude, leading to improved posture, relief from pain, and a better ability to maintain an upright position.