The appearance of a severe, rounded upper back, often referred to as a “humpback,” is medically known as hyperkyphosis. This condition involves an excessive forward curvature of the thoracic spine, which is the section of the backbone located in the upper and middle back. Kyphosis is a natural curve present in the spine, but when it becomes exaggerated, it can lead to noticeable postural changes and potential health issues.
Defining Kyphosis and the Visual Appearance
Kyphosis is the natural outward, convex curve of the thoracic spine when viewed from the side. The normal range for this curvature is typically between 20 and 45 degrees. Hyperkyphosis, or excessive kyphosis, is diagnosed when this angle exceeds 50 degrees, as measured on a standing X-ray.
This exaggeration of the spine’s natural curve results in the characteristic visual appearance of a rounded upper back and shoulders that appear stooped forward. In severe cases, the head may be positioned forward compared to the rest of the body, creating a pronounced rounding. This spinal deformity is sometimes referred to as “roundback” or “hunchback” by the general public. Milder cases might only present as poor posture, while a significantly increased angle creates a distinct, visible hump.
Different Types and Primary Causes
Kyphosis is broadly categorized into flexible types, which are correctable, and rigid types, which involve structural changes to the vertebrae. Postural kyphosis is the most common and least severe type, typically presenting during adolescence due to habitual slouching or poor posture.
Scheuermann’s Kyphosis is a structural, rigid form that usually appears during the teenage growth spurt and is the most common type of structural kyphosis in adolescents. It is caused by a growth disturbance in which three or more consecutive vertebrae develop a wedge shape instead of their normal rectangular form.
Age-related and congenital forms constitute other primary causes of hyperkyphosis. Kyphosis in older adults often results from degenerative changes, such as osteoporosis, which can lead to vertebral compression fractures in the spine. Congenital kyphosis is present at birth, occurring when the spinal column does not develop correctly in the womb, which may include vertebrae fusing together.
Functional Impact on Daily Life
The altered spinal alignment forces the neck, back, and shoulder muscles to work harder, often resulting in chronic pain and stiffness. The body compensates for the forward-shifted center of mass, which can also lead to muscle fatigue and tightness, particularly in the hamstrings.
Mobility and physical function can also be diminished, especially in older adults with the condition. The decreased flexibility of the spine can make everyday tasks like reaching for objects or climbing stairs more difficult.
In the most severe cases, the curvature can restrict the space in the chest cavity, leading to potential respiratory complications. This reduction in space can limit the mobility of the rib cage and the expansion of the lungs, potentially causing shortness of breath and decreased lung function.
Management and Treatment Options
Treatment for kyphosis is determined by the specific type, the severity of the curve, the patient’s age, and the presence of symptoms like pain. Non-surgical management is the initial approach for most mild to moderate cases. This includes physical therapy and targeted exercises focused on strengthening the back extensor muscles and improving posture.
For adolescents with Scheuermann’s Kyphosis, bracing may be recommended to prevent the curve from worsening while the bones are still growing. A brace is typically used for curves between 50 and 80 degrees and is worn until the spine reaches skeletal maturity. Bracing is less effective for adults because their bones have stopped growing and cannot be reshaped.
Surgical intervention is reserved for severe cases, generally when the kyphosis is greater than 70 to 80 degrees, causes intractable pain, or results in neurological or pulmonary compromise. The most common procedure is spinal fusion, which involves using metal rods, screws, and bone grafts to straighten the spine and fuse the affected vertebrae into a single, solid bone. This operation aims to correct the deformity, stabilize the spine, and relieve pressure on nerves or organs.